Lipoprotein(a) Levels, Risk of Cardiovascular Events and Benefit of Evolocumab: Findings From the VESALIUS-CV Trial

Circulation, Ahead of Print. Background: Lipoprotein(a) [Lp(a)] is a risk factor for coronary heart disease.

Whether baseline Lp(a) identifies higher risk patients who derive more benefit from evolocumab is not established in a population without prior myocardial infarction (MI) or stroke.Methods: From June 2019 to November 2021, the VESALIUS-CV trial enrolled patients with qualifying atherosclerosis or high-risk diabetes, without prior MI or stroke and randomized them to evolocumab or placebo (median follow-up 4.6 years). In a prespecified analysis, Lp(a) was assessed at baseline in 7557 patients.

Cox models were used to assess the adjusted risk of cardiovascular events by baseline Lp(a) in the placebo arm, and the efficacy of evolocumab by baseline Lp(a). The primary outcome of interest was the composite of major coronary events (coronary heart disease death, MI or urgent coronary revascularization).Results: Median age was 66 [interquartile range 60-71] years and 42.8% were women; median Lp(a) was 28 (interquartile range 9-132) nmol/L.