Evolocumab Shows No Benefit in Preventing Vein Graft Disease After Coronary Bypass Surgery, Major Trial Finds

A recent large-scale clinical trial has demonstrated that evolocumab, a potent PCSK9 inhibitor used to lower LDL cholesterol levels, does not improve the condition of vein grafts in patients following coronary artery bypass grafting (CABG). The study, presented on September 1, 2025, at ESC Congress 2025 and published in The Lancet, involved over 780 participants and aimed to assess whether aggressive LDL-C reduction could enhance vein graft patency. Despite achieving a significant 48.4% reduction in LDL-C levels at 24 months, evolocumab did not significantly decrease the rate of vein graft disease, defined as graft occlusion of 50% or more, compared to placebo. The disease rate was approximately 22% in the evolocumab group versus 20% in the placebo group. Secondary measures, including complete graft occlusion and the presence of at least one occluded graft, also showed no meaningful differences. The treatment was well-tolerated, with similar adverse events across groups. Professor Subodh Verma, the principal investigator, noted that although evolocumab effectively lowers LDL-C, it does not appear to influence early graft failure mechanisms, which may involve processes like vascular remodeling, thrombosis, or inflammation. This failure suggests that further research into other therapeutic targets is needed to address the persistent problem of vein graft failure, which affects up to 20% of grafts within the first year and nearly half within 10 years post-surgery. The findings underscore the complexity of vein graft disease and highlight that lowering LDL-C alone might not be sufficient to improve long-term graft outcomes. For more details, see the full study in The Lancet: effect of evolocumab on vein grafts.