Publication details
Studie FOURIER přepisuje guidelines sekundární prevence
| Title in English | The FOURIER study transcribes secondary prevention guidelines |
|---|---|
| Authors | |
| Year of publication | 2017 |
| Type | Article in Periodical |
| Magazine / Source | Remedia |
| MU Faculty or unit | |
| Citation | |
| Field | Cardiovascular diseases incl. cardiosurgery |
| Keywords | secondary prevention; cholesterol; evolocumab; the FOURIER trial |
| Description | The first epidemiological trials (Framingham Study and MRFIT - Multifactorial Risk Factors Interventional Trial) have shown that high blood cholesterol level, arterial hypertension, and smoking represent the three most prominent causal risk factors of myocardial infarction. Later epidemiological and interventional trials with statins have demonstrated that blood cholesterol (or LDL cholesterol) level lowering is indirectly proportional to the incidence of myocardial infarction plus other atherosclerotic events and to the total mortality. Since the SOties, prescription of statins has been raising throughout the entire Europe. In the EUROASPIRE IV (2012-2013) trial, 90.4% patients with a history of myocardial infarction took statins. Statins are currently the most commonly prescribed hypolipidernics (80%), followed by fibrates (20%) and ezetimibe (5%). In the FOURIER trial, 27,564 patients suffering from confirmed cardiovascular disease and treated with the maximal tolerated statin dose were recruited from February 2013 until June 2015. These patients were randomized to either evolocumab or placebo. Mean cholesterol level lowering by 59% was noted following evolocumab, corresponding to decrease from 90 to 30mg/L, i.e. to about 0.8mmol/L. The primary endpoint (comprising myocardial infarction, stroke, hospitalization because of angina, revascularizaton, and/or death) rate decreased from 14.6% to 12.6% (p < 0.0001), the main secondary endpoint (death, myocardial infarction, stroke) rate dropping from 9.9% to 7.9% (p < 0.0001). The total mortality did not change (2.5% vs. 2.4%) while the incidence of myocardial infarction (4.4% vs. 6.3%) and stroke (2,2% vs. 2.6%) decreased significantly. The frequency of dosing (once in 2 weeks vs. once in 4 weeks) was not decisive; no statistically significant difference concerning side effects was apparent, either. |