Amgen announced results from a large real world comparative study showing that treatment with Repatha (evolocumab) reduced the risk of fatal or nonfatal heart attacks by 20 percent compared with ezetimibe in people with atherosclerotic cardiovascular disease and prior statin use. The findings were published in the American Journal of Preventive Cardiology.
The active comparator, new user cohort study used deidentified data from the Komodo Health Healthcare Map database. It included 544,103 adults, of whom 64,421 initiated evolocumab and 479,682 initiated ezetimibe between January 2017 and December 2024, with follow up through June 2026. The primary outcome was the first fatal or nonfatal myocardial infarction during up to 48 months of follow up. The hazard ratio was 0.80, with a 95 percent confidence interval of 0.70 to 0.91.
Among the 225,048 participants with a baseline LDL cholesterol measurement, the estimated four year cumulative risk of heart attack was 5.88 percent with evolocumab against 7.76 percent with ezetimibe. Among patients without a baseline measurement, the corresponding risks were 5.65 percent and 7.06 percent. Median baseline LDL cholesterol was higher in the evolocumab group, at 114 mg/dL against 99 mg/dL, which reflects that the injectable is typically used in higher risk patients who have not reached goals on other therapy.
The comparison matters because guidelines recognise both ezetimibe, a cheap oral generic, and PCSK9 inhibitors such as Repatha as nonstatin options, but clinicians have lacked direct cardiovascular outcomes evidence comparing them. Amgen’s chief medical officer Paul Burton said patients who received Repatha had a 20 percent lower risk of heart attack or death from a heart attack than those who received ezetimibe.
The limits are the usual ones for this design. The study is observational and noninterventional, built on records of routine care rather than randomisation, so residual differences between the two patient groups cannot be fully excluded even with the target trial framework the authors applied. A prespecified sensitivity analysis that tracked patients regardless of statin therapy changes produced consistent results, Amgen said.