New research from the VESALIUS-CV trial shows that evolocumab (Repatha) significantly reduces cardiovascular (CV) risk in people with diabetes – even in those without known atherosclerotic cardiovascular disease.
In this subgroup:
- Risk of major CV events (heart attack, stroke, or coronary death) was reduced by 31%
- Overall mortality was reduced by 24%
- Benefits were seen over a 5-year period compared to a placebo
Why this matters
Traditionally, patients with diabetes but no known heart disease are treated with statins (medications that lower LDL cholesterol) alone. More intensive therapies, like PCSK9 inhibitors (which raise HDL cholesterol), are usually reserved for patients who have already experienced a cardiovascular event.
However, this study suggests that earlier, more aggressive cholesterol lowering may benefit high-risk patients with diabetes before a first event occurs.
LDL cholesterol findings
Patients taking evolocumab achieved much lower LDL levels:
- ~52 mg/dL with treatment
- ~111 mg/dL with placebo
These levels are closer to targets typically used for very high-risk patients, raising questions about whether current LDL goals for diabetes should be lower.
Important considerations
- Long-term safety data for PCSK9 inhibitors is still evolving
- Cost and insurance coverage remain major barriers
- Benefits may be greatest in higher-risk individuals, not necessarily younger or lower-risk patients
Bottom line:
For patients with diabetes at high cardiovascular risk, adding therapies like evolocumab may significantly reduce first-time heart attacks and strokes, potentially shifting how we approach prevention.
References:
Phend, Crystal. “PCSK9 Drug Prevents First Heart Events in Diabetes Patients without Atherosclerosis.” Medical News, MedpageToday, 29 Mar. 2026.
