Powerful cholesterol drug cuts heart attack risk by 31%
A powerful cholesterol drug may prevent heart attacks before they ever happen.
- Date:
- March 30, 2026
- Source:
- Mass General Brigham
- Summary:
- A powerful cholesterol-lowering drug may be changing the rules of heart disease prevention. Researchers found that evolocumab, typically used for people who already have cardiovascular disease, can significantly cut the risk of first-time heart attacks and strokes in high-risk patients with diabetes—even before any artery-clogging plaque is detected.
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Mass General Brigham researchers report that the cholesterol-lowering drug evolocumab can significantly reduce the risk of a first major cardiovascular event in people with diabetes who are considered high risk but do not yet have diagnosed atherosclerosis (the build-up of plaque inside artery walls). The findings were presented at the American College of Cardiology's Annual Scientific Session & Expo and published at the same time in JAMA.
"For over a decade, the intensive cholesterol-lowering have been reserved for patients who already have cardiovascular disease," said corresponding author Nicholas A. Marston, MD, MPH, a cardiologist with the Mass General Brigham Heart and Vascular Institute. "These results demonstrate the benefit of intensive lowering cholesterol earlier and should change how we think about the prevention of heart attacks, strokes, and heart disease in patients without known significant atherosclerosis."
Why Lowering "Bad Cholesterol" Matters
Heart disease continues to be the leading cause of death worldwide. Reducing levels of low-density lipoprotein cholesterol (LDL-C), often called "bad cholesterol," is one of the most effective ways to lower risk. Evolocumab belongs to a class of drugs known as PCSK9 inhibitors and can cut LDL-C levels by about 60%. It is typically used alongside statins, which are the standard treatment. However, people without atherosclerosis but at high risk are usually treated only with statins, if they receive medication at all.
The results come from a subgroup analysis of the VESALIUS-CV randomized trial, funded by Amgen Inc. Researchers studied 3,655 patients who had high-risk diabetes but no significant atherosclerosis. High-risk diabetes included people who had the condition for at least 10 years, required daily insulin, or had diabetes-related small blood vessel damage.
Participants were assigned to receive either evolocumab injections every two weeks or a placebo. All participants continued standard cholesterol treatments such as statins and ezetimibe during the study.
Significant Drop in Cholesterol Levels
Patients treated with evolocumab experienced much larger reductions in cholesterol. After 48 weeks, median LDL-C levels were about 51% lower in the evolocumab group compared with the placebo group (52 mg/dL versus 111mg/dL).
Lower Risk of First Heart Attack or Stroke
Over a follow-up period of nearly five years, those receiving evolocumab in addition to standard therapy had a 31% lower risk of experiencing their first major cardiovascular event. These events included death from coronary heart disease, heart attack, or ischemic stroke.
At five years, 5% of patients in the evolocumab group had experienced an event, compared with 7.1% in the placebo group.
Safety and Future Research
Serious side effects were reported at similar rates in both groups, indicating that the treatment was generally well tolerated.
Researchers note that additional studies will be needed to determine whether these benefits apply to other high-risk groups who do not yet have established atherosclerosis.
Authors, Disclosures, and Funding
In addition to Marston, Mass General Brigham contributors include Erin A. Bohula, Jeong-Gun Park, Sabina A. Murphy, Ron Blankstein, Robert P. Giugliano, and Marc S. Sabatine. Other authors include Ajay K. Bhatia, Gaetano M. De Ferrari, Lawrence A. Leiter, Jose C. Nicolau, Emileigh Walsh, Lyrica Liu, Subodh Verma, Naveed Sattar, Stephen J. Nicholls, Jose Lopez-Sendon, Ioanna Gouni-Berthold, Lale Tokgozoglu, Marcoli Cyrille, and Gabriel Paiva da Silva Lima.
