President’s Message

Dear IAS members,

We have come far in cardiovascular prevention, but the job is far from finished. We see numerous and exciting developments on the horizon regarding the management of lipid disorders. The most immediate dividend of our research enterprise will be the public presentation of the results of the Cholesterol Lowering via Bempedoic Acid – an ACLY-inhibiting Regimen (CLEAR) outcomes study of bempedoic acid in patients with statin intolerance. All practitioners know that reluctance to take statins plagues our practices and interferes with our getting patients to their guideline-directed goals for low-density lipoprotein (LDL). In particular, those of us with specialized referral clinics for cardiovascular prevention seem to have a steady stream of patients who cannot or will not tolerate statins. The results of the CLEAR study will be presented at the American College of Cardiology Conference in early March. We know from the press release that the study met its primary endpoint. We eagerly await the formal presentation. The results could offer a boon for our statin-reluctant or statin-intolerance patients.

Of course, we are excited also about other innovations in the treatment of dyslipidemia. Among them, we eagerly await the results of the trials with the RNA therapeutics that target lipoprotein(a), unfinished business in cardiovascular prevention. We already have in hand inclisiran, the siRNA that can be administered only twice a year to inhibit PCSK9 and achieve substantial LDL lowering. A small molecule CETP inhibitor is also under evaluation not for raising HDL, but for LDL lowering. Also related to HDL, a trial of an Apolipoprotein A1 product in recent acute myocardial infarction is underway. On the therapeutic antibody front, we await results from outcome studies with antibodies that neutralize Apolipoprotein C3 and other regulators of lipoprotein lipase. What seemed science fiction merely a few years ago has now become reality. Base editing using CRISPR to inactivate PCSK9 achieves sustained LDL lowering in nonhuman primates, and is currently under clinical investigation in people. This strategy aims for a “one and done” approach to the therapy of high LDL. This list is not comprehensive but illustrative of the ferment in our field.

Despite our excitement about the new and emerging therapies for managing lipid disorders, we must all be concerned about inadequate access and equitable availability of effective treatments for patients around the world. We must couple the scientific and clinical advances with implementation science and work together to improve access of the fruits of our activities to a greater number of individuals who could benefit. The battle is joined, but not yet won. The IAS can play a pivotal role in all of these aspects of the fight against cardiovascular disease and we thank each of the 68 member societies and each of their members for their engagement in these undertakings.