Notably, the OSLER study demonstrated very similar results with an alternative PCSK-9 inhibitor, evolocumab. If Alexios wanted to fulfill his role as Keeper, he had quite the job ahead of him. Focused Update of the 2016 ACC Non-Statin Guidelines. Standardization in the Odyssey CMS implements notable features, such as accurate Quarterly Case Status Reports. Multiple studies including the landmark 4S trial have established statins as standard of care in both primary and secondary prevention of cardiovascular events among high-risk patients. N Engl J Med 2018;379:2161-2. MACE rates were higher with increasing Lp(a) levels, mostly driven by a higher risk of MACE and CHD death/nonfatal MI. The wiki knowledgebase for all that is Eden Eternal. Inhibition of PCSK-9 with the use of monoclonal antibodies has been demonstrated to reduce LDL cholesterol levels by 40-70% when added to background statin therapy in small subsets of patients in phase II studies followed over the short term. Incremental cost-effectiveness ratio (ICER) analyses were also performed using patient-level data directly from the trial. Editorial Comment: PCSK9 Inhibition for Therapeutic Decision-Making: Assessing the Value. J Am Coll Cardiol 2020;75:2297-308. In light of the results of ODYSSEY LONG TERM, alirocumab received FDA approval as an adjunct to maximal statin therapy and lifestyle modification in patients with HeFH or patients with clinical atherosclerotic disease who require additional lowering of LDL cholesterol. Alirocumab Reduces Total Nonfatal Cardiovascular and Fatal Events: The ODYSSEY OUTCOMES Trial. Effect of Alirocumab on Lipoprotein(a) and Cardiovascular Risk After Acute Coronary Syndrome. They are often associated with game-related events. 14 ODYSSEY OUTCOMES was a multicenter, randomized, double-blind, placebo-controlled trial … J Am Coll Cardiol 2020;75:145-7. LDL-C reductions of >50% were observed early, and appeared more or less sustained during follow-up. Furthermore, a post-hoc analysis demonstrated a 2% absolute risk reduction in major adverse cardiovascular events with alirocumab therapy. J Am Coll Cardiol 2019;73:387-96. Lloyd-Jones DM et al. Epub 2014 Aug 7. Although statins may work via multiple mechanisms, slowing endogenous cholesterol production through inhibition HMG-CoA reductase with resultant LDL lowering is thought to be the primary means by which statin therapy improves cardiovascular outcomes. Secondary outcomes (for alirocumab vs. placebo): On-treatment analysis, LDL-C reduction in alirocumab vs. placebo at 4 months (37.6 mg/dl vs. 93.3 mg/dl, 62.7% reduction), at 48 months (53.3 vs. 101.4 mg/dl, 54.7% reduction). Bhatt DL, Briggs AH, Reed SD, et al., on behalf of the ODYSSEY OUTCOMES Investigators. Cicones (six men lost from each ship2. Compared with baseline, Lp(a) levels decreased by 0, 5.1, 9.8, and 20.2 mg/dl across the four quartiles of baseline Lp(a) levels. Mario Tennis Aces is a multiplayer sports game for the Nintendo Switch and the eighth installment in the Mario Tennis series. Mack and Cooke are by their lonesome, traveling down the train tracks in an unknown direction. N Engl J Med 2018;379:2097-107. FDA News release. A royal decree from Princess Persephone of Lemuria has gathered the realm's greatest explorers to the floating city of Maginia. Alirocumab Reduces Total Hospitalizations and Increases Days Alive and Out of Hospital in the ODYSSEY OUTCOMES Trial. Chronologically (remember there were 12 boats, and 40 men per boat, so 480 men): The Cicone, a village neighboring another village they raided. Circulation 2020;141:1608-17. ODYSSEY OUTCOMES is an ongoing trial designed specifically to investigate the effects of alirocumab on cardiovascular endpoints over long-term follow up. Age-based analysis: Mean age, 59 years; 