Disclosures: Marston, Bohula, Kuder, Park, Murphy, Giugliano, and Sabatine are members of the TIMI Study Group. The TIMI Study Group reports grant support through Brigham and Women's Hospital from Amgen and other pharmaceutical companies. Marston, Bohula, De Ferrari, Nicolau, Gouni-Berthold Tokgozoglu, Giugliano, and Sabatine report personal fees from Amgen. Bhatia, Walsh, Liu, Cyrille, and Paiva da Silva Lima are employees and stockholders of Amgen. Blankstein reports research support and consulting fees from Amgen Inc. Giugliano reports honoraria for lectures and CME programs from Amgen. Additional author disclosures can be found in the paper.
Funding: Amgen Inc.
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Materials provided by Mass General Brigham. Note: Content may be edited for style and length.
Journal Reference:
- Nicholas A. Marston, Erin A. Bohula, Ajay K. Bhatia, Gaetano M. De Ferrari, Lawrence A. Leiter, Jose C. Nicolau, Jeong-Gun Park, Sabina A. Murphy, Emileigh Walsh, Lyrica Liu, Subodh Verma, Naveed Sattar, Stephen J. Nicholls, Jose Lopez-Sendon, Ioanna Gouni-Berthold, Lale Tokgozoglu, Ron Blankstein, Marcoli Cyrille, Gabriel Paiva da Silva Lima, Robert P. Giugliano, Marc S. Sabatine, Alberto J. Lorenzatti, Marcos R. Litvak Bruno, Ignacio Mackinnon, Emilio D. Alaguibe, Gustavo Giunta, Oscar Romano Montana, Daniel Vogel, Jorgelina Sala, Diego A. Besada, Angela Romero Zarante, Marisa Vico, Tomas E. Smith Casabella, Patricia del C. Gonzalez Colaso, Eleonora Montenegro, Cesar Zaidman, Maria C. de Salvo, Eduardo Perna, Claudio R. Majul, Ruben O. Garcia Duran, Miguel Hominal, Sonia Hermida, Carolina Chacon, Andrea P. Serrano, Juan P. Albisu Di Gennaro, Walter R. Stoermann, Maria V. Mansilla, Martin Koretzky, Leonardo Novaretto, Lilia Schiavi, Andres D. Orlandini, Fernando O. 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Nagy, Tamas Barany, Istvan Berhes, Andras C. Nagy, Piera A. Merlini, Giovanni Licciardello, Maria P.A. Baldassarre, Sergio Berti, Enrico Rinaldi, Giuliano Tocci, Salvatore De Rosa, Andrea Palermo, Nazzareno Galie, Roberto Trevisan, Gaetano M. De Ferrari, Daniela Trabattoni, Inga Morozova, Dace Teterovska, Andrejs Erglis, Irina Veze, Inga Jasinkevica, Jolita Badariene, Lina Venceviciene, Rimvydas Slapikas, Gediminas Urbonas, Valdas Dobilas, Danute Strazdiene, Nora Kupstyte-Kristapone, Roma Kavaliauskiene, Enrique Morales Villegas, Fernando Aguilera Almazan, Vicente E. Ruiz Ruiz, Marco A. 