To the Editor In an analysis of the Further Cardiovascular Outcomes Research With PCSK9 Inhibition in Subjects With Elevated Risk (FOURIER) randomized clinical trial in patients with stable atherosclerotic disease receiving statin therapy, Wiviott et al1 report that the PCSK9 inhibitor evolocumab reduced type 1 (spontaneous) myocardial infarction (MI) by 32% (hazard ratio [HR], 0.68; 95% CI, 0.59-0.79) but had no effect on type 2 (supply/demand mismatch) MI (HR, 1.09; 95% CI, 0.82-1.45). The latter finding is contrary to previous observations from the Evaluation of Cardiovascular Outcomes After an Acute Coronary Syndrome During Treatment With Alirocumab (ODYSSEY OUTCOMES) trial2 in patients with recent acute coronary syndrome receiving intensive statin therapy. In that analysis, the PCSK9 inhibitor alirocumab reduced type 2 MI by 23% (HR, 0.77; 95% CI, 0.61-0.97; P = .03).2
White HD, Steg PG, Schwartz GG. Myocardial Infarction and Evolocumab. JAMA Cardiol. 2021;6(10):1220–1221. doi:10.1001/jamacardio.2021.1994
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