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
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