A real-world study found evolocumab cut fatal or nonfatal heart attack risk 20% vs ezetimibe in adults with ASCVD and prior statin use.
Amgen announced on November 5, 2026, results from a large real-world study showing that
"These findings provide important comparative data that can help clinicians distinguish between these treatment options and make more informed choices to reduce their patients' cardiovascular risk," said
Treatment with evolocumab lowered the rate of fatal or nonfatal myocardial infarction (MI) compared with ezetimibe (hazard ratio [HR], 0.80; 95% confidence interval [CI], 0.70-0.91).¹,² Among the 225,048 patients with a baseline low-density lipoprotein cholesterol (LDL-C) measurement, the 4-year cumulative risk of heart attack was 5.88% with evolocumab vs 7.76% with ezetimibe.¹
The non-interventional, active-comparator, new-user
To account for differences between the groups, the researchers used inverse probability weighting to balance measured baseline characteristics and a calibrated estimator to address incomplete baseline LDL-C data.² A prespecified sensitivity analysis that continued follow-up regardless of changes in background statin therapy produced consistent results.²
Many patients with ASCVD cannot reach recommended LDL-C levels with statins alone, and clinicians add a non-statin therapy as a next step.¹ According to Amgen, direct cardiovascular outcomes evidence comparing ezetimibe and PCSK9 inhibitors has been limited, even as guidelines target LDL-C goals below 70 mg/dL and below 55 mg/dL for higher-risk patients.¹ Amgen positioned the analysis as a real-world complement to clinical trial evidence that may inform treatment decisions.¹
Evolocumab is a human monoclonal antibody that inhibits proprotein convertase subtilisin/kexin type 9 (PCSK9).¹ By blocking PCSK9 from binding to the LDL receptor, it increases the number of receptors available to clear LDL from the blood, lowering LDL-C levels.¹ In the randomized FOURIER trial, evolocumab added to statin therapy reduced cardiovascular events in patients with established ASCVD.³ According to Amgen, the ACC/AHA multisociety guideline update recognizes both ezetimibe and PCSK9 inhibitors such as evolocumab as non-statin options for patients with ASCVD.¹
Repatha was first approved in 2015.¹ In August 2025,
As an observational analysis, the study cannot establish causation, and residual confounding may remain despite the statistical methods used to balance the groups. A baseline LDL-C measurement was available for about 41% of participants, and the study was conducted by Amgen's Center for Observational Research. The analysis did not compare evolocumab with other lipid-lowering options, and it reflects US clinical practice, which may limit generalizability.
