SCIENTIFIC JOURNAL of the Hungarian Society of Cardiology

The FOURIER-OLE – evidence of the benefits of very low LDL-cholesterol level in long term

█ Review

DOI: 10.26430/CHUNGARICA.2023.53.1.63

Márk László
Békés Megyei Központi Kórház Pándy Kálmán Tagkórház, Kardiológia Osztály, Gyula
Levelezési cím:
Prof. dr. Márk László, Békés Megyei Központi Kórház, Pándy Kálmán Tagkórház, Kardiológia Osztály,
5700 Gyula, Semmelweis u. 1.


The 2019 European lipid guidelines and as a result, the Hungarian consensus conference recommend a lower LDL-cholesterol target values. These could be achieved with statins, ezetimibe and PCSK9 inhibitors. The latter appeared on the therapeutic palette a few years ago, the monoclonal antibodies evolocumab and alirocumab have been shown to have favorable cardiovascular benefits in large scale randomized clinical trials. After completing the FOURIER (Further Cardiovascular Outcomes Research With PCSK9 Inhibition in Subjects With Elevated Risk) trial, with 27,000 patients, lasted 2.2 years, 6634 patients received evolocumab for 5 years during an open-phase study (FOURIER-OLE). The ave­rage LDL-cholesterol was 0.75 mmol/l, the clinical benefit of long-term administration of the drug was confirmed, cardiovascular events, including cardiovascular death, were significantly reduced. The very low LDL-cholesterol level did not raise safety concerns. Nowadays in Hungary the PCSK9 inhibitors are mainly used in patients after a vascular event who did not achieve the target value of LDL-cholesterol by the administration of high-intensity statins and ezetimibe. According to a new European expert viewpoint, the administration of PCSK9-inhibitors with statins and ezetimibe could be part of first-line therapy in extremely high risk patients.


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