Key result
In patients with type 1 diabetes and ASCVD, evolocumab reduced major cardiovascular events with a hazard ratio of 0.66 (95% CI 0.32-1.38) and an absolute risk reduction of 7.3%.
Why the study?
Does evolocumab reduce cardiovascular events in patients with ASCVD and type 1 diabetes mellitus on statin therapy?
RCT (n=27,564)
Does evolocumab reduce cardiovascular events in patients with ASCVD and type 1 diabetes mellitus on statin therapy?
Intensive LDL-C lowering with evolocumab provides a substantial absolute risk reduction of 7.3% for cardiovascular events in patients with type 1 diabetes and ASCVD, though limited by small sample size.
OBJECTIVE: To evaluate the clinical efficacy of intensive LDL cholesterol (LDL-C) lowering in type 1 diabetes mellitus (T1DM). RESEARCH DESIGN AND METHODS: Further Cardiovascular Outcomes Research With PCSK9 Inhibition in Subjects With Elevated Risk (FOURIER) randomized participants with atherosclerotic cardiovascular disease (ASCVD) on statins to evolocumab or placebo (median follow-up 2.2 years). The primary end point (PEP) was cardiovascular death, myocardial infarction, stroke, hospitalization for unstable angina, or coronary revascularization. RESULTS: Of 27,564 participants, 10,834 (39.3%) had type 2 diabetes mellitus (T2DM), and 197 (0.7%) had T1DM. In the placebo arm, there was a stepwise increase in the 2.5-year PEP Kaplan-Meier rate from 11.0% to 15.2% to 20.4% in participants with no diabetes, T2DM, and T1DM, respectively (P < 0.0001). Hazard ratios for PEP with evolocumab were 0.87 (95% CI 0.79-0.96), 0.84 (0.75-0.93), and 0.66 (0.32-1.38) in the no diabetes, T2DM, and T1DM groups, and absolute risk reduction was 1.3%, 2.5%, and 7.3%, respectively. CONCLUSIONS: Intensive LDL-C lowering may provide substantial clinical benefit in individuals with T1DM and ASCVD. Additional randomized controlled cardiovascular outcomes trials are needed in this population.
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Kang et al. (2025) conducted an RCT in Type 1 diabetes mellitus and atherosclerotic cardiovascular disease (n=27,564). Evolocumab vs. Placebo was evaluated on cardiovascular death, myocardial infarction, stroke, hospitalization for unstable angina, or coronary revascularization (HR 0.66, 95% CI 0.32-1.38). In patients with type 1 diabetes and ASCVD, evolocumab reduced major cardiovascular events with a hazard ratio of 0.66 (95% CI 0.32-1.38) and an absolute risk reduction of 7.3%.
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