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Obesity, ASCVD and PCSK9 Inhibition: What FOURIER Really Shows
Pablo Corral/LinkedIn
Dec 11, 2025, 23:28

Obesity, ASCVD and PCSK9 Inhibition: What FOURIER Really Shows

Pablo Corral, Pharmacology Professor at FASTA University, Past President of Argentine Lipid Society, shared on LinkedIn:

”Obesity, ASCVD and PCSK9 Inhibition: What FOURIER Really Shows

Obesity = higher cardiovascular risk. In the placebo arm, every +5 BMI units above 30 kg/m² increased MACE risk by 11%.

Benefit of evolocumab grows as BMI increases.
•BMI <30: 11% RRR, ARR 1.4%
•BMI 30–34.9: 14% RRR, ARR 1.8%
•BMI ≥35: 29% RRR, ARR 5.7%, NNT = 17 at 3 years

LDL-C lowering remains equally powerful across all BMI categories (≈–56% to –61%). Obesity didn’t blunt the lipid response.

Inflammation amplifies risk. Highest MACE rates occurred in patients with both obesity and elevated hsCRP (>3 mg/L) – and this group also derived the largest benefit from evolocumab.

Key insight: Obesity appears to create an “atherogenic + inflammatory” residual-risk phenotype that is highly modifiable with intensive LDL-C lowering.

Clinical message: For ASCVD patients with obesity – particularly those with class 2–3 obesity or high hsCRP – PCSK9 inhibition is not optional; it’s essential.

Open access.”

Title: Obesity-Associated Cardiovascular Risk and Benefit From PCSK9 Inhibition: A Prespecified Analysis From FOURIER

Authors: Yu Mi Kang, Robert P. Giugliano, Anthony C. Keech, J. Antonio G. López, Maria Laura Monsalvo, E. Magnus Ohman, Xinhui Ran, Sabina A. Murphy, Marc S. Sabatine, and Michelle L. O’Donoghue

ASCVD

 

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and Michelle L. O’Donoghue Anthony C. Keech Argentine Lipid Society ASCVD Cardiology cardiovascular risk E. Magnus Ohman European Atherosclerosis Society FASTA University FOURIER Health Heart Health Hematology Hemostasis Hemostasis Today J. Antonio G. López Marc S Sabatine Maria Laura Monsalvo Medicine Obesity Pablo Corral PCSK9 inhibition Robert P. Giugliano Sabina A. Murphy thrombosis Xinhui Ran Yu Mi Kang
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