Top Tweets for #REPATHA

🚨 Repatha just proved it can save your life before you ever have a heart attack. For years, PCSK9 inhibitors were reserved for patients who already survived an event. VESALIUS-CV (evolocumab) just buried that thinking. But the data says otherwise. And no, this is not just a modest signal in a small study. 💓 Here is what the science actually says. VESALIUS-CV (evolocumab) enrolled 12,257 patients with atherosclerosis or high-risk diabetes. None of them had a prior heart attack or stroke. That is primary prevention. The trial ran for a median of 4.6 years and landed in the New England Journal of Medicine in November 2025. ✅ VESALIUS-CV (evolocumab): cardiovascular death, heart attack, or ischemic stroke reduced 25% That is not a rounding error. That is a 25% reduction in the hardest outcomes in cardiology, in patients who had not yet had their first event. 🔬 Why this matters mechanistically: Evolocumab blocks PCSK9, the protein that degrades LDL receptors in the liver. Fewer receptors means more LDL circulating in the blood. More LDL means more plaque. More plaque means more events. Evolocumab breaks that chain before the first catastrophic rupture. 🫀 The old thinking was that you had to earn aggressive lipid therapy by surviving a heart attack first. VESALIUS-CV ends that logic. Atherosclerosis does not wait for your first event to cause damage. The plaque is building now. The inflammation is happening now. Waiting for a heart attack to act aggressively is waiting for the house to burn down before calling the fire department. 🩺 I am a cardiologist. I have patients with subclinical atherosclerosis, elevated ApoB, and high-risk diabetes who never qualified under the old secondary prevention framework. VESALIUS-CV changes the conversation I have with every single one of them starting today. ⚠️ Who should be paying attention right now: 🔸 Patients with confirmed atherosclerosis on imaging but no prior heart attack or stroke 🔸 Patients with high-risk diabetes and additional cardiovascular risk factors 🔸 Patients already on maximally tolerated statins who still carry significant residual LDL risk 🔸 Clinicians still waiting for a second event before escalating lipid therapy ❌ The old framework said primary prevention patients were not sick enough for this class of drug. ❌ 12,257 patients and 4.6 years of follow-up say that framework was wrong. That is the real story. The question is no longer whether PCSK9 inhibitors work. The question is whether we are deploying them early enough. ❤️ Bottom line: Evolocumab is not just a post-event drug anymore. VESALIUS-CV proved it cuts death, heart attack, and stroke by 25% in patients who have never had either. 12,257 patients over 4.6 years. Published in the New England Journal of Medicine. This is tier-one evidence. If you have atherosclerosis or high-risk diabetes and your LDL is not optimized, ask your doctor whether evolocumab belongs in your plan now. Not after a heart attack. Now. Are you waiting for an event that this drug could have prevented? #Cardiology #HeartDisease #HeartHealth #CardiovascularHealth #PCSK9 #Evolocumab #Repatha #LDLCholesterol #PreventiveCardiology #MetabolicHealth