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Message: More important points on Fourier... NNT

6. Evolocumab reduced both the primary and secondary composite end points. But the absolute risk reduction was modest, at 1.5%. The authors estimate that 74 patients would need to take evolocumab to prevent a cardiovascular death, MI, or stroke.

7. The benefits of evolocumab came in the prevention of nonfatal events: stroke was lower by 0.4%,, myocardial infarction lower by 1.2%, and coronary revascularization by 1.5%.

8. Evolocumab did not reduce cardiovascular or death from any cause. There was not even a trend for improvement. This is important. See point number 10.

9. The shortness of follow-up of FOURIER deserves mention. On the upside, the Kaplan Meier curves for both the primary and secondary end points looked to be separating over time. This makes sense biologically, as the benefits of exposure to LDL would accrue over time. But so would potential side effects, such as diabetes and neurocognitive effects. The mean age of patients in FOURIER was 63 years; LDL lowering is not a 2-year proposition. The heart and blood vessels are not the only important parts of the body.

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