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CARDIOVASCULAR
DISEASE REMAINS THE
#1 CAUSE OF MORTALITY
AND A MAJOR CAUSE
OF MORBIDITY IN EUROPE1

LDL-C reduction has a substantial impact on patients’ CV risk

There is a linear relationship between reduction in LDL-C levels and reduction in the rate of major vascular events.2
Each 1-mmol/l (39-mg/dl) reduction in LDL-C levels reduces the annual rate of major vascular events* by 22%.3

Association between reduction in LDL-C and clinical benefit†2

Statins alone lower LDL-C, but sometimes not enough
For more than 20 years, statins have helped millions of people avoid CV events.4 But many very-high-risk patients don’t reach LDL-C goals with a statin alone.5

Results of lipid-lowering trials

Additional LDL-C reduction can help minimise residual CV risk
Many very-high-risk patients remain at risk of a subsequent CV event. This “residual CV risk” can potentially be reduced further through incremental, intensive LDL-C lowering.9

Lipid-lowering treatment options for very-high-risk patients and associated average expected reductions in LDL-C and CV risk

*Major vascular events defined as myocardial infarction, revascularisation, or ischaemic stroke.
Vertical bars indicate 1 SE. The size of the box is proportional to the number of endpoints in the study. Letters from a to n denote the following trials: a: Gruppo Italiano per lo Studio della Sopravvivenza nell’Infarto Miocardico (GISSI Prevenzione); b: Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial–Lipid Lowering Trial (ALLHAT-LLT); c: Assessment of Lescol in Renal Transplantation (ALERT); d: Lescol Intervention Prevention Study (LIPS); e: Air Force/Texas Coronary Atherosclerosis Prevention Study (AFCAPS/TexCAPS); f: Cholesterol and Recurrent Events (CARE); g: Long-term Intervention with Pravastatin in Ischaemic Disease (LIPID); h: Prospective Study of Pravastatin in the Elderly at Risk (PROSPER); i: Anglo-Scandinavian Cardiac Outcomes Trial–Lipid Lowering Arm (ASCOT-LLA); j: West of Scotland Coronary Prevention Study (WOSCOPS); k: Post–Coronary Artery Bypass Graft (Post CABG); l: Collaborative Atorvastatin Diabetes Study (CARDS); m: Heart Protection Study (HPS); and n: Scandinavian Simvastatin Survival Study (4S).
Independent studies. Data shown are not intended to be a direct comparison.
§In the study, 2690 recent MI patients received Repatha®, 2254 of whom achieved LDL-C levels <55 mg/dl.
25% RRR reported as the key secondary endpoint: composite of cardiovascular death, MI or stroke. HR: 0.75; 95% CI: 0.62-0.91; p=0.003. ARR: 3.2%; 95% CI: 1.2-5.2.
4S = Scandinavian Simvastatin Survival Study; ACS = Acute coronary syndrome; ARR = Absolute risk reduction; CARE = Cholesterol and Recurrent Events trial; CV = Cardiovascular; EAS = European Atherosclerosis Society; ESC = European Society of Cardiology; EVOPACS = EVOlocumab for Early Reduction of LDL-cholesterol Levels in Patients With Acute Coronary Syndromes; FOURIER = Further Cardiovascular Outcomes Research with PCSK9 Inhibition in Subjects with Elevated Risk; IMPROVE-IT = Improved Reduction of Outcomes: Vytorin Efficacy International Trial; LDL-C = Low-density lipoprotein cholesterol; MI = Myocardial infarction; PCSK9 = Protein convertase subtilisin/kexin type 9; PROVE-IT = Pravastatin or Atorvastatin Evaluation and Infection Therapy; RRR = Relative risk reduction; TNT = Treating to New Targets study.
  1. European Cardiovascular Disease Statistics 2017. Fifth Edition: February 2017. European Heart Network, Brussels.
  2. Cannon CP, et al. New Engl J Med. 2015;372:2387-97.
  3. Cholesterol Treatment Trialists’ (CTT) Collaboration. Lancet 2010;376:1670-81.
  4. Endo A. Proc Jpn Acad Ser B Phys Biol Sci. 2010;86:484-93.
  5. Yusuf S, et al. Lancet. 2004;364:937-52.
  6. 4S Investigators. Lancet. 1994;344:1383-9.
  7. Sacks FM, et al. N Engl J Med. 1996;335:1001-9.
  8. Cannon CP, et al. N Engl J Med. 2004;350:1495-504.
  9. LaRosa JC, et al. N Engl J Med. 2005;352:1425-35.
  10. Sabatine MS, et al. N Engl J Med. 2017;376:1713-22.
  11. Cannon CP, et al. J Am Coll Cardiol. 2006;48:438-45.
  12. Gencer B, et al. JAMA Cardiol. 2020;5(8):1-6. Main paper & Supplementary appendix.

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