Would you consider PCSK9 inhibitors for patients with elevated coronary calcium score or coronary calcification for primary prevention in lieu of statins/ezetimibe and/or bempedoic acid?   

The VESALIUS-CV trial did include subjects with calcium scores >100. Hence, there is now RCT data demonstrating reductions in major adverse cardiovascular events for individuals with elevated CAC and elevated LDLc. There is, however, no head-to-head data between PCSK9-i/ statins/ ezetimibe/ bempe...

Absolutely! The VASELIUS trial confirms that lower is better even in people without a prior event. I wouldn’t use a PCSK9i in lieu of a statin, though. I would add it to the statin if someone’s LDL-C is still elevated. If someone has a high CAC score, I target an LDL-C and apoB <55 mg...