26.9% ≥65 years; 5.3% ≥75 years; 0.2% ≥85 years. http://www.wikijournalclub.org/w/index.php?title=ODYSSEY_LONG_TERM&oldid=28104. It is a web-based computer system, allowing configuration to be accomplished centrally, while still supporting both statewide and county-specific rules. Check the page here for more info. The ODYSSEY LONG TERM trial was a phase 3, randomized, double-blind, placebo-controlled, parallel-group, multinational study, which was conducted at 320 sites in 27 countries throughout Africa, Europe, and North and South America. Total hospitalizations: Approximately 40% of patients experienced at least one hospitalization during the study, while approximately 1% of patients died before experiencing a hospitalization. One of the best epic tales in literature is Homer’s Odyssey based on the return of the ruler, Odysseus, to his home subsequent to Trojan War. PCSK-9 is an enzyme whose activity results in internalization and destruction of LDL receptors. Invasive Cardiovascular Angiography and Intervention. Furthermore, a post-hoc analysis demonstrated a 2% absolute risk reduction in major adverse cardiovascular events. Presented by Dr. Philippe Steg at the American College of Cardiology Annual Scientific Session (ACC 2018), Orlando, FL, March 10, 2018. Szarek M, White HD, Schwartz GG, et al. Nearly 90% of these patients were on a high dose of a potent statin (atorvastatin or rosuvastatin). She designed many of the incidental characters. The key to controlling the Staff would lie in simulations created by Aletheia. "Efficacy and safety of alirocumab in reducing lipids and cardiovascular events". "FDA approves Praluent to treat certain patients with high cholesterol." Alirocumab-induced reductions in Lp(a) (median -5.0 [-13.6, 0] mg/dl) and corrected LDL-C (median -51.3 [-67.1, -34.0] mg/dl) independently predicted lower risk of total cardiovascular events. Results of ODYSSEY OUTCOMES and FOURIER trials complement each other 3' education - Mar. Clinical Topics: Acute Coronary Syndromes, Cardiac Surgery, Diabetes and Cardiometabolic Disease, Dyslipidemia, Geriatric Cardiology, Invasive Cardiovascular Angiography and Intervention, Prevention, Pulmonary Hypertension and Venous Thromboembolism, Vascular Medicine, Atherosclerotic Disease (CAD/PAD), Cardiac Surgery and Arrhythmias, Lipid Metabolism, Nonstatins, Novel Agents, Statins, Interventions and ACS, Interventions and Vascular Medicine, Keywords: ACC Annual Scientific Session, ACC19, AHA18, AHA Annual Scientific Sessions, ACC18, Acute Coronary Syndrome, Antibodies, Monoclonal, Angina, Unstable, Apolipoproteins A, Apolipoproteins B, Brain Ischemia, Cholesterol, HDL, Cholesterol, LDL, Coronary Disease, Cost-Benefit Analysis, Diabetes Mellitus, Dyslipidemias, Geriatrics, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Lipids, Myocardial Infarction, Myocardial Revascularization, Peripheral Arterial Disease, Secondary Prevention, Stroke, Treatment Outcome, Venous Thromboembolism. High risk for cardiovascular events, defined by ≥1 of the following: HeFH (confirmed by genotyping or clinical criteria), Coronary heart disease risk equivalent (PAD, ischemic stroke, moderate CKD, DM plus ≥2 CHD risk factors outlined in the supplemental appendix, On high-dose statin therapy or maximum tolerated statin dose for at ≥4 weeks, ACS, stroke, or PVD intervention in prior 3 months, Systemic corticosteroids except for adrenal insufficiency, Demographics: Age 61 years, 60% male, 93% White, Lipid Therapy: Statin 99.9%, high-intensity statin 47%, other lipid-lowering drug 28% (ezetimibe 15%), Lipid Levels (mg/dL): LDL 122, non-HDL 152, apolipoprotein B 101, lipoprotein a 21, fasting triglycerides 135, HDL 50, apolipoprotein A1 147, Patients were randomized in a 2:1 ratio to alirocumab 150mg