Evolocumab was projected to prevent 55 first and repeat events per 1,000 over five years in patients with no prior MI or stroke

The edition in brief

In VESALIUS-CV, 12,257 high-risk patients without prior MI or stroke and LDL cholesterol of 90 mg/dL or more on optimised therapy were randomised to evolocumab or placebo. Counting first and subsequent events, evolocumab reduced total four-point MACE by 20% (IRR 0.80) and three-point MACE by 27% (IRR 0.73), projected as 55 fewer four-point events per 1,000 patients over five years. In TARGET-D, 630 patients after MI received vitamin D3 titrated to 25(OH)D above 40 ng/mL or usual care; MACE was 15.7% vs 18.4% (HR 0.85, 0.58 to 1.24), not significant. In a general-population cohort of 19,499, about half of raised troponin results were discordant between the I and T assays; 92.5% of discordant troponin I was due to macrotroponin complexes, and those people did not carry the raised risk seen with true myocardial injury. HALO-SCE randomised 164 patients after left atrial appendage occlusion to rivaroxaban 10 mg or antiplatelet therapy; new silent cerebral emboli occurred in 12.2% vs 31.7%. In HELIOS-B, vutrisiran's benefit in transthyretin cardiomyopathy showed no evidence of modification by tafamidis or heart failure therapies.