Heart disease is still the leading cause of death around the world. Many people only begin treatment after they already have serious problems such as blocked arteries or a previous heart attack.
However, new research suggests that starting stronger treatment earlier may help prevent these problems before they happen.
A new study from Mass General Brigham, published in JAMA and presented at the American College of Cardiology’s Annual Scientific Session, has found that a drug called evolocumab can significantly reduce the risk of a first major heart event in people with diabetes who are at high risk but do not yet have clear signs of artery disease.
The heart relies on clean and open blood vessels to deliver oxygen throughout the body. Over time, a substance called plaque can build up inside artery walls. This process is known as atherosclerosis. When plaque becomes severe, it can block blood flow and lead to heart attacks or strokes.
One of the main drivers of this process is low-density lipoprotein cholesterol, often called LDL or “bad cholesterol.” High levels of LDL can lead to plaque build-up. For many years, doctors have focused on lowering LDL using drugs called statins. These drugs are effective, but they may not always reduce cholesterol enough, especially in people at high risk.
Evolocumab is a newer type of drug known as a PCSK9 inhibitor. It works in a different way from statins and can lower LDL cholesterol by about 60 percent. Until now, this type of treatment has mainly been used for people who already have heart disease.
The new study looked at whether using evolocumab earlier could help prevent heart problems in people who are at high risk but have not yet developed serious artery damage. The researchers focused on people with diabetes, as they are more likely to develop heart disease over time.
The study included 3,655 participants with high-risk diabetes. This group included people who had diabetes for many years, required insulin, or had damage to small blood vessels. Importantly, these individuals did not yet have clear signs of atherosclerosis.
Participants were randomly assigned to receive either evolocumab injections every two weeks or a placebo. All participants continued their usual treatments, such as statins or other cholesterol-lowering medications.
After about one year, the results showed that people taking evolocumab had much lower cholesterol levels. Their LDL levels dropped by about 51 percent compared to those who did not receive the drug.
More importantly, over nearly five years of follow-up, those taking evolocumab had a 31 percent lower risk of experiencing their first major heart-related event. These events included heart attack, stroke, or death related to heart disease.
This finding is important because it suggests that treating high-risk patients earlier could prevent serious outcomes before they occur. Instead of waiting for disease to develop, doctors may be able to act sooner and reduce risk more effectively.
The study also found that the drug was generally safe. Serious side effects were similar in both the treatment and placebo groups, suggesting that evolocumab is well tolerated.
When reviewing this research, it is clear that the study is strong. It used a randomized design, which is considered one of the best ways to test medical treatments. The long follow-up period also adds confidence to the results. However, the study focused specifically on people with high-risk diabetes, so it is not yet clear whether the same benefits apply to other groups.
Overall, the findings suggest a shift in how doctors may approach heart disease prevention. Treating high-risk individuals earlier and more aggressively could help reduce the number of heart attacks and strokes in the future. Further research will help determine how widely this approach can be used.
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Source: Mass General Brigham.