subq q2weeks or placebo, Baseline cholesterol-lowering therapy was continued without modification, All patients instructed to follow a stable Therapeutic Lifestyle Changes diet, Study was not designed to investigate the effects of alirocumab therapy on cardiovascular outcomes and lacks optimal power and duration of follow up for doing so, Lack of formal neurocognitive assessments prevents better characterization of this possible side effect of alirocumab therapy, Study funded by Sanofi and Regeneron Pharmaceuticals, the makers of Praluent (the brand name of alirocumab), Sponsors designed the trial protocol and were involved in data collection, management, and analysis. For an incremental cost-effectiveness ratio of $50,000/QALY, the corresponding values were $3,293, $6,910, and $1,139 for all patients, LDL ≥100 mg/dl and LDL mg/dl <100, respectively. Yasuo, the Morning Star Captain Blood Type Hobby Awesome Reading stupid romance novels Girlfriend Shoulder lizard status Rumored to exist, probably quite angry by now Adorable Setting The setting of this epic takes place in Ithaca with… Published 2015-07-24. opgeschreven. ODYSSEY OUTCOMES was a randomized, double-blind, placebo-controlled cardiovascular outcomes trial. Profile. The ODYSSEY OUTCOMES trial showed that use of alirocumab, taken every other week, significantly reduces ischemic events, including all-cause mortality and MI, compared with placebo among patients with an ACS event within the preceding 1-12 months. LDL-C lowering with alirocumab independent of age. Of note, the target LDL-C in this trial was 25-50 mg/dl, and the dose was adjusted to keep the LDL-C above 15 mg/dl. In patients at high risk for cardiovascular events by virtue of a confirmed diagnosis of heterozygous familial hypercholesterolemia, established coronary disease, or a coronary disease equivalent followed for 1.5 years, the use of the monoclonal antibody alirocumab in addition to high-intensity statin therapy resulted in an additional 62% reduction in LDL cholesterol with no significant increase in serious adverse events. Results were independent of baseline LDL-C or history of cerebrovascular disease. ODYSSEY LONG TERM demonstrated that in 2341 patients at high risk for cardiovascular events by virtue of a confirmed diagnosis of heterozygous familial hypercholesterolemia (HeFH), established coronary disease, or a coronary disease equivalent followed for 1.5 years, the use of the monoclonal antibody alirocumab in addition to statin therapy (high-intensity in 50%) resulted in an additional 62% reduction in LDL cholesterol with no significant increase in adverse events. The much anticipated ODYSSEY Outcomes: Evaluation of Cardiovascular Outcomes After an Acute Coronary Syndrome During Treatment With Alirocumab trial of alirocumab was presented during the 2018 ACC 67th Scientific Sessions as a Late Breaking Trial (the study has not been published at this time; presentation slides available are here).On the heels of the FOURIER (Further … The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Bittner VA, Szarek M, Aylward PE, et al., on behalf of the ODYSSEY OUTCOMES Committees and Investigators. Jukema JW, Zijlstra LE, Bhatt DL, et al. Het werk is waarschijnlijk rond 800 v.Chr. Eur Heart J 2020;41:2259-61. . 