Erin D. Michos, MD, MHS

Insights from the AHA 2025 Scientific Sessions

The panelists share their perspectives on key updates from the AHA 2025 Scientific Sessions that have implications for ASCVD management. They highlight ongoing efforts to achieve earlier and more aggressive LDL-C lowering, supported by data reinforcing the impact of cumulative LDL exposure on recurrent event risk. The experts discuss new findings from the VESALIUS trial, which evaluated evolocumab in patients without prior myocardial infarction or stroke, showing significant LDL-C reduction and suggesting potential benefit even in earlier stages of ASCVD. They also reference presentations on PCSK9 and siRNA-based therapies, which continue to demonstrate strong efficacy, safety, and adherence in real-world practice. The panel underscores the growing evidence for hospital-based initiation of lipid-lowering therapy to improve continuity of care. Collectively, these updates highlight a paradigm shift toward earlier intervention and sustained LDL-C reduction as essential strategies for preventing recurrent and first cardiovascular events.

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Experts discuss innovative strategies for managing statin-intolerant patients, highlighting new therapies and the importance of individualized care.

Expanding Options for Statin-Intolerant Patients with ASCVD

The panelists focus on management strategies for statin-intolerant patients with ASCVD, emphasizing that while many patients report intolerance, most can still tolerate some level of statin exposure through dose adjustment or rechallenge. For those unable to take statins, the experts highlight the growing range of non-statin options, including ezetimibe, PCSK9 inhibitors, bempedoic acid, and inclisiran. They note that inclisiran’s updated FDA indication now allows its use as monotherapy for patients who cannot tolerate statins, expanding its role in secondary prevention. Bempedoic acid is also cited for its demonstrated LDL-C and event reduction benefits in statin-intolerant populations. The panelists emphasize the importance of tailoring therapy to balance efficacy, tolerability, and patient preference, while ensuring LDL-C goals are still achieved. They conclude that education, reassurance, and thoughtful therapy sequencing can help overcome fear of side effects and support sustained lipid lowering in this high-risk group.

Optimizing the Timing of PCSK9 Therapy After an ASCVD Event

The panelists explore the question of when to initiate PCSK9 therapy following an ASCVD event. They note that evidence from large trials and real-world data supports the early introduction of PCSK9 inhibitors, often before hospital discharge, to maximize LDL-C lowering and reduce the risk of recurrent events. The experts point out that patients remain at the highest risk for a second event in the first year after an acute coronary syndrome, making this window crucial for aggressive lipid management. They also discuss how logistical barriers—such as prior authorizations and coordination between inpatient and outpatient teams—often delay therapy initiation. Early administration, the panelists emphasize, can improve adherence and long-term outcomes, particularly when combined with educational efforts and structured follow-up. Overall, the experts agree that integrating PCSK9 inhibitors into the acute-to-chronic care continuum represents a practical and evidence-based approach to optimizing secondary prevention in high-risk ASCVD patients.

Healthcare professionals discuss strategies for effectively lowering LDL cholesterol in patients post-cardiac events, emphasizing early intervention and tailored therapies.

Identifying Candidates for PCSK9 Therapy After ASCVD Events

The panelists discuss how to identify appropriate candidates for PCSK9 inhibitor therapy following an ASCVD event. They emphasize that treatment decisions should be guided by both LDL-C levels and overall risk profile, with particular attention to patients who remain above guideline-recommended thresholds despite maximally tolerated statin and ezetimibe therapy. The experts highlight that individuals with recurrent cardiovascular events, multivessel disease, or premature ASCVD are at especially high risk and stand to benefit from early PCSK9 inhibitor initiation. The conversation also touches on secondary prevention timing, noting that introducing PCSK9 inhibition soon after an acute event may help achieve rapid and durable LDL-C reduction, potentially lowering near-term event risk. The panelists agree that improved access, clinician education, and integration of lipid management into the hospital-to-outpatient transition are key to expanding appropriate PCSK9 use and reducing the persistent burden of recurrent ASCVD events in high-risk patients.

Healthcare professionals explore effective strategies for LDL cholesterol management, emphasizing patient involvement and innovative therapies for optimal outcomes.

Erin D. Michos, MD, MHS

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