{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T18:39:40Z","timestamp":1791225580997,"version":"4.1.0"},"reference-count":26,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"25","funder":[{"name":"Amgen","award":["n\/a"],"award-info":[{"award-number":["n\/a"]}]}],"content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circulation"],"published-print":{"date-parts":[[2026,6,23]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND:<\/jats:title>\n                    <jats:p>Lp(a) (lipoprotein[a]) is a risk factor for coronary heart disease. Whether baseline Lp(a) identifies higher-risk patients who derive more benefit from evolocumab is not established in a population without previous myocardial infarction (MI) or stroke.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS:<\/jats:title>\n                    <jats:p>From June 2019 to November 2021, the VESALIUS-CV trial (Effect of Evolocumab in Patients at High Cardiovascular Risk Without Prior Myocardial Infarctions or Stroke) enrolled patients with qualifying atherosclerosis or high-risk diabetes without previous MI or stroke and randomized them to evolocumab or placebo (median follow-up 4.6 years). In a prespecified analysis, Lp(a) was assessed at baseline in 7557 patients. Cox models were used to assess the adjusted risk of cardiovascular events by baseline Lp(a) in the placebo arm, and the efficacy of evolocumab by baseline Lp(a). The primary outcome of interest was the composite of major coronary events (coronary heart disease death, MI, or urgent coronary revascularization).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS:<\/jats:title>\n                    <jats:p>\n                      Median age was 66 [interquartile range, 60\u201371] years, and 42.8% were women; median Lp(a) was 28 [interquartile range, 9\u2013132] nmol\/L. Higher baseline Lp(a) was associated with an increased risk of major coronary events (adjusted hazard ratio [HR\n                      <jats:sub>adjusted<\/jats:sub>\n                      ] per 100 nmol\/L increase in Lp(a), 1.15 [95% CI, 1.05\u20131.26];\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.004), particularly for MI (HR\n                      <jats:sub>adjusted<\/jats:sub>\n                      , 1.23 [95% CI, 1.10\u20131.38];\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt;0.001). There was no association between Lp(a) and ischemic stroke (HR\n                      <jats:sub>adjusted<\/jats:sub>\n                      , 1.00 [95% CI, 0.84\u20131.19];\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.99). After 48 weeks, evolocumab reduced LDL-C (low-density lipoprotein cholesterol) by 66.8 mg\/dL and Lp(a) by 38.0 nmol\/L in patients with baseline Lp(a) &gt;105 nmol\/L versus 61.1 mg\/dL and 6.0 nmol\/L in those with baseline Lp(a) \u2264105 nmol\/L. The relative reductions in the rate of major coronary events were 41% (HR, 0.59 [95% CI, 0.41\u20130.83]) in those with Lp(a) &gt;105 nmol\/L compared with 35% (HR, 0.65 [95% CI, 0.51\u20130.82]) in those below (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      -interaction=0.45 for Lp[a] modeled as continuous variable). The corresponding absolute reductions were 3.7% versus 2.5% (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      -interaction=0.09), corresponding to a number needed to treat of 28 versus 40 to prevent 1 major coronary event at 5 years.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS:<\/jats:title>\n                    <jats:p>In patients with atherosclerosis or high-risk diabetes but without previous MI or stroke, Lp(a) was independently associated with an increased risk of major coronary events but not ischemic stroke. Evolocumab reduced the relative risk of major coronary events to a similar degree irrespective of baseline Lp(a), with a numerically greater absolute risk reduction in patients with elevated Lp(a).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>REGISTRATION:<\/jats:title>\n                    <jats:p>\n                      URL:\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/www.clinicaltrials.gov\">https:\/\/www.clinicaltrials.gov<\/jats:ext-link>\n                      ; Unique identifier: NCT03872401.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/circulationaha.126.080999","type":"journal-article","created":{"date-parts":[[2026,5,25]],"date-time":"2026-05-25T13:39:23Z","timestamp":1779716363000},"page":"1960-1968","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":7,"title":["Lipoprotein(a) Levels, Risk of Cardiovascular Events, and Benefit of Evolocumab: Findings From the VESALIUS-CV Trial"],"prefix":"10.1161","volume":"153","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-3387-7092","authenticated-orcid":true,"given":"Victorien","family":"Monguillon","sequence":"first","affiliation":[{"name":"TIMI (Thrombolysis in Myocardial Infarction Study) Group, Boston, MA (V.M., N.A.M., E.A.B., J.-G.P., J.F.K., S.A.M., R.P.G., M.S.S., M.L.O.)."},{"name":"Heart Vascular Institute (V.M., N.A.M., E.A.B., J.