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FOURIER
About the Trial
FOURIER randomized 27,564 patients with atherosclerotic disease on optimized statins to the PCSK9 inhibitor evolocumab or placebo. The drug lowered LDL from 92 to 30 mg per dL and reduced major cardiovascular events by 15 percent, with greater reduction in those reaching LDL under 20. It proved the cholesterol lowering hypothesis holds at extremely low LDL with no safety signal over 2.2 years. FOURIER opened the ultra low LDL era and validated PCSK9 as a target discovered by human genetics. Cost debates limited uptake, but the efficacy question was settled: there appears to be no lower limit of LDL benefit.
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