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Stanciulescu, Constantin Militaru, Dragos Vinereanu, Cristian G. Podoleanu, Marilena R. Spiridon, Dana Cosma, Ella Pintilei, Carmen Crisan, Laurentia D. Andrei, Oleg Averkov, Elena Radchenko, Yulia Argunova, Svetlana Berns, Alexander Bykov, Mikhail Voevoda, Ivan Gordeev, Dmitry Dronov, Nadezhda Veselovskaya, Dmitry Duplyakov, Marat Ezhov, Konstantin Zrazhevskiy, Mikhail Zykov, Zhanna Kobalava, Natalya Koziolova, Elena Kosmacheva, Viktor Kostenko, Elena Kulibaba, Natalya Lozhkina, Yury Lukyanov, Valeriy Makukhin, Aleksey Meshkov, Viktor Milyagin, Vladimir Nosov, Irina Osipova, Elena Pavlysh, Leonid Pimenov, Vyacheslav Ryabov, Irina Semenova, Olga Smolenskaya, Oleg Solovev, Maxim Sorokin, Mikhail Statsenko, Tatiana Treshkur, Sergey Shalaev, Evgeny Petrik, Yury Shvarts, Valerii Popov, Elena Shutemova, Victor Mordovin, Evgeny Morozov, Ruslan Sardinov, Alexander Sherenkov, Tatiana Sveklina, Daniel Pella, Peter Fulop, Lubomir Antalik, Jozef Semetko, Ivan Majercak, Jan Nociar, Rudolf Smik, Andrej Dzupina, Daniela Vinanska, Michal Banik, Alexander Klabnik, Roman Oriesek, Ivana Soosova, Rudolf Uhliar, Jana Lukacova, Dalibor Sosovec, Jozef Lacka, Dasa Skripova, Lubica Urgeova, Kyung W. Park, Young W. Jang, Tae-Hyun Yang, Byung J. Kim, Chang-Wook Nam, Soon J. Hong, Jong S. Park, Bum K. Hong, Doo S. Sim, Weon Kim, Yun-Seok Choi, Cheol W. Lee, Byeong-Keuk Kim, Myeong-Chan Cho, Joo-Yong Hahn, SungGyun Ahn, So-Yeon Choi, In-Ho Chae, Carmen Suarez Fernandez, Daiana Ibarretxe Gerediaga, Estibaliz Jarauta Simon, Jose Lopez Miranda, Agustin Blanco Echevarria, Francisco J. Tinahones Madueño, Nuria Alonso Pedrol, Carlos Brotons Cuixart, Juan F. Merino Torres, Juan F. Arenillas Lara, Miguel A. Vazquez Ronda, Emilio Ortega Martinez de Victoria, Rafael J. Hidalgo Urbano, Andres Iñiguez Romo, Jose R. Gonzalez Juanatey, Miguel Civera Andres, Violeta Rodriguez Rodriguez, Regina Dalmau Gonzalez-Gallarza, Jesus Peteiro Vazquez, Joao L. Modesto dos Santos, Jose A. Martin Armas, Pablo Gonzalez Bustos, Domingo A. Pascual Figal, Thomas Mooe, Carl-Johan Lindholm, Asa Drakesby, Stefan Soderberg, Jacob Odenstedt, Ake Olsson, Magnus Peterson, Pekka Koskinen, Staffan Salmonsson, Rudolfs Sakne, Par Bjorklund, Tsung-Hsien Lin, Chin-Chou Huang, I-Te Lee, Ji-Hung Wang, Hung-I Yeh, Yi-Chih Wang, Yi-Heng Li, I-Chang Hsieh, Chiung-Jen Wu, Chien-Ning Huang, Vira Tseluyko, Roman Stets, Mykola Stanislavchuk, Leonid Rudenko, Mykola Rishko, Anna Popova, Oleksandr Prokhorov, Oleksandr Parkhomenko, Iuliia Melashchenko, Larysa Mishchenko, Yurii Lymar, Oleksii Korzh, Oleksandr Karpenko, Igor Vakaliuk, Liudmyla Alieksieieva, Olena Mitchenko, Damien McNally, Ryan D Costa, Terry McCormack, Adrian Beltran-Martinez, Derek Connolly, Deepa Narayanan, Dirk Felmeden, Stephen Bain, Mary Lynch, Neil Paul, Richard Burkimsher, John Webster, Patrick Donnelly, Ponnusamy Saravanan, Louise Shaw, Basil Issa, Rashed Hossain, Ronak Rajani, Alex Bickerton, Abdul Negahban, Patrick Moore, Susan Fairhead, Amardeep Heer, Sam Davies, Peter