Journal of the American College of CardiologyNov 11, 2026, 00:14 GMT

Evolocumab cut combined heart and stroke risk in kidney impairment

Evolocumab reduced the relative risk of coronary heart disease death, heart attack or stroke by 39% versus placebo in people with reduced kidney function.

Paper by Jan H. Cornel, Robert Patrick Giugliano, Ajay Bhatia, +21Erin A. Bohula

Artery cross-sections beneath kidneys contrast an open passage with sparse cholesterol particles against a clot-blocked passage with dense particles.

Our read

Interventions

Studied:: Randomized trial in 2,140 adults with reduced kidney function, median 4.6 years, against placebo (Placebo-controlled, registered NCT03872401)
What changed:: Evolocumab lowered combined coronary death, heart attack or stroke risk by 39% versus placebo in people with reduced kidney function
The catch:: Participants had no prior heart attack or stroke, limiting relevance to patients with previous events
Stake:: Amgen, which develops evolocumab, funded the study.
In the record:: The 33rd paper on evolocumab with results in people; 82 on record in all. Its result on LDL cholesterol agrees with all 12 other findings on record.

Editor of record: Boris Djordjevic · AgingResearch.News

Paper

Adults with reduced kidney function—2,140 people with a median age of 69, 55% female—formed a prespecified subgroup in the VESALIUS-CV randomized trial. The trial assigned 12,257 people with fatty buildup in their arteries or high-risk diabetes to evolocumab, a cholesterol-lowering drug, or placebo. None had previously had a heart attack or stroke.

Over a median 4.6 years, evolocumab reduced the combined risk of death from coronary heart disease, heart attack or ischemic stroke, caused by a blocked artery. At five years, the absolute risk reduction was 4.0 percentage points in the reduced-kidney-function group. A broader outcome also counted procedures to restore blood flow prompted by inadequate blood supply. Evolocumab reduced its relative risk by 23%, with a 4.1-percentage-point absolute risk reduction at five years.

Why it matters

Reduced kidney function carries a high risk of cardiovascular disease. Preventing a first heart attack or stroke is an important goal for this older, high-risk population.

Caveats

The analysis covered a high-risk subgroup with artery disease or high-risk diabetes and no prior heart attack or stroke. These results do not establish the benefit for people with reduced kidney function but low cardiovascular risk.

Where the evidence stands

Evolocumab

28 independent labs in 16 countries
93 trials, 7 with no results posted

Funders: Amgen and others
37 of 85 findings with company ties
52 of 93 trials sponsored by its developers

PCSK9

C, W, M, H: cells, worms or flies, mice, humans. Dark: independent labs found the same change there. Light: one lab or one study. Outline: nothing yet.

Labs are independent when their papers share no last author and no institution.

Against: findings that point the other way from most findings on the same outcome.

No results posted: trials that ended over a year ago with no results on ClinicalTrials.gov and no paper reporting them.

Company ties: findings with an author at a company, or from a paper whose competing-interests statement declares ties to one.

Includes the processes named after it and trials of drugs aimed at it.

32 independent labs in 13 countries
2 findings against
162 trials, 11 with no results posted

Funders: Gouvernement du Canada | Canadian Institutes of Health Research and others
7 of 46 findings with company ties
149 of 162 trials sponsored by developers of drugs aimed at it