New Data Highlights Urgency of Achieving LDL Goals

In an interview with Pharmaceutical Executive, Leandro Boer, MD, PhD, VP, US general medicines, Amgen, discussed the striking findings of the US arm of the VESALIUS-REAL study, presented at the recent American College of Cardiology (ACC) meeting. The observational study, which analyzed data from over 278,000 high-risk patients between 2016 and 2022, uncovered major deficiencies in lipid management following cardiovascular events such as heart attacks and strokes. The conversation shed light on why these care gaps persist, particularly among patients over 50, and highlighted the urgent need to rethink prevention strategies, streamline treatment guidelines, and increase accountability across care transitions.

Pharmaceutical Executive: How might these findings shape future guidelines or clinical practices for lipid management in primary prevention settings?

Leandro Boer: I think these findings are incredibly useful in reinforcing the urgency around achieving LDL-C goals. The goals exist for a reason, and there are proven ways to reach them. As I mentioned earlier, 88% of patients are not meeting their targets. That means only 12% are achieving optimal LDL levels—and we can and should do better than that. Achieving these goals is critical to reducing the risk of major cardiovascular events like myocardial infarction or stroke.

This data also supports the push toward simplifying clinical decision-making. That’s why Amgen is positioning itself as a leader in this space—by convening thought leaders at forums like the LDL Action Summit, where stakeholders from medical societies, healthcare organizations, and policy groups come together to help streamline the message.

We're also collaborating with groups like the National Lipid Association, who are deeply committed to this mission. Their goal, like ours, is to ensure that patients receive the right treatment, reach their LDL targets, and ultimately avoid preventable events.

It’s also important to highlight the recurrent risk: for example, among patients who experience a myocardial infarction, one in five will suffer another MI within a year. I’m not sure patients fully realize how high that risk is. That’s why we need to keep driving awareness and improving treatment adherence.

Full Interview Summary: The VESALIUS-REAL study revealed alarming gaps in LDL-C testing and treatment among high-risk U.S. patients. Notably, 70% of patients who experienced a myocardial infarction (MI) or stroke did not begin lipid-lowering therapy afterward, and 88% failed to intensify treatment within a year. Even more concerning, 50% of these patients never had a follow-up LDL-C test, and of those tested, 82% did not achieve guideline-recommended goals. Despite the availability of proven therapies like statins, ezetimibe, and PCSK9 inhibitors, usage remains low—with only 9.8% of patients on high-intensity statins—suggesting the United States remains stuck in outdated treatment patterns.

For patients over 50 without a prior cardiovascular event, several factors contribute to under-treatment. These include being in the "pre-Medicare gap" with limited insurance, poor risk perception of cardiovascular disease compared to cancer, over-reliance on lifestyle interventions, limited time with primary care providers (PCPs), and overly complex treatment guidelines. Together, these barriers prevent effective prevention and intervention.

Findings from VESALIUS-REAL may shape future guidelines by emphasizing treatment urgency, simplifying decision-making, and streamlining guidelines—particularly for primary care. Collaborative efforts, such as Amgen’s LDL-C Action Summit and partnerships with the National Lipid Association, aim to raise awareness, improve communication, and promote treatment adherence.

Amgen is pursuing a bold ambition to cut the number of heart attacks and strokes in the US in half by 2030. The company is advancing this goal through initiatives such as free LDL-C testing in collaboration with CVS MinuteClinics, community partnerships with organizations like the Association of Black Cardiologists and the Family Heart Foundation, and the LATTICE Consortium—focused on implementation science to reduce the time from discovery to practice. These collective efforts aim to close existing care gaps and ensure more patients achieve life-saving LDL-C targets.