Alirocumab after acute coronary syndrome in patients with a history of heart failure
Open accessAbstract
Aims: Patients with heart failure (HF) have not been shown to benefit from statins. In a post hoc analysis, we evaluated outcomes in ODYSSEY OUTCOMES in patients with vs. without a history of HF randomized to the proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitor alirocumab or placebo. Methods and results: Among 18 924 patients with recent acute coronary syndrome (ACS) receiving intensive or maximum-tolerated statin treatment, the primary outcome of major adverse cardiovascular events (MACE) was compared in patients with or without a history of HF. The pre-specified secondary outcome of hospitalization for HF was also analysed. Overall, 2815 (14.9%) patients had a history of HF. Alirocumab reduced low-density lipoprotein cholesterol and lipoprotein(a) similarly in patients with or without HF. Overall, alirocumab reduced MACE compared with placebo [hazard ratio (HR): 0.85; 95% confidence interval (CI): 0.78–0.93; P = 0.0001]. This effect was observed among patients without a history of HF (HR: 0.78; 95% CI: 0.70–0.86; P < 0.0001), but not in those with a history of HF (HR: 1.17; 95% CI: 0.97–1.40; P = 0.10) (P interaction = 0.0001). Alirocumab did not reduce hospitalization for HF, overall or in patients with or without prior HF. Conclusion: Alirocumab reduced MACE in patients without a history of HF but not in patients with a history of HF. Alirocumab did not reduce hospitalizations for HF in either group. Patients with a history of HF are a high-risk group that does not appear to benefit from PCSK9 inhibition after ACS.
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Trials of low-dose anticoagulation, PCSK9 inhibitors, and statins in patients with heart failure have been disappointing to date.
“Trials of low‐dose anticoagulation, 4 PCSK9 (proprotein convertase subtilisin/kexin type 9) inhibitors, 5 as well as statins 2 , 6 in patients with HF have been disappointing to date”
From Impact of Icosapent Ethyl on Cardiovascular Risk Reduction in Patients With Heart Failure in REDUCE‐IT (2022) · cites this paper as [5]
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- Authors
- White, H. D., Schwartz, G. G., Szarek, M., Bhatt, D. L., Bittner, V. A., Chiang, C.-E., Diaz, R., Goodman, S. G., Jukema, J. W., Loy, M., Pagidipati, N., Pordy, R., Ristić, A. D., Zeiher, A. M., Wojdyla, D. M., Steg, P. G., & for the ODYSSEY OUTCOMES Investigators
- Affiliations
- Auckland City Hospital (NZ)
- University of Colorado Anschutz (US)
- State University of New York (US)
- Brigham and Women's Hospital (US)
- University of Alabama at Birmingham (US)
- Taipei Veterans General Hospital (TW)
- Estudios Clınicos Latino America, Instituto Cardiovascular de Rosario , Paraguay 160, Santa Fe, Rosario 2000, Argentina
- St. Michael's Hospital (CA)
- Leiden University Medical Center (NL)
- Sanofi (United States) (US)
- Duke University (US)
- Regeneron (United States) (US)
- University of Belgrade (RS)
- Goethe University Frankfurt (DE)
- Assistance Publique-Hôpitaux de Paris, Hôpital Bichat, Université de Paris, FACT (French Alliance for Cardiovascular Trials) , INSERM U1148, 46 Rue Henri Huchard, Paris, 75018 France
- Corresponding author
- White, Harvey D
- ORCID
- Venue
- European Heart Journal
- Publisher
- Oxford University Press (OUP)
- Published
- 2021-12-18
- Volume
- 43
- Issue
- 16
- Pages
- 1554-1565
- ISSN
- 0195-668X (ISSN-L)
- 1522-9645
- PMC
- PMC9020985
- OpenAlex
- W4200115483
- Cited by
- 41
- References
- 29
- Citations by year
- 2026: 4 · 2025: 7 · 2024: 8 · 2023: 12 · 2022: 8 · 2021: 1
- FWCI
- 7.04
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- European Heart Journal (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- Leiden Repository (Leiden University) (submittedVersion, cc-by-nc)
- Data Archiving and Networked Services (DANS) (submittedVersion, cc-by-nc)
- Funders
- Sanofi and Regeneron Pharmaceuticals
- Topics
- Health Sciences › Medicine › Surgery › Lipoproteins and Cardiovascular Health
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Acute Myocardial Infarction Research
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Failure Treatment and Management
- Keywords
- alirocumab, PCSK9 inhibitors, acute coronary syndrome, heart failure, major adverse cardiovascular events, heart failure hospitalization, LDL cholesterol lowering, lipoprotein(a), statin therapy
- MeSH terms
- Proprotein Convertase 9, Anticholesteremic Agents, Heart Failure, Humans, Treatment Outcome, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Acute Coronary Syndrome, Antibodies, Monoclonal, Humanized
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