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[Correspondence] Clinical benefits of evolocumab appear less than hoped

The strong correlation between on-treatment LDL cholesterol and cardiovascular events observed in the prespecified secondary analysis of the FOURIER trial published in The Lancet (Oct 28, 2017, p 1962)1 is no different from that reported on treatment in several previous clinical trials of statins and on no treatment in epidemiological studies. The on treatment correlation conflates the epidemiology with pharmacological lowering of LDL2 by evolocumab and the co-prescribed statin. In FOURIER,3 the addition of evolocumab to statin therapy lowered LDL by 59%, but the risk of myocardial infarction was only reduced by 27% compared with studies of statin versus placebo, which lowered LDL by 30% and myocardial infarction risk by 38% in the Heart Protection Study4 and 50% and 54%, respectively, in the JUPITER trial.