Prevention & lipidsSecondary analysis
Predicting Benefit From Evolocumab Therapy in Patients With Atherosclerotic Disease Using a Genetic Risk Score
- Secondary analysis of the FOURIER randomised trial
Authors' conclusion
Patients with high genetic risk, regardless of clinical risk, had a high event rate and derived the greatest relative and absolute benefit from evolocumab, which mitigated this risk.
Study context
- Population
- Patients with atherosclerotic CVD in the FOURIER trial
- Participants
- 14,298 patients
- Comparison
- Evolocumab benefit by genetic risk score and clinical risk
- Primary endpoint
- Major coronary events (coronary heart death, MI or coronary revascularization) and major vascular events (major coronary events and ischemic stroke)
- Follow-up
- Median 2.3 years
Primary result
As reported in the abstract
Major vascular events, by clinical and genetic risk
Each group vs lowHazard ratio (CI)P value
Multiple clinical risk factors, no high genetic risk13% relative risk reduction; 1.4% ARR
0.87(0.75–0.998)
P = 0.047High genetic risk, irrespective of clinical risk31% relative risk reduction; 4.0% ARR
0.69(0.55–0.86)
P = 0.0012- No multiple clinical risk factors or high genetic risk · ARR −0.2%
- HR 1.02; P = 0.86
Further findings
Association of genetic risk score with events (adjusted for clinical factors)
- Major vascular events
- P for trend = 0.005
- Major coronary events
- P for trend < 0.0001
- Increased hazard for major coronary events, intermediate genetic risk
- 1.23-fold
- Increased hazard for major coronary events, high genetic risk
- 1.65-fold
Original publication
Predicting Benefit From Evolocumab Therapy in Patients With Atherosclerotic Disease Using a Genetic Risk Score. Circulation. Published 11 November 2019. doi:10.1161/circulationaha.119.043805
Summarised from the published abstract; every number is checked against it