1 Trial Organization and Oversight. Secondly, this trial further reinforces the “lower is better” hypothesis with LDL-C, and will likely once again reopen the debate about treating patients based on lipid levels rather than intensity of statin therapy alone. The Cat Has 9 Lives, Until it Dies. Each 5 mg/dl reduction in Lp(a) predicted a 2.5% relative reduction in cardiovascular events. Schwartz GG, Steg PG, Szarek M, et al., on behalf of the ODYSSEY OUTCOMES Committees and Investigators. Clinicians should preferentially prescribe drugs that have been shown in RCTs to provide CV risk-reduction benefits that outweigh the potential for adverse effects and drug–drug interactions, and consider patient preferences. In contrast, absolute risk reduction for MACE was greater at higher baseline Lp(a) levels exceeding 2% in the upper two quartiles (p for interaction = 0.0011 across Lp(a) quartiles. Trial by Fire is the 66 th Adventures in Odyssey mainstream album.It was released on the AIOC on December 13, 2018, on digital download on January 31, 2019, and on CD on March 5, 2019. All rights reserved. Alirocumab reduced risk of PAD events (HR 0.69, 95% CI 0.54-0.89, p = 0.004), with nonsignificantly fewer VTE events (HR 0.67, 95% CI 0.44-1.01, p = 0.06). Effect of alirocumab, a monoclonal antibody to PCSK9, on long-term cardiovascular outcomes following acute coronary syndromes: rationale and design of the ODYSSEY outcomes trial Am Heart J . De Odyssee (Grieks: Ὀδύσσεια) is een episch dichtwerk van de Griekse dichter Homeros, die daarnaast ook de Ilias schreef. These explorers will plunge into the mysteries of the Lemuria archipelago and its Yggdrasil Tree seeking treasure and glory. Missions are a system that rewards players for completing in specific objectives in-game. Relative risk reduction was similar across Lp(a) quartiles. J Am Coll Cardiol 2019;73:397-9. Safety and efficacy of a monoclonal antibody to proprotein convertase subtilisin/kexin type 9 serine protease, SAR236553/REGN727, in patients with primary hypercholesterolemia receiving ongoing stable atorvastatin therapy, Efficacy and safety of evolocumab in reducing lipids and cardiovascular events. The 2015 Long-term Safety and Tolerability of Alirocumab in High Cardiovascular Risk Patients with Hypercholesterolemia Not Adequately Controlled with Their Lipid Modifying Therapy (ODYSSEY LONG TERM) was the first phase III trial investigating the use of the PCSK-9 inhibitor alirocumab. It has all the great features that a standard Computer needs, including an 8GB LPDDR4 RAM, 64GB eMMC Storage(optional), onboard Wi-Fi/BLE, Dual Gigabit Ethernet Ports, Audio Input and Output, USB Ports, HDMI, SATA Connectors, PCIe, etc. Adverse events were similar for alirocumab vs. placebo for age <65 years vs. ≥65 years. Lipoprotein (a) [Lp(a)] reduction: Higher Lp(a) levels were associated with female gender, non-White race, and lower prevalence of diabetes and smoking. & Sun. ODYSSEY LONG TERM demonstrated that in 2341 patients at high risk for cardiovascular events by virtue of a confirmed diagnosis of heterozygous familial hypercholesterolemia (HeFH), established coronary disease, or a coronary disease equivalent followed for 1.5 years, the use of the monoclonal antibody alirocumab in addition to statin therapy (high-intensity in 50%) resulted in an … Despite differences in patient populations and trial design, both trials resulted in a significant but modest 15% reduction in the primary endpoint. Etrian Odyssey Nexus has been released in the west. Game Basics Beginner's Guide History Story Races Quests Equipment Items World Maps Warp Dungeons Monsters Boss Locations NPC Guilds Features Break Point System Couple's System The Warehouse … Patients with baseline LDL-C ≥100 mg/dl appeared to derive the highest benefit: MACE: 11.5% vs. 14.9%, HR 0.76; CHD death: 2.5% vs. 3.4%, cardiovascular death: 2.9% vs.4.2%, all-cause mortality: 4.1% vs. 5.7%, although the p-value for interaction based on baseline LDL-C levels was not significant. Proportion of MACE events reduced by alirocumab increased from 4% to 11% to 27% for Lp(a) levels at the 25th, 50th, and 75th percentiles, respectively. ODYSSEY Trial is a pragmatic strategy trialevaluating the efficacy and safety of once daily DTG-based ART compared with