Patients with high-risk diabetes may have substantial cardiovascular risk even without a prior myocardial infarction or stroke. Patients with microvascular disease, insulin use, or diabetes duration of 10 years or more may require additional strategies to reduce their cardiovascular risk. This analysis evaluated whether evolocumab could reduce first cardiovascular events in patients with high-risk diabetes.

Among 6,002 patients with high-risk diabetes, 67% were receiving a high-intensity statin and 24% were receiving a sodium-glucose cotransporter 2 inhibitor or glucagon-like peptide 1 receptor agonist at baseline. At 48 weeks, median low-density lipoprotein cholesterol was 47 mg/dL with evolocumab versus 109 mg/dL with placebo. After a median follow-up of 4.6 years, evolocumab reduced the relative rate of 3-point major adverse cardiovascular events by 29% and 4-point major adverse…