When do you think physicians should seriously consider prescribing PCSK9 inhibitors for the prevention of heart attack and stroke in people with ASCVD or diabetes, based on the results of the VESALIUS-CV trial?

Although I checked 'high lipoprotein (a) as a reason to go with a PCSK9 first, I would almost never do it is practice. Statins first and then add a PCSK9 if LDL is above my goal for the patient. I might use a lower dose of the statin to get 35% lowering and then add the inhibitor if the patient was ...

The VESALIUS-CV trial gives us the evidence we need to use PCSK9 inhibitors in high-risk patients who have not had a prior CV event. I would not say this is primary prevention. These patients had high calcium scores, potentially ischemia on stress, PAD, and high-risk diabetes. These patients benefit...

The VESALIUS-CV trial included individuals with atherosclerosis or diabetes, an LDL-c >90 mg/dl, but without a history of an MI or stroke on maximally tolerated statin therapy/ ezetimibe, and demonstrated a reduction in major adverse cardiovascular events. Overall, the study reaffirmed the value of ...