-G.P., J.F.K., S.A.M., R.B., R.P.G., M.S.S., M.L.O.), Brigham and Women\u2019s Hospital, Harvard Medical School, Boston, MA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6164-4617","authenticated-orcid":true,"given":"Nicholas A.","family":"Marston","sequence":"additional","affiliation":[{"name":"TIMI (Thrombolysis in Myocardial Infarction Study) Group, Boston, MA (V.M., N.A.M., E.A.B., J.-G.P., J.F.K., S.A.M., R.P.G., M.S.S., M.L.O.)."},{"name":"Heart Vascular Institute (V.M., N.A.M., E.A.B., J.-G.P., J.F.K., S.A.M., R.B., R.P.G., M.S.S., M.L.O.), Brigham and Women\u2019s Hospital, Harvard Medical School, Boston, MA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5559-8172","authenticated-orcid":true,"given":"Erin A.","family":"Bohula","sequence":"additional","affiliation":[{"name":"TIMI (Thrombolysis in Myocardial Infarction Study) Group, Boston, MA (V.M., N.A.M., E.A.B., J.-G.P., J.F.K., S.A.M., R.P.G., M.S.S., M.L.O.)."},{"name":"Heart Vascular Institute (V.M., N.A.M., E.A.B., J.-G.P., J.F.K., S.A.M., R.B., R.P.G., M.S.S., M.L.O.), Brigham and Women\u2019s Hospital, Harvard Medical School, Boston, MA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4615-1747","authenticated-orcid":true,"given":"Jeong-Gun","family":"Park","sequence":"additional","affiliation":[{"name":"TIMI (Thrombolysis in Myocardial Infarction Study) Group, Boston, MA (V.M., N.A.M., E.A.B., J.-G.P., J.F.K., S.A.M., R.P.G., M.S.S., M.L.O.)."},{"name":"Heart Vascular Institute (V.M., N.A.M., E.A.B., J.-G.P., J.F.K., S.A.M., R.B., R.P.G., M.S.S., M.L.O.), Brigham and Women\u2019s Hospital, Harvard Medical School, Boston, MA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julia F.","family":"Kuder","sequence":"additional","affiliation":[{"name":"TIMI (Thrombolysis in Myocardial Infarction Study) Group, Boston, MA (V.M., N.A.M., E.A.B., J.-G.P., J.F.K., S.A.M., R.P.G., M.S.S., M.L.O.)."},{"name":"Heart Vascular Institute (V.M., N.A.M., E.A.B., J.-G.P., J.F.K., S.A.M., R.B., R.P.G., M.S.S., M.L.O.), Brigham and Women\u2019s Hospital, Harvard Medical School, Boston, MA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8231-3611","authenticated-orcid":true,"given":"Sabina A.","family":"Murphy","sequence":"additional","affiliation":[{"name":"TIMI (Thrombolysis in Myocardial Infarction Study) Group, Boston, MA (V.M., N.A.M., E.A.B., J.-G.P., J.F.K., S.A.M., R.P.G., M.S.S., M.L.O.)."},{"name":"Heart Vascular Institute (V.M., N.A.M., E.A.B., J.-G.P., J.F.K., S.A.M., R.B., R.P.G., M.S.S., M.L.O.), Brigham and Women\u2019s Hospital, Harvard Medical School, Boston, MA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4940-0876","authenticated-orcid":true,"given":"Gaetano M.","family":"De Ferrari","sequence":"additional","affiliation":[{"name":"Cardiology Division, Department of Medical Sciences, University of Turin and Azienda Ospedaliero\u2013Universitaria Citt\u00e0 della Salute e della Scienza, Italy (G.M.D.F.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1040-6229","authenticated-orcid":true,"given":"Lawrence A.","family":"Leiter","sequence":"additional","affiliation":[{"name":"Division of Endocrinology and Metabolism, St. Michael\u2019s Hospital, University of Toronto, Canada (L.A.L.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9680-3689","authenticated-orcid":true,"given":"Jose C.","family":"Nicolau","sequence":"additional","affiliation":[{"name":"Instituto do Coracao (InCor), Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo, Brazil (J.C.N.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christoph","family":"Ebenbichler","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine I, Medical University Innsbruck, Austria (C.E.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4716-5892","authenticated-orcid":true,"given":"Peter","family":"Sinnaeve","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Katholieke Universiteit Leuven Universitaire Ziekenhuizen Leuven, Belgium (P.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Assen","family":"Goudev","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Medical University of Sofia, Bulgaria (A.G.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6395-2098","authenticated-orcid":true,"given":"Andrzej","family":"Budaj","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Center of Postgraduate Medical Education, Grochowski Hospital, Warsaw, Poland (A.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3010-755X","authenticated-orcid":true,"given":"Oleg","family":"Averkov","sequence":"additional","affiliation":[{"name":"Pirogov Russian National Research Medical University and Hadassah Medical Ltd, Moscow (O.A.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lale","family":"Tokg\u00f6zo\u011flu","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Hacettepe University, Ankara, Turkiye (L.T.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8393-6562","authenticated-orcid":true,"given":"Ron","family":"Blankstein","sequence":"additional","affiliation":[{"name":"Heart Vascular Institute (V.M., N.A.M., E.A.B., J.