The proprotein convertase subtilisin/kexin type 9 inhibitor alirocumab conveys almost double the cardio-protective benefit in patients with diabetes following acute coronary syndrome than those without diabetes, a large international trial has shown.

The study, funded by Sanofi and Regeneron Pharmaceuticals, also suggests that an aggressive lipid-lowering treatment with an LDL cholesterol concentration target of 0.65-1.30mmol/L does not increase the risk of new-onset diabetes, the researchers say.

In the multicentre ODYSSEY OUTCOMES study, 18,900 patients (aged 50-66) hospitalised with ACS 1-12 months before randomisation, and who had elevated atherogenic lipoprotein levels despite the use of high-intensity statins, were assigned to either alirocumab or placebo.

At baseline, some 5400 participants had diabetes, 8200 had prediabetes and 5200 had normoglycaemia. The median LDL cholesterol across the three categories ranged between 2.20mmol/L and 2.28mmol/L.