standard of care in children and adolescents starting first- or second-line ART in resource-limited and well-resourced settings The goal of the trial was to compare the safety and efficacy of alirocumab compared with placebo among patients with recent acute coronary syndrome (ACS) already on intensive or maximum-tolerated statin therapy. Odysseus's trials:1. Differences in mortality noted in this trial were not noted in FOURIER, possibly due to the higher risk patient population enrolled in ODYSSEY OUTCOMES; reductions in LDL-C seemed qualitatively similar. Very late on this, but Etrian Odyssey Nexus was announced for a western release on February 5, 2019. Alexios just had to step inside. Odyssey is also a person-based system, which allows for a directory of people and enti… The Odyssey (/ ˈ ɒ d ə s i /; Greek: Ὀδύσσεια, Odýsseia; Attic Greek: [o.dýs.sej.ja]) is one of two major ancient Greek epic poems attributed to Homer.It is one of the oldest extant works of literature still read by contemporary audiences. 21:00 Genre: Fantasy Language: Korean Country: South Korea Plot Synopsis by AsianWiki Staff © Next, there was a slight attenuation of reduction in LDL-C over long-term follow-up in this trial. 2017 Focused Update of the 2016 ACC Expert Consensus Decision Pathway on the Role of Non-Statin Therapies for LDL-Cholesterol Lowering in the Management of Atherosclerotic Cardiovascular Disease Risk: A Report of the American College of Cardiology Task Force on Expert Consensus Decision Pathways. Patients who were 1 … If patients with clinical CV disease and comorbidities require >25% additional lowering of LDL, a PCSK9 inhibitor may be preferred as the initial non-statin agent. The clinician–patient discussion should consider the extent of available scientific evidence for net CV risk-reduction benefit, cost, administration by subcutaneous injection, every 14-day or monthly dosing schedule, and storage requirements (refrigeration). Listing a study does not mean it has been evaluated by the U.S. Federal Government.  Despite ODYSSEY LONG TERM's encouraging results, it is important to note that the trial was not designed to assess cardiovascular outcomes prospectively, and so these results should be interpreted with caution. 12, 2018 - ACC 2018, Orlando, FL, USA - Steven Nissen, MD - Cleveland, OH, USA ACC 2018 Steven Nissen compares ODYSSEY OUTCOMES with FOURIER and concludes that he results of these 2 studies in 2 different patient populations reinforce our understanding of the benefit of reducing LDL-c … This trend upward in the LDL is thought to be due to the study design of reducing treatment dose in the face of very low LDL levels and not due to a significant presence of neutralizing antibodies. FDA.gov. J Am Coll Cardiol 2020;75:2309-11. Primary composite endpoint for alirocumab vs. placebo for age ≥65 years: 12.9% vs. 16.8% (HR 0.78); age <65 years: 8.8% vs. 9.7% (HR 0.89; p for interaction = 0.19). For patients with LDL-C ≥100 mg/dl, this value was $13,357, and for those with LDL <100 mg/dl, it was $2,083. Lotus-eaters (must by force drag the intoxicated men back to boats)3. Presented by Dr. Deepak Bhatt at the American Heart Association Annual Scientific Sessions (AHA 2018), Chicago, IL, November 10, 2018. 