Heart drug study aims to boost tiny vessel blood flow

Copied word for word from the study's registry entry, so the wording is the study team's rather than ours.

Intervention Group: Inclusion Criteria: * Age: ≥ 50 (men) or ≥ 55 (women) * Low-density lipoprotein cholesterol (LDL-C) ≥ 70 mg/dL * Stable coronary artery disease (without plan to undergo revascularization before randomization) defined as one or more of the following: 1. Abnormal nuclear perfusion imaging 1. At least moderate ischemia involving \>10% of the LV myocardium or 2. Global coronary flow reserve (CFR) \<1.8 or 3. Stress myocardial blood flow (MBF) \<1.8 2. Abnormal coronary angiography (invasive coronary angiography or coronary computed tomography) 1. ≥ 50% stenosis in ≥ 2 coronary vessels or 2. Diffuse atherosclerosis in a 3-vessel distribution 3. Elevated coronary calcium score 1. CAC \>100 + \>1 ASCVD risk factor 2. CAC \>300 * If the patient is on a statin they must be on a stable dose for at least 3 months prior to enrollment. Exclusion Criteria: * History of myocardial infarction or stroke * CABG \< 3 months prior to screening * Homozygous familial hypercholesterolemia * History of cardiac transplantation * LV ejection fraction \< 40% or New York Heart Failure Association (NYHA) class III-IV for angina and/or dyspnea. * History of infiltrative or hypertrophic cardiomyopathy * Severe valvular disease * Uncontrolled or recurrent ventricular tachycardia * Fasting triglycerides \> 500 mg/dL * GFR ˂ 30 mL/min/1.73 m² * Current use of a PCSK-9 inhibitor * Currently pregnant or breastfeeding * Contraindication to receive vasodilator agent * Latex allergy Parallel Control Group: Patients will be invited to participate in the parallel control group if they meet study criteria, but 1) have a latex allergy and cannot use the Evolocumab autoinjector 2) LDL-C is just below the enrollment criteria (LDL 60-69), or 3) meet study criteria but prefer to not take an injectable medication at this time.