AHA 2025 – PCSK9 Inhibitors & Enlicitide (Oral PCSK9i)
AHA 2025 – PCSK9 Inhibitors & Enlicitide (Oral PCSK9i)
Source: theheart.org on Medscape — Nov 24, 2025
1. VESALIUS-CV: Evolocumab lowered MACE in high-risk primary-prevention patients, with signals of reduced mortality.
2. LDL principle: Lower LDL-C consistently reduces events across all risk levels — no real primary vs secondary separation.
3. Underuse: PCSK9 inhibitors remain rarely prescribed despite improved access and low cost; injections and clinic time are major barriers.
4. Enlicitide (oral PCSK9i): Phase 3 shows LDL-C reduction equal to monoclonal antibodies with strong adherence and excellent safety.
5. Combination therapy: Target-based LDL-C management is preferred; stepwise escalation often fails for patients far from goal.
6. Add-on options:
• Some very high-risk patients may require triple therapy (statin + ezetimibe + a third agent).
• Quadruple therapy is possible when LDL-C remains high: statin + ezetimibe + PCSK9 inhibitor + bempedoic acid.
7. Outlook: Oral therapy may reduce inertia, expand use, accelerate reaching LDL-C targets, and potentially lower costs.
