Lipoprotein(a) Levels, Risk of Cardiovascular Events, and Benefit of Evolocumab: Findings From the VESALIUS-CV Trial
Authors' conclusion
In patients with atherosclerosis or high-risk diabetes but without previous MI or stroke, Lp(a) was independently associated with an increased risk of major coronary events but not ischemic stroke. Evolocumab reduced the relative risk of major coronary events to a similar degree irrespective of baseline Lp(a), with a numerically greater absolute risk reduction in patients with elevated Lp(a).
Study context
- Population
- Patients with qualifying atherosclerosis or high-risk diabetes without previous myocardial infarction (MI) or strokeLp(a) assessed at baseline
- Participants
- 7,557 patients
- Comparison
- Evolocumab vs placebo, by baseline Lp
- Primary endpoint
- Major coronary events:
- CHD death
- MI
- Urgent coronary revascularization
- Follow-up
- Median 4.6 years
Methodological detailsprespecified analysis, placebo-controlled, Median age 66 (IQR 60-71) years; 42.8% women; median Lp(a) 28 (IQR 9-132) nmol/L
- Prespecified analysis
- Placebo-controlled
- Median age 66 (IQR 60-71) years; 42.8% women; median Lp(a) 28 (IQR 9-132) nmol/L
Primary result
As reported in the abstract
Major coronary events, evolocumab vs placebo, by baseline Lp(a)
Lp(a) >105 nmol/L
- Relative reduction
- 41%
- Absolute reduction
- 3.7%
- NNT at 5 years
- 28
Lp(a) ≤105 nmol/L
- Relative reduction
- 35%
- Absolute reduction
- 2.5%
- NNT at 5 years
- 40
Relative reduction
Lp(a) >105 nmol/L41%
Lp(a) ≤105 nmol/L35%
Absolute reduction
Lp(a) >105 nmol/L3.7%
Lp(a) ≤105 nmol/L2.5%
NNT at 5 years
Lp(a) >105 nmol/L28
Lp(a) ≤105 nmol/L40
Evolocumab vs PlaceboHazard ratio (95% CI)
Lp(a) >105 nmol/L
0.59(0.41–0.83)
Lp(a) ≤105 nmol/L
0.65(0.51–0.82)
Further findings
| Outcome | Adjusted HR (95% CI) | P value | |
|---|---|---|---|
| Major coronary events by baseline Lp(a) (placebo) | 1.15 (1.05–1.26) | P = 0.004 | |
| MI by baseline Lp(a) (placebo) | 1.23 (1.10–1.38) | P < 0.001 | |
| 0.512Adjusted hazard ratio (log scale) |
Ischemic stroke by baseline Lp(a) (placebo)
| Comparison | Adjusted HR (95% CI) | P value | |
|---|---|---|---|
| Lp(a)No association | 1.00 (0.84–1.19) | P = 0.99 | |
| 0.512Adjusted hazard ratio (log scale) |
Absolute reduction in major coronary events with evolocumab, by baseline Lp(a) · 5 years
NNT Lp(a) >105 nmol/L 28 · Lp(a) ≤105 nmol/L 40
| Outcome | Lp(a) >105 nmol/L | Lp(a) ≤105 nmol/L |
|---|---|---|
| Reduction in LDL-C and Lp(a) with evolocumab, by baseline Lp(a) · 48 weeks | ||
| LDL-C reduction | 66.8 mg/dL | 61.1 mg/dL |
| Lp(a) reduction | 38.0 nmol/L | 6.0 nmol/L |
- Absolute reduction in major coronary events with evolocumab, by baseline Lp(a): P-interaction=0.09
Original publication
Lipoprotein(a) Levels, Risk of Cardiovascular Events, and Benefit of Evolocumab: Findings From the VESALIUS-CV Trial. Circulation. Published 25 May 2026. doi:10.
Summarised from the published abstract; every number is checked against it