Kidney disease: add-on evolocumab lowers cardiovascular risk

  • Charytan DM & al.
  • J Am Coll Cardiol
  • 18 Jun 2019

  • International Clinical Digest
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Takeaway

  • Cardiovascular benefit of adding evolocumab (Repatha) to statins is preserved as renal function declines, according to the FOURIER trial.

Why this matters

  • Absolute benefit may be magnified as risk increases with chronic kidney disease (CKD) progression.

Study design

  • Randomized trial of 27,554 statin-treated patients (no-CKD, 29.3%; stage II CKD, 54.6%; stage ≥III CKD, 16.1%) with atherosclerosis and low-density lipoprotein cholesterol (LDL-C) ≥70 mg/dL or non-high-density lipoprotein cholesterol ≥100 mg/dL receiving evolocumab vs placebo.
  • Funding: Amgen, Inc.

Key results

  • At 48 weeks, LDL-C reduction was similar with stage II and stage ≥III CKD vs no-CKD (59% and 58% vs 59%).
  • Risk reduction was similar for the primary endpoint (cardiovascular death, myocardial infarction, stroke, hospitalization for unstable angina, or coronary revascularization; Pinteraction=.77):
    • No-CKD: HR=0.82 (95% CI, 0.71-0.94).
    • Stage II CKD: HR=0.85 (95% CI, 0.77-0.94).
    • Stage ≥III CKD: HR=0.89 (nonsignificant 95% CI, 0.76-1.05).
  • Risk reduction was similar for the secondary endpoint (cardiovascular death, myocardial infarction, or stroke; Pinteraction=.75) and 30-month absolute risk reduction (ARR) favored advanced CKD.
    • No-CKD: HR=0.75 (95% CI, 0.62-0.90); ARR, −1.7% (95% CI, −2.8% to 0.5%).
    • Stage II CKD: HR=0.82 (95% CI, 0.72-0.93); ARR, −1.5% (95% CI, −2.3% to −0.7%).
    • Stage ≥III CKD: HR=0.79 (95% CI, 0.65-0.95); ARR, −2.5% (95% CI, −4.7% to −0.4%).

Limitations

  • Few with stage IV/V CKD.