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Evolocumab, a proprotein convertase subtilisin–kexin type 9 (PCSK9) inhibitor, reduces the risk for major adverse cardiovascular events (MACE) in secondary prevention patients; however, the effects among patients who have never had a cardiovascular event is unknown. Investigators conducted an industry-funded, randomized, placebo-controlled trial of evolocumab (140 mg biweekly) in 12,000 patients who had LDL cholesterol ≥90 mg/dL, atherosclerosis, or diabetes. These patients had no history of myocardial infarction (MI) or stroke, but they were definitely high risk: Two thirds had documented coronary heart, cerebrovascular, or peripheral vascular disease, one third had undergone coronary revascularization for multivessel disease, and h…