Wilson, Alan Jackson, Shanmugapriya Ganeshkumar, Gordon Irvine, Anton Poterajlo, Beata Krawczyk, Paul Walukiewicz, Joshua Asubiaro, Motunrayo Adesanya, Iulia Dinu, Devaki Nair, Shamaila Aslam, Michael Lillestol, Samir Abdelshaheed, Nicolas Shammas, Tehreen Khan, Edward Portnay, Narendra Singh, Steven Brodie, Faisal Wahid, Vladimir Santos, Thomas Knickelbine, Michael Shapiro, Madaiah Revana, Vance Wilson, Vikas Desai, Steven Hearne, Kenneth Hershon, Norman Lepor, Paul Ziajka, Ronald Fritz, Pratik Mondal, Alan Wiseman, John Nayda, Colby Grossman, Steven Lupovitch, Leslie Forgosh, Stephen Grubb, Sandeep Khurana, Sumana Gangi, Philip Nicol, William Smith, Minesh Patel, Fernando Boccalandro, Kenneth Hilty, Scott Gabler, Carlos Sotolongo, Brian Bergmark, Rebecca Jordan, J Russell Strader, Sean Donahoe, Sumant Lamba, Catherine P. Benziger, Ahmed Arif, Wael Eid, Samer Nakhle, Faiq Akhter, Jakkidi Reddy, William Pomeroy, Ayotunde Dokun, Robert Cohen, Drew Purdy, Jonathan Purnell, Rakesh Prashad, Dominick Angiolillo, Michael Hafran, Kevin DeAndrade, Karen Aspry, Archna Bajaj, Randall Miller, Lance Sloan, Chrisette Dharma, Terence Connelly, Walter Haught, Louis Kantaros, Hugh Durrence, Ira Lieber, Matthew Budoff, Mahfouz El Shahawy, Chad Travers, Ranganatha Potu, Mark Tannenbaum, Ira Dauber, Sharath Subramanian, Venkatesh Nadar, Mourhaf Traboulssi, Jeremy Cox, Dean Kereiakes, Luther Carter, Amit Shah, Dominic Onyema, Naim Farhat, Robert Schnitzler, Daniel Humiston, Mariana Garcia-Touza, Aryan Aiyer, Michael Koren, Dinesh Arab, Matthew Voss, Sanjay Vora, Jose Perez, Ronald Mayfield, Ronald Karlsberg, Cara East, Bruce Iteld, Jonathan Fialkow, Andrew Teklinski, Marc Bernstein, Vinay Malhotra, Libby Lake, Bryan Austin, George Platt, Matthew Cavender, Nicole Pant, James Hansen, Robert McNeill, Anil Chhabra, Naseem Jaffrani, David Jones, Ayim Akyea-Djamson, Mauricio Concha, Andreas Wali, Eugenia Gianos, Cyrus Desouza, Linda Bassett Shaftoe, Alfred Tan, Josiah Zubairu, William Eaves, Eric Auerbach, Lisa Connery, Michael Jardula, David Kandath, Sam Lerman, Edward Teufel, Sabrina Benjamin, Sandeep Bajaj, Justin Arambasick, Andrew Feldman, Axel Sigurdsson, Ingibjorg Gudmundsdottir, Jose Nicolau, Subodh Verma, Lawrence Leiter, Ma Changsheng, Jindrich Spinar, Margus Viigimaa, Ioanna Gouni-Berthold, Jan H. Cornel, Jorge Ferreira, Hyo-soo Kim, Jose Lopez-Sendon, Min-Ji Charng, Lale Tokgozoglu, Naveed Sattar, Ron Blankstein, Jeffery Saver, Marc Bonaca, Rafael Diaz, Matthew Roe, Robert P. Giugliano, Erin A. Bohula, Marc S. Sabatine. Evolocumab to Reduce First Major Cardiovascular Events in Patients Without Known Significant Atherosclerosis and With Diabetes. JAMA, 2026; DOI: 10.1001/jama.2026.3277
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