-G.P., J.F.K., S.A.M., R.B., R.P.G., M.S.S., M.L.O.), Brigham and Women\u2019s Hospital, Harvard Medical School, Boston, MA."},{"name":"Department of Radiology (R.B.), Brigham and Women\u2019s Hospital, Harvard Medical School, Boston, MA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9054-8779","authenticated-orcid":true,"given":"Dragos","family":"Vinereanu","sequence":"additional","affiliation":[{"name":"Cardiology and Cardiovascular Surgery Department, University of Medicine and Pharmacy Carol Davila, University and Emergency Hospital, Bucharest, Romania (D.V.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4110-7675","authenticated-orcid":true,"given":"Robert P.","family":"Giugliano","sequence":"additional","affiliation":[{"name":"TIMI (Thrombolysis in Myocardial Infarction Study) Group, Boston, MA (V.M., N.A.M., E.A.B., J.-G.P., J.F.K., S.A.M., R.P.G., M.S.S., M.L.O.)."},{"name":"Heart Vascular Institute (V.M., N.A.M., E.A.B., J.-G.P., J.F.K., S.A.M., R.B., R.P.G., M.S.S., M.L.O.), Brigham and Women\u2019s Hospital, Harvard Medical School, Boston, MA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0691-3359","authenticated-orcid":true,"given":"Marc S.","family":"Sabatine","sequence":"additional","affiliation":[{"name":"TIMI (Thrombolysis in Myocardial Infarction Study) Group, Boston, MA (V.M., N.A.M., E.A.B., J.-G.P., J.F.K., S.A.M., R.P.G., M.S.S., M.L.O.)."},{"name":"Heart Vascular Institute (V.M., N.A.M., E.A.B., J.-G.P., J.F.K., S.A.M., R.B., R.P.G., M.S.S., M.L.O.), Brigham and Women\u2019s Hospital, Harvard Medical School, Boston, MA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8663-0067","authenticated-orcid":true,"given":"Michelle L.","family":"O\u2019Donoghue","sequence":"additional","affiliation":[{"name":"TIMI (Thrombolysis in Myocardial Infarction Study) Group, Boston, MA (V.M., N.A.M., E.A.B., J.-G.P., J.F.K., S.A.M., R.P.G., M.S.S., M.L.O.)."},{"name":"Heart Vascular Institute (V.M., N.A.M., E.A.B., J.-G.P., J.F.K., S.A.M., R.B., R.P.G., M.S.S., M.L.O.), Brigham and Women\u2019s Hospital, Harvard Medical School, Boston, MA."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamacardio.2018.2258"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11883-011-0219-7"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1161\/atvbaha.120.315291"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.124.069556"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehac361"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa043175"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2009.1063"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.168.6.598"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2023.12.031"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa0902604"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2012.04.038"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.118.037184"},{"key":"e_1_3_3_14_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2019.10.057"},{"key":"e_1_3_3_15_2","doi-asserted-by":"publisher","DOI":"10.1097\/FJC.0000000000000963"},{"key":"e_1_3_3_16_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2514428"},{"key":"e_1_3_3_17_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehaf190"},{"key":"e_1_3_3_18_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000001423"},{"key":"e_1_3_3_19_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ahj.2023.12.004"},{"key":"e_1_3_3_20_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacl.2020.06.010"},{"key":"e_1_3_3_21_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacbts.2016.06.006"},{"key":"e_1_3_3_22_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.116.025253"},{"key":"e_1_3_3_23_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamacardio.2019.1041"},{"key":"e_1_3_3_24_2","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.123.031255"},{"key":"e_1_3_3_25_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehaf422"},{"key":"e_1_3_3_26_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehz310"},{"key":"e_1_3_3_27_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.plabm.2021.e00218"}],"container-title":["Circulation"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/CIRCULATIONAHA.126.080999","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T13:35:01Z","timestamp":1782826501000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/CIRCULATIONAHA.126.080999"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,23]]},"references-count":26,"journal-issue":{"issue":"25","published-print":{"date-parts":[[2026,6,23]]}},"alternative-id":["10.1161\/CIRCULATIONAHA.126.080999"],"URL":"https:\/\/doi.org\/10.1161\/circulationaha.126.080999","relation":{},"ISSN":["0009-7322","1524-4539"],"issn-type":[{"value":"0009-7322","type":"print"},{"value":"1524-4539","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,23]]},"assertion":[{"value":"2026-04-15","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-05-15","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-05-25","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}