Effects of Evolocumab on Low‐Density Lipoprotein Cholesterol, Non–High Density Lipoprotein Cholesterol, Apolipoprotein B, and Lipoprotein(a) by Race and Ethnicity: A Meta‐Analysis of Individual Participant Data From Double‐Blind and Open‐Label Extension Studies

Abstract

Background Prevalence of cardiovascular disease risk factors and rates of atherosclerotic cardiovascular disease outcomes vary across racial/ethnic groups. This analysis examined the effects of evolocumab on LDL‐C (low‐density lipoprotein cholesterol) levels and LDL‐C goals achievement by race/ethnicity. Methods and Results Data from 15 phase 2 and 3 studies of treatment with evolocumab versus placebo or ezetimibe were pooled (n=7669). Results were analyzed by participant clinical characteristics and by self‐identified race/ethnicity. Key outcomes included percent change from baseline in LDL‐C, achievement of LDL‐C <70 mg/dL, and LDL‐C reduction of ≥50% at 12 weeks and at 1 to 5 years. Across 12‐week studies, mean percent change in LDL‐C from baseline in evolocumab‐treated participants was −52% to −59% for White and −46% to −67% for non‐White participants, across clinical characteristics groups. LDL‐C <70 mg/dL was achieved in 43% to 84% and 62% to 94% and LDL‐C reduction of ≥50% in 63% to 78% and 58% to 86%, respectively. In 1‐ to 5‐year studies, mean percent change in LDL‐C was −46% to −52% for White and −49% to −55% for non‐White participants. LDL‐C <70 mg/dL was achieved in 53% to 84% and 66% to 77%, and LDL‐C reduction of ≥50% in 53% to 67% and 58% to 68%, respectively. The treatment effect on mean percent change in LDL‐C differed only in participants with type 2 diabetes mellitus, with a larger reduction in Asian participants. The qualitative interaction P values were nonsignificant, indicating consistent directionality of effect. Conclusions Similar reduction in LDL‐C levels with evolocumab was observed across racial/ethnic groups in 12‐week and 1‐ to 5‐year studies. Among those with diabetes mellitus, Asian participants had greater LDL‐C reduction.