ESC Congress in Review - Main Edition 2019 - 19
ESC Congress 2019 In Review
in ODYSSEY and more than 3 years in the FOURIER trial,
compared with 1 to 3 days in the EVOPACS trial.
In EVOPACS, patients hospitalised for ACS with
elevated LDL-C levels were randomised to receive
either evolocumab (420 mg subcutaneously/every 4
weeks; n = 155) or matching placebo (n = 153), alongside
atorvastatin (40 mg) daily therapy. Most patients (78%)
were statin-naïve at baseline.
At 8 weeks, the primary endpoint of percentage change
in LDL-C from baseline was -77.1% (mean 3.61 mmol/L to
0.79 mmol/L [139 mg/dL to 31 mg/dL]) in the evolocumab
group and -35.4% (mean 3.42 mmol/L to 2.06 mmol/L
[132 mg/dL to 80 mg/dL]) in the placebo group (difference
in mean percentage change from baseline, -40.7%; 95%
CI, -45.2 to -36.2; P < .001; Figure 6).
Overall, 95.7% of patients in the evolocumab group
and 37.6% in the placebo group reached an LDL-C target
of < 1.8 mmol/L (< 70 mg/dL). Moreover, an LDL-C level of
< 1.4 mmol/L (< 55 mg/dL) -a more stringent target for very
high-risk patients set out in the 2019 ESC dyslipidaemia
guidelines [Mach F et a l. Eur Heart J. 2019]- was achieved
by 90.1% with evolocumab versus 10.7% with placebo.
Rates of adverse events, serious adverse events,
and events leading to drug discontinuation were similar
between groups. Adjudicated cardiovascular events also did
not differ in the evolocumab and placebo groups, although
the trial was not powered to assess clinical outcomes.
EVOPACS shows that evolocumab can safely and rapidly
lower LDL-C in very high-risk ACS patients. These findings
warrant further investigation in a dedicated cardiovascular
outcomes trial.
Replay presentation onESC365
Multi-Faceted Intervention in
Colombia and Malaysia Lowers
CVD Risk
Written by Michiel Tent
A comprehensive model of care led by non-physician
health workers (NPHWs) resulted in a 49% relative
reduction in cardiovascular disease (CVD) risk defined
as improvements in systolic blood pressure, LDL cholesterol, medication adherence, and health behaviour in 2
middle-income countries: Colombia and Malaysia. This
strategy is widely applicable and scalable.
Hypertension is the leading cause of CVD globally, but
hypertension control remains poor [Schwalm JD et al.
Lancet. 2019]. Of all CVD deaths, 80% occur in low- and
middle-income countries. The Heart Outcomes Prevention
and Evaluation [HOPE 4; NCT01826019] trial evaluated a
community-based intervention focusing on a collaborative
approach between NPHWs and primary-care physicians,
along with strategies to overcome health system barriers,
to substantially reduce CVD risk. It was designed as a
community-based cluster randomised controlled trial
involving 30 urban and rural communities in Colombia
and Malaysia. Participants (n = 1,371) were ≥50 years old
with new or poorly controlled hypertension. Communities
were randomised to control (usual care; n = 727) or to a
multifaceted intervention (n = 644) consisting of:
1. community screening, treatment, and control of CVD
risk factors by NPHWs (in conjunction with local
physicians) using tablet-based, simplified management
algorithms and counselling programmes;
Calculated LDL Cholesterol(mmol/L)
Figure 6. Primary Endpoint: Percentage Change in Low-Density Lipoprotein Cholesterol (LDL-C) at 8 Weeks
4
Placebo
Evolocumab
3
2.06 mmol/L
2
2.00 mmol/L
0.79 mmol/L
1
0.79 mmol/L
0
Baseline
No. of patients
Placebo
Evolocumab
148
146
Absolute difference (mmol/L)
Percentage difference
P-value
Week 4
Week 8
144
136
149
141
1.34
38.4%
< .001
1.43
40.7%
< .001
Reprinted from Koskinas KC et al. Evolocumab for Early Reduction of LDL-cholesterol Levels in Patients with Acute Coronary Syndromes (EVOPACS). J Am Coll Cardiol. 2019. DOI: https://doi.org/10.1016/j.jacc.2019.08.010. Copyright 2019 by the American College of Cardiology Foundation. Reprinted with permission from Elsevier.
Official Peer-Reviewed Highlights From ESC Congress 2019
19
https://esc365.escardio.org/Congress/ESC-CONGRESS-2019/Late-Breaking-Science-in-Acute-Coronary-Syndromes-1/202101-evolocumab-for-early-reduction-of-ldl-cholesterol-levels-in-patients-with-acute-coronary-syndromes
https://www.doi.org/10.1016/j.jacc.2019.08.010
ESC Congress in Review - Main Edition 2019
Table of Contents for the Digital Edition of ESC Congress in Review - Main Edition 2019
ESC Congress in Review - Main Edition 2019 - Cover1
ESC Congress in Review - Main Edition 2019 - Cover2
ESC Congress in Review - Main Edition 2019 - 1
ESC Congress in Review - Main Edition 2019 - 2
ESC Congress in Review - Main Edition 2019 - 3
ESC Congress in Review - Main Edition 2019 - 4
ESC Congress in Review - Main Edition 2019 - 5
ESC Congress in Review - Main Edition 2019 - 6
ESC Congress in Review - Main Edition 2019 - 7
ESC Congress in Review - Main Edition 2019 - 8
ESC Congress in Review - Main Edition 2019 - 9
ESC Congress in Review - Main Edition 2019 - 10
ESC Congress in Review - Main Edition 2019 - 11
ESC Congress in Review - Main Edition 2019 - 12
ESC Congress in Review - Main Edition 2019 - 13
ESC Congress in Review - Main Edition 2019 - 14
ESC Congress in Review - Main Edition 2019 - 15
ESC Congress in Review - Main Edition 2019 - 16
ESC Congress in Review - Main Edition 2019 - 17
ESC Congress in Review - Main Edition 2019 - 18
ESC Congress in Review - Main Edition 2019 - 19
ESC Congress in Review - Main Edition 2019 - 20
ESC Congress in Review - Main Edition 2019 - 21
ESC Congress in Review - Main Edition 2019 - 22
ESC Congress in Review - Main Edition 2019 - 23
ESC Congress in Review - Main Edition 2019 - 24
ESC Congress in Review - Main Edition 2019 - 25
ESC Congress in Review - Main Edition 2019 - 26
ESC Congress in Review - Main Edition 2019 - 27
ESC Congress in Review - Main Edition 2019 - 28
ESC Congress in Review - Main Edition 2019 - 29
ESC Congress in Review - Main Edition 2019 - 30
ESC Congress in Review - Main Edition 2019 - 31
ESC Congress in Review - Main Edition 2019 - 32
ESC Congress in Review - Main Edition 2019 - Cover3
ESC Congress in Review - Main Edition 2019 - Cover4
https://www.nxtbookmedia.com