2026-2027 Respiratory Vaccine Effectiveness and Safety, Evolocumab for LDL Lowering Before Percutaneous Coronary Intervention, Digital Outreach to Increase Statin Refills, and more

Preeti, let's start with the Amundsen trial looking at Evalocumab.

Thanks,

Linda.

In patients with acute myocardial infarction, early initiation of intensive statin therapy is standard practice.

However, among patients requiring additional lipid-lowering agents to achieve LDL targets, treatment intensification is often delayed, resulting in suboptimal LDL control.

In this study, which was done at 48 sites in six countries, Dr. Montelsko and colleagues assessed whether starting Evalocumab, an injectable PCSK9 inhibitor before PCI rather than later stepwise initiation, would improve lipid control and outcomes at 12 months.

The investigators report an early and large difference in the more than 2,100 participants with STEMI or non-STEMI undergoing PCI.

By six weeks, the groups differed in the proportion reaching LDL goal, 91 percent compared with 34 percent, favoring the Evalocumab group.

This was sustained at 12 months, 82 percent compared with 40 percent, which was the trial's primary outcome.

However, the main clinical endpoint, all-cause death or unplanned cardiovascular hospitalization at 12 months, was not significantly different.

14.6% in the evalocumab group compared with 15.4% with standard care.

So although early evalocumab clearly improved LDL control, it did not produce a detectable clinical benefit at 12 months.

In an accompanying editorial, Dr. Ray and colleagues say the key lesson is that LDL lowering after MI is a marathon, not a sprint.

They contend that rapid goal attainment matters, and several factors may explain why this trial did not demonstrate clinical benefits.

including the fact that 12 months may simply be too short of a time period to see the clinical benefits from this intervention.

So while the trial's results do not change current clinical care guidelines, data from other trials are anticipated, and this topic remains one to watch.