Alirocumab after Acute Coronary Syndrome

To the Editor: In the ODYSSEY OUTCOMES trial, Schwartz et al. (Nov. 29 issue)(1) report that the proprotein convertase subtilisin-kexin type 9 (PCSK9) inhibitor alirocumab could reduce the risk of recurrent ischemic cardiovascular events in patients who have had an acute coronary syndrome and are receiving intensive statin therapy. However, because less than 3% of these patients were receiving ezetimibe in addition to statin therapy, the trial might not support the use of alirocumab in similar patients in clinical practice. According to the latest guideline on the management of cholesterol,(2) ezetimibe should be added to statin therapy (given at the . . .