2) Our expert faculty @DLBHATTMD @DrM_ODonoghue and Chris Cannon were your 👀and 👂for this subject in Madrid #ESC2025 and have also produced an on-demand #accredited webcast now available for your viewing at https://t.co/40pg0uYYfc.
— cardio-met (@cardiomet_CE) October 21, 2025
4) What has become clear from randomized trials, meta-analyses, epidemiology, and genetics is that lower #LDL_cholesterol is better especially for those at higher #cardiovascular risk. See 🔓 https://t.co/3ls9mTshTd pic.twitter.com/Y89HlzR7d7
— cardio-met (@cardiomet_CE) October 21, 2025
6a) For patients who can't tolerate statins or whose LDL remains high after statin therapy, multiple add-on treatment options include #ezetimibe, #bempedoic acid, & #PCSK9i. It is updates on non-statin management from new data presented at #ESC25 on which we comment here. pic.twitter.com/BNNOu9AZQB
— cardio-met (@cardiomet_CE) October 21, 2025
6c) Oral versions of #PCSK9 inhibitors currently in clinical trials have achieved how much #LDL reduction?
— cardio-met (@cardiomet_CE) October 21, 2025
7b) An important update in these guidelines is this important chart showing levels of risk and the target #LDL_C for each. They have added the category "extreme risk" (e.g., #polyvascular disease & pts with #ASCVD who have had recurrent events despite max tolerated #statins. pic.twitter.com/jH4FXgNbUt
— cardio-met (@cardiomet_CE) October 21, 2025
7d) These recs for more aggressive #LLT than before are helpful & are consistent with latest trials. Specific phenotype descriptions make them very practical. Our experts did, though, express a little hesitancy to embrace an "imaging" definition of #ASCVD, pending further data. pic.twitter.com/uozXBhk7mQ
— cardio-met (@cardiomet_CE) October 21, 2025
8a) Now to individual trials #ESC25: first #VICTORION_Difference, now published at 🔓https://t.co/8mh3gRpKPi. Pts with high #CV risk & LDL > 55 (v hi risk) or > 70 (hi risk) on stable statin dose > 1 mo were rand to #inclisiran + indiv optimized #rosuvatatin vs statin only. pic.twitter.com/YcmErRAECf
— cardio-met (@cardiomet_CE) October 21, 2025
8c) Subgroup analyses across age (inc >75), ♂️& ♀️, hi vs v hi risk, were consistent, with impressive benefit in all from adding #inclisiran.
— cardio-met (@cardiomet_CE) October 21, 2025
Seems like a good strategy for pts who fit guidelines indications for intensive & rapid LLT and who have no cost/access challenges. pic.twitter.com/cLSkjvEkON
9a) Now on to #NEWTON_CABG, now published at https://t.co/qOY44tnvaa. This study looked at a less commonly eval'd #LLT target: graft patency after #CABG. Does potent #LDL lowering with a #PCSK9i positively impact progression of vein graft patency? pic.twitter.com/P5ARKotCD9
— cardio-met (@cardiomet_CE) October 21, 2025
9c) Perhaps longer f/u would have shown more diff. What we can draw from these data is that at least early (< 2y) graft failure doesn't seem to be an outcome that a potent #PCSK9i can impact. Note too that these pts were well-managed in general–baseline LDL, BP management, etc
— cardio-met (@cardiomet_CE) October 21, 2025
11a) Very exciting to see so much new data between #ESC25 and #AHA25 on advances in #LDL_C lowering! In addition to VESALIUS-CV, with CV outcomes and not just lipid-lowering results from an injectable #PCSK9i, we also expect at #AHA25 . . .
— cardio-met (@cardiomet_CE) October 21, 2025
12) Now back to #ESC25: Those new #guidelines also had 2⃣new recs for pts w/ ⬆️#TG: (1) the already well known #icosapent_ethyl (#IPE) and (2) the new #APOC3-targeted strategy #volanesorsen. pic.twitter.com/9QAYkKDac9
— cardio-met (@cardiomet_CE) October 21, 2025
13b) At #ESC2025 we saw new data on total #hospitalizations: #IPE in those pts seen in 13a experienced a significant 9% reduction over time: pic.twitter.com/nzFOFhb8FE
— cardio-met (@cardiomet_CE) October 21, 2025
13d) IPE ➡️signif ⬇️s in that endpoint across ALL quartiles of baseline #ApoB (so even if ApoB low at baseline!), & across quartiles 2 through 4 of baseline #TRL_C. pic.twitter.com/okIOE0j8hw
— cardio-met (@cardiomet_CE) October 21, 2025
14a) So now: newer very potent agents that 🎯#Apolipoprotein C-III #APOC3. Much interest in alternative LLT tx's such as APOC3, #ANGPTL3, #ANGPTL4, & #CETP. These all can ➡️#TG & remnant cholesterol ⬇️. As above, the #ESCardio guidelines specifically rec #volanesorsen
— cardio-met (@cardiomet_CE) October 21, 2025
14c) There were no new data on #volanesorsen at #ESC25. We did, tho, see new data on #Olezarsen, a #GalNac3-conj #ASO that 🎯#APOC3 #mRNA, was shown to ⬇️#TG vs placebo by ~60% at 2 different doses. Remains to be seen if there is corresponding improvement in clinical outcomes.
— cardio-met (@cardiomet_CE) October 21, 2025
15a) Then there's #CETPi, with which we were originally focused on #HDL but are now looking more closely at #LDL effects. The mechanism is unique and is shown here: pic.twitter.com/CZp4xqoMem
— cardio-met (@cardiomet_CE) October 21, 2025
15c) Especially in more stable populations, benefit may accrue only after a lag period. And we need longer-term data to see if ongoing ⬇️in #MACE is proportional to the ⬇️in LDL & if there is additional benefit from ⬇️Lp(a). There is a large outcomes trial in progress. pic.twitter.com/4mMpIRWEy6
— cardio-met (@cardiomet_CE) October 21, 2025
16b)
— cardio-met (@cardiomet_CE) October 21, 2025
3⃣ As per ⬆️#LDL: lower=better, sooner=better, indep of mechanism/specific target.
4⃣ Re ⬆️#TG, new tx's may be coming, but for now #IPE is underused
5⃣ Hopefully wealth of new data will help overcome resistance to more aggressive #LLT from providers, patients, & insurers!
17) Now we invite you to point your 🖱️over to https://t.co/28P92xzLdF claim your 🆓0.5hr CE/#CME credit 🇺🇸🇨🇦🇪🇺🇬🇧! Thanks for joining us & reinforcing important lessons learned from #ESC25.
— cardio-met (@cardiomet_CE) October 21, 2025
Again we encourage you to view the video discussion at https://t.co/KAIpvznU62