12.000 versregels zijn ingedeeld in 24 boeken, genummerd met Griekse kleine letters α (alpha) t/m ω (omega). The book may be her way of saying, "No, I Did Not Make That Up" by depicting the very real creatures who inspired her. Before fighting Koschei the deathless, you are allowed to use the Peer the Seer to bank your forbidden items. The primary outcome, major adverse cardiac events (MACE), for alirocumab vs. placebo, was 9.5% vs. 11.1%, hazard ratio (HR) 0.85, 95% confidence interval 0.78-0.93, p < 0.001. Trials of the Keeper, quest walkthrough and hints. ODYSSEY LONG TERM (2015): PCSK9 inhibitor alirocumab for HLD PROVE IT-TIMI 22 (2004): Pravastatin vs. atorvastatin after ACS Stopping Statins at … Szarek M, Steg PG, DiCenso D, et al. Odysseus / oʊ ˈ d ɪ s iː ə s / (Greek: Ὀδυσσεύς, Ὀδυσεύς, Ὀdysseús), also known by the Latin variant Ulysses (US: / juː ˈ l ɪ s iː z /, UK: / ˈ juː l ɪ s iː z /; Latin: Ulyssēs, Ulixēs), is a legendary Greek king of Ithaca and the hero of Homer's epic poem the Odyssey.Odysseus also plays a key role in Homer's Iliad and other works in that same epic cycle. Robinson JG, et al. ODYSSEY, he said, may represent the end of the campaign to consistently drive LDL levels ever lower. Effect of Alirocumab on Stroke in ODYSSEY OUTCOMES. The study was funded by Sanofi and Regeneron Pharmaceuticals. Circulation 2019;140:2054-62. Congenital Heart Disease and Pediatric Cardiology, Invasive Cardiovascular Angiography and Intervention, Pulmonary Hypertension and Venous Thromboembolism, CardioSource Plus for Institutions and Practices, Nuclear Cardiology and Cardiac CT Meeting on Demand, Annual Scientific Session and Related Events, ACC Quality Improvement for Institutions Program, National Cardiovascular Data Registry (NCDR). Editorial Comment: Mora S. Lp(a)’s Odyssey: Should We Measure Lp(a) Post-ACS and What Should We Do With the Results? ODYSSEY will likely be seen as both consistent with FOURIER, the earlier cardiovascular outcomes trial (CVOT) with Amgen’s evolocumab, and an incremental advance on that trial. The ODYSSEY OUTCOMES trial showed that use of alirocumab, taken every other week, significantly reduces ischemic events, including all-cause mortality and MI, compared with placebo among patients with an ACS event within the preceding 1-12 months. The therapeutic age paradox coming to an end. Due to higher event rates in older patients, absolute benefit was higher with increasing age. PCSK9 — A Journey to Cardiovascular Outcomes. Lipoprotein(a) lowering by alirocumab reduces the total burden of cardiovascular events independent of low-density lipoprotein cholesterol lowering: ODYSSEY OUTCOMES trial. Thus, reduction of PCSK-9 activity may lead to increased LDL receptor expression and subsequent reduction in circulating LDL levels. Among patients at high risk for cardiovascular events, does the addition of the PCSK-9 inhibitor alirocumab to high-intensity statin therapy reduce LDL cholesterol levels versus placebo? Details of the trial design have been reported previously. Sinnaeve PR, Schwartz GG, Wojdyla DM, et al., on behalf of the ODYSSEY OUTCOMES Investigators. The recent IMPROVE-IT trial demonstrated that additional LDL reduction with ezetimibe added to statin therapy results in incremental improvement in cardiovascular outcomes, suggesting that further reduction of LDL cholesterol levels may optimize cardiovascular risk. This was particularly meaningful for patients with high baseline Lp(a) levels. Accessed 2015-09-30. Effect of alirocumab on cardiovascular outcomes after acute coronary syndromes according to age: an ODYSSEY OUTCOMES trial analysis. However, their role in larger populations of patients at high risk for cardiovascular events has not been established. Etrian Odyssey X has been announced for Japan, releasing on … The ODYSSEY - X86J4105, is based on Intel Celeron J4105, a Quad-Core 1.5GHz CPU that bursts up to 2.5GHz. Drama: A Korean Odyssey Revised romanization: Hwayuki Hangul: 화유기 Director: Park Hong-Kyun, Kim Jung-Hyun, Kim Byung-Soo Writer: Hong Jung-Eun, Hong Mi-Ran Network: tvN Episodes: 20 Release Date: December 23, 2017 - March 4, 2018 Runtime: Sat. A few points to consider: This trial differs from the other PCSK9 inhibitor outcomes trial (FOURIER – evolocumab) in the patient population enrolled – post-ACS vs. stable established atherosclerotic disease. Considerations that may favor the initial choice of ezetimibe include: patients who require <25% additional lowering of LDL, patients with recent ACS <3 months, cost considerations with recent availability of generic ezetimibe and future cost savings, ease of use as oral agent with low pill burden, patient preferences, heart failure, hypertension, age >75 years, diabetes, stroke, CABG, PVD, eGFR <60, and smoking. This page was last modified on 14 December 2017, at 19:48. Drug was titrated between 75 and 150 mg to keep the low-density lipoprotein cholesterol (LDL-C) between 25 and 50 mg/dl, but above 15 mg/dl. ODYSSEY Outcomes: Evaluation of Cardiovascular Outcomes After an Acute Coronary Syndrome During Treatment With Alirocumab. Peripheral artery disease (PAD) and venous thromboembolic (VTE) events: In the placebo group, risk of incident PAD events (critical limb ischemia, limb revascularization, or ischemic amputation) was related to baseline quartile of lipoprotein(a) (ptrend = 0.0021), but not to baseline quartile of LDL-Ccorrected (ptrend = 0.06). The results of this landmark trial indicate that the use of alirocumab, taken every other week, significantly reduces ischemic events, including all-cause mortality and MI, among patients with an ACS event within the preceding 1-12 months. The Odyssey Case Management System is a fully integrated case and financial management system designed specifically for statewide deployment. 2014 Nov;168(5):682-9. doi: 10.1016/j.ahj.2014.07.028. Eur Heart J 2020;41:2248-58. Alirocumab and Cardiovascular Outcomes After Acute Coronary Syndrome. Pulmonary Hypertension and Venous Thromboembolism, Further Cardiovascular Outcomes Research With PCSK9 Inhibition in Subjects With Elevated Risk, Congenital Heart Disease and Pediatric Cardiology, Invasive Cardiovascular Angiography and Intervention, Pulmonary Hypertension and Venous Thromboembolism, Acute myocardial infarction (MI) or unstable angina, High-intensity statin therapy (or documented intolerance to statins), Maximum tolerated dose of one of these agents for ≥2 weeks, New York Heart Association class III or IV heart failure; left ventricular ejection fraction <25% if measured, Fasting triglycerides >400 mg/dl (4.52 mmol/L), Use of fibrates other than fenofibrate or fenofibric acid, Recurrent ACS within 2 weeks prior to randomization visit, Coronary revascularization performed within 2 weeks prior to randomization visit, or planned after randomization, Liver transaminases >3 x upper limit of normal (ULN); hepatitis B or C infection, Estimated glomerular filtration rate <30 ml/min/1.73 m, Time from ACS to randomization: 2.6 months (median), ACS type: non-ST-segment elevation MI (NSTEMI): 49%, STEMI: 35%, Baseline LDL-C: 87 mg/dl, HDL-C: 43 mg/dl, triglycerides: 129 mg/dl, High-dose atorvastatin/rosuvastatin: 89%; ezetimibe: 3%, Coronary heart disease (CHD) death: 2.2% vs. 2.3%, p = 0.38, Death/MI/ischemic stroke: 10.3% vs. 11.9%, p = 0.0003, All-cause mortality: 3.5% vs. 4.1%, p = 0.026, Ischemia-driven coronary revascularization: 7.7% vs. 8.8%, p = 0.009, Neutralizing antidrug antibodies: 42 vs. 6, LDL-C at 48 months: 66 mg/dl vs. 103 mg/dl. Effect on stroke: Alirocumab reduced the risk of any stroke (HR, 0.72; 95% CI, 0.57-0.91) and ischemic stroke (HR, 0.73; 95% CI, 0.57-0.93) without increasing hemorrhagic stroke (HR, 0.83; 95% CI, 0.42-1.65). Note: If you start the quest, you will not be able to use Peer the Seer to bank your items, unless the player completes the easy Fremennik Achievement Diary(requires completion of this quest), which re-enables his deposit boxfunctionality. This is one of the first trials to show a therapeutic benefit with reduction in Lp(a) that is independent of LDL-C.