From the Guidelines
Repatha (evolocumab) is not known to cause or worsen atrial fibrillation (AFib), and its use can be continued without concern about worsening heart rhythm conditions in patients with AFib. The FOURIER trial, a large-scale randomized controlled trial, evaluated the efficacy and safety of evolocumab in patients with established cardiovascular disease, and found no significant increase in the risk of atrial fibrillation or other cardiac arrhythmias 1. In fact, the trial demonstrated a significant reduction in major adverse cardiovascular events, including myocardial infarction, stroke, and cardiovascular death, with evolocumab treatment. While patients requiring Repatha often have underlying cardiovascular risk factors that may independently increase AFib risk, the medication itself is not associated with an increased risk of atrial fibrillation. If you experience new or worsening heart rhythm symptoms while on Repatha, it is essential to consult your healthcare provider, but these symptoms are likely related to other factors rather than the medication itself. Regular follow-up with your cardiologist is recommended to monitor both your cholesterol management and AFib condition.
Some key points to consider:
- The FOURIER trial demonstrated a significant reduction in major adverse cardiovascular events with evolocumab treatment, without an increase in atrial fibrillation or other cardiac arrhythmias 1.
- Repatha is a PCSK9 inhibitor that works by helping the liver remove more LDL cholesterol from the blood, primarily used to lower cholesterol levels in patients with high cholesterol, particularly those with familial hypercholesterolemia or established cardiovascular disease.
- Patients with AFib can generally continue using Repatha without concern about worsening their heart rhythm condition, but should be monitored regularly by their cardiologist to manage both their cholesterol and AFib conditions.
- The ACC/AHA/ESC guidelines for the management of patients with atrial fibrillation emphasize the importance of controlling underlying cardiovascular risk factors, which may include the use of medications like Repatha to manage high cholesterol 1.
From the Research
Relationship Between Repatha (Evolocumab) and Atrial Fibrillation (AFib)
- There is no direct evidence in the provided studies that establishes a relationship between Repatha (evolocumab) and atrial fibrillation (AFib) 2, 3, 4, 5, 6.
- The studies primarily focus on the efficacy and safety of evolocumab in reducing low-density lipoprotein cholesterol (LDL-C) levels and its impact on cardiovascular events, such as myocardial infarction, stroke, and coronary revascularization 3, 5.
- None of the studies mention atrial fibrillation as a specific outcome or adverse event associated with evolocumab treatment 2, 3, 4, 5, 6.
- The safety profiles of evolocumab reported in the studies include adverse events such as injection-site reactions, nasopharyngitis, influenza, headache, and upper respiratory tract infection, but do not mention atrial fibrillation 3, 6.