Haarhaus M, Ray KK, Nicholls SJ, et al. - Since alkaline phosphatase (ALP) has been proposed as a modifiable cardiovascular risk factor, researchers investigated if cardiovascular risk attenuation by apabetalone (bromodomain and extra-terminal protein inhibitor) is related to the concomitant lowering of serum ALP. They performed this post-hoc analysis including 795 patients with established coronary heart disease and statin treatment. They evaluated how the incidence of major adverse cardiovascular events and serum ALP was influenced by the assigned treatment for up to 24 weeks among these people who took part in phase 2 placebo-controlled trials of apabetalone. They found that residual cardiovascular risk in patients with cardiovascular disease on statin treatment was predicted by serum ALP, independent of high-sensitivity C-reactive protein, established cardiovascular risk factors and chronic kidney disease. An attenuation in serum ALP was noted in correlation with treatment with apabetalone, resulting in a lower risk of cardiovascular events. It remained unknown if the beneficial cardiovascular influences of apabetalone are causally associated with ALP decrease.