Long-Term Cognitive Safety of Achieving Very Low LDL Cholesterol with Evolocumab Concerns persist regarding the cognitive safety of achieving very low levels of low-density lipoprotein (LDL) cholesterol. Although short-term studies are reassuring, the long-term cognitive effect...

In summary, for patients requiring lipid-lowering meds:

i) There is *no* evidence of cognitive impairment over the longer term

ii) The proven cardiovascular benefits of lowering LDL-C must outweigh any speculative risks

Link: evidence.nejm.org/doi/full/10....

3⃣ No meaningful differences between the two originally randomized groups over time.

2⃣ No association between cognitive change and LDL-C in patients who transitioned to evolocumab.

(Even in patients with LDL-C <25 mg/dL.)

1⃣ There was no meaningful cognitive decline up to 7.2 years of follow-up.

Now, for the first time, we followed:

- Hundreds of patients
- For over 7 years
- On evolocumab + statin (median LDL-C ~35 mg/dL)

This is an open-label extension analysis of the EBBINGHAUS study from the FOURIER trial.

These are the 3 takeaways 👇

Many "influencers" say that lipid-lowering therapies cause dementia.

This is despite the fact that brain cells generate their own cholesterol.

And despite reassuring short-term randomized trials.

"Does lowering LDL-C to very low levels result in long-term cognitive impairment?" 🧠🫀

I've heard this question many times.

Now we have long-term data.

A 🧵 on our new NEJM Evidence paper: evidence.nejm.org/doi/full/10....

Thank you #CVCTForum for the opportunity to talk about clinical trials in LATAM.

Exciting time for global cardiovascular trials 🌎