Erin D. Michos, MD, MHS

Emerging Innovations in Post-Event Lipid Management for ASCVD

The panelists conclude by examining emerging innovations in post-event lipid management aimed at improving outcomes for patients with ASCVD. They highlight a shift toward earlier initiation of intensive LDL-C lowering—beginning during hospitalization or soon after discharge—to prevent recurrent events during the period of highest vulnerability. The experts discuss the growing use of siRNA-based therapies such as inclisiran and the development of next-generation PCSK9-targeting agents that combine potency with simplified dosing schedules to improve adherence. They also note increasing interest in combination approaches, including pairing statins with bempedoic acid or PCSK9-directed therapies for sustained LDL-C control. The conversation underscores the importance of integrating lipid management into hospital discharge planning and ensuring seamless transitions to outpatient care. The panelists express optimism that continued innovation—coupled with improved access and education—will help clinicians achieve earlier, more durable LDL-C reduction and ultimately reduce recurrent ASCVD events.

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Experts discuss groundbreaking innovations in cardiovascular disease prevention, highlighting personalized medicine and new therapies for effective treatment.

Sustaining Long-Term Adherence to PCSK9 Therapy in ASCVD

The panelists discuss strategies to improve long-term adherence to PCSK9-targeting therapies among patients with ASCVD. They note that while these agents are highly effective, adherence often declines after the first year due to cost, complex refill processes, and perceived lack of symptoms once LDL-C levels normalize. The experts emphasize that successful long-term use depends on simplifying care pathways, such as incorporating pharmacy-led coordination, automated refill reminders, and structured follow-up visits. They highlight the advantage of siRNA-based therapies like inclisiran, which require administration only twice per year, reducing the burden of self-injection and improving persistence. The panelists also stress the importance of patient education—helping individuals understand that LDL-C reduction is a lifelong goal, not a short-term fix. By combining streamlined delivery models, consistent communication, and shared accountability among the care team, clinicians can sustain adherence and maximize the benefits of PCSK9 therapy in ASCVD management.

Engaging patients in their treatment journey enhances adherence to therapies, ultimately improving health outcomes and managing cholesterol effectively.

Barriers to Using PCSK9-Targeting Therapies

The panelists address the real-world barriers that continue to limit the use of PCSK9-targeting therapies in ASCVD care. Despite strong evidence supporting their efficacy and safety, the experts note that cost, insurance restrictions, and prior authorization delays remain the most significant obstacles to access. Many patients who qualify under current guidelines face long approval processes or denials, leading to treatment gaps and frustration for both patients and clinicians. The panel also highlights the burden on healthcare teams, who spend substantial time navigating paperwork and appeals. Even when access is granted, lack of awareness or familiarity among some clinicians can delay therapy initiation. The experts emphasize that broader education, simplified approval pathways, and improved affordability are essential to expanding use. They conclude that overcoming these administrative and systemic hurdles is critical to ensuring more patients benefit from potent LDL-C–lowering therapies proven to reduce recurrent ASCVD events.

Explore the barriers to PCSK9 inhibitors, their underuse, and how addressing misconceptions can enhance patient outcomes in cholesterol management.

Rethinking Prevention in ASCVD Through Cumulative LDL Exposure

The panelists revisit the concept of cumulative LDL-C exposure as a central driver of atherosclerotic risk, emphasizing that prevention must begin earlier and continue consistently throughout life. The experts explain that ASCVD develops over decades, with long-term exposure to elevated LDL-C creating a continuous burden on the vascular system. They discuss emerging data showing that earlier LDL-C lowering yields greater benefit than later intervention, even when the same LDL targets are eventually reached. This reinforces the principle that both the magnitude and duration of LDL-C reduction determine clinical outcomes. The panelists suggest that prevention frameworks should expand beyond “high-risk” patients to include younger adults with elevated LDL-C or familial predisposition, aiming to limit lifetime cholesterol exposure. They conclude that achieving and maintaining low LDL-C levels over time—rather than short-term correction—represents a paradigm shift in ASCVD prevention strategy and population health management.

Experts discuss evolving strategies in atherosclerosis prevention, emphasizing early intervention and the importance of cholesterol monitoring for better patient outcomes.

Erin D. Michos, MD, MHS

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