SynthesisBMC cardiovascular disorders2026
Evolocumab in patients with atherosclerotic cardiovascular disease: a systematic review and meta-analysis of efficacy and safety.
Synthesis in BMC cardiovascular disorders, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundEvolocumab, a proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitor, potently reduces low-density lipoprotein cholesterol. However, its effects on hard clinical endpoints and safety in patients with atherosclerotic cardiovascular disease (ASCVD) require updated synthesis, particularly incorporating data from recent long-term extension studies and diverse subpopulations.
objectiveTo systematically evaluate the efficacy and safety of evolocumab in patients with ASCVD.
methodsPubMed, Embase, Cochrane Library, OVID, China National Knowledge Infrastructure (WANFANG MED ONLINE and CNKI), and ClinicalTrials.gov were systematically searched from January 2014 to March 2026. Randomized controlled trials (RCTs) comparing evolocumab with placebo in patients with ASCVD were included. The primary endpoint was major adverse cardiovascular events (MACE). A random-effects model was used for meta-analysis, with subgroup analyses, meta-regression, sensitivity analyses, and publication bias assessment.
resultsEight RCTs comprising 40,658 patients were included. Regarding lipid parameters, evolocumab significantly reduced levels of low-density lipoprotein cholesterol (LDL-C; standardized mean difference [SMD]: -2.546, 95% confidence interval [CI]: -3.024 to -2.067, P < 0.001), total cholesterol (TC; SMD: -1.543, 95% CI: -1.947 to -1.139, P < 0.001), apolipoprotein B (Apo B; SMD: -1.598, 95% CI: -2.169 to -1.027, P < 0.001), and lipoprotein(a) (Lp(a); SMD: -0.713, 95% CI: -0.938 to -0.489, P < 0.001) compared with placebo, but showed no significant effect on high-density lipoprotein cholesterol (HDL-C; SMD: 0.233, 95% CI: -0.058 to 0.524, P = 0.117) or triglycerides (TG; SMD: -0.315, 95% CI: -0.765 to 0.136, P = 0.171). For clinical endpoints, evolocumab significantly reduced the odds of MACE compared with placebo (OR: 0.416, 95% CI: 0.248-0.698, P < 0.001; I
conclusionsIn the context of optimized background therapy, evolocumab significantly reduces the odds of MACE, myocardial infarction, and stroke, and improves multiple atherogenic lipid parameters in patients with ASCVD. Notably, significant reductions in both cardiovascular and all-cause mortality were also observed in this updated analysis. Its overall safety profile is favorable.
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