The objective of this study is to evaluate ischemic event rates among individuals with established atherosclerotic cardiovascular disease without prior acute ischemic events, comparing those treated with alirocumab versus those receiving no proprotein convertase subtilisin/kexin type 9 inhibitor (PCSK9i) therapy. The study will leverage observational data reflective of routine clinical practice and will apply contemporary approaches in target trial emulation and causal inference to estimate treatment effects.

The study aims to estimate the reduction in major cardiovascular events (MACE) with intensive lipid lowering therapy (LLT) via Alirocumab in a population with ASCVD but without a history of ischemic events. The current study will closely mirror the adopted methodological approach for the prior investigation of the impact of PCSK9i mAb class on MACE in this population.

Inclusion Criteria:

• Adult participants (aged ≥18 years at index) with ASCVD without evidence of prior ischemic events (myocardial infarction, unstable angina, or ischemic stroke) will be included.
• Participants initiating Alirocumab will be initially selected, with index (time zero) set as initiation of therapy. This index will be a point where the participants meet all the inclusion criteria in a hypothetical trial enrolling this population who would qualify for therapy.

Exclusion Criteria:

• Participants with evidence of ischemic events either concurrent with or prior to the earliest record of ASCVD will be excluded.

The above information is not intended to contain all considerations relevant to a potential participation in a clinical trial.

Participants who initiated treatment with Alirocumab from January 01, 2016 till December 31, 2022.

Qualified researchers may request access to patient level data and related study documents including the clinical study report, study protocol with any amendments, blank case report form, statistical analysis plan, and dataset specifications. Patient level data will be anonymized and study documents will be redacted to protect the privacy of trial participants. Further details on Sanofi's data sharing criteria, eligible studies, and process for requesting access can be found at: https://vivli.org