Prevention & lipidsSecondary analysis
Safety of low lipoprotein(a) levels: the FOURIER trial
- Secondary analysis of the FOURIER randomised trial
Authors' conclusion
In patients with ASCVD, low Lp(a) concentration was not associated with an increased risk of most adverse safety outcomes, but lower Lp(a) was associated with an increased risk of prevalent and incident DM.
Study context
- Population
- Patients with stable atherosclerotic CVD (atherosclerotic cardiovascular disease (ASCVD)) randomized to evolocumab vs placebo on background statin therapyLp(a) assessed in 25,090
- Participants
- 27,564 patients
- Comparison
- Lower vs higher baseline Lp concentration
- Primary endpoint
- Association between Lp(a) and prevalent and incident adverse safety outcomes
Primary result
As reported in the abstract
Lp(a) and adverse safety outcomes
Lower Lp(a) (per 50 nmol/L lower)Estimate (95% CI)P value
prevalent DM at baseline
adjusted OR 1.03(1.02–1.04)
P < 0.001incident DM during follow-up; consistent by treatment arm
adjusted HR 1.05(1.02–1.08)
P = 0.002Per 50 nmol/L lower, as printed
Further findings
| Outcome | adjusted HR (95% CI) |
|---|---|
| Incident DM with evolocumab, top decile of baseline Lp(a) (subgroup) · evolocumab reduced Lp(a) by a median of 71 nmol/L | .72 (.38-1.35) |
Baseline Lp(a)
- Median Lp(a), nmol/L (IQR 13-165)
- 37
Incident diabetes mellitus (DM) with evolocumab, top decile of baseline Lp(a) (subgroup)
- Evolocumab did not increase DM risk irrespective of baseline Lp(a)
Original publication
Safety of low lipoprotein(a) levels: the FOURIER trial. Eur Heart J. Published 3 June 2026. doi:10.1093/eurheartj/ehag398
Summarised from the published abstract; every number is checked against it