The expert panel discussion focused on the results of the VICTORION-INITIATE trial, which compared an "Inclisiran First" strategy to usual care in patients with atherosclerotic cardiovascular disease (ASCVD). The discussion highlighted several key points regarding the underutilization of effective therapies and the importance of addressing clinical inertia in managing high-risk patients. The panel noted that despite the availability of innovative approaches like inclisiran, there remains a significant undertreatment of individuals at high risk of ASCVD. They emphasized the urgent need for clinical cardiologists to better communicate the severity of ASCVD risk to patients, particularly considering that 80% of the trial population fell into the category of very high risk. Clinical inertia, where patients resist additional medication due to lifestyle choices or misconceptions about treatment necessity, was also discussed. The panel recognized the challenges in convincing patients of the need for additional therapies beyond diet and exercise, especially when patients perceive lifestyle changes as sufficient. Regarding the trial's findings, the panel questioned whether patients presenting acutely with ASCVD responded differently to traditional therapy compared to those approached with the inclisiran-first strategy. While specific breakdowns were pending further data analysis, the consensus was that more aggressive treatment approaches are warranted to improve patient outcomes. The discussion also touched on patient compliance with inclisiran injections. Although some patients experienced injection site reactions leading to dropout, the majority were compliant with the structured treatment regimen. The panel stressed the importance of scheduled follow-ups and a structured approach to improve patient adherence. There was enthusiasm among the panelists for initiating treatments at the onset of the ASCVD to prevent worsening outcomes. Suggestions included integrating additional lipid-lowering medications like ezetimibe and PCSK9 inhibitors into acute care protocols to achieve better LDL control and mitigate future risks. In conclusion, the expert panel underscored the need for more proactive and structured approaches to manage ASCVD, advocating for early intervention strategies and pragmatic studies to determine the most effective treatment pathways.

American College of Cardiology (ACC) Congress 2024, 6th April – 8th April 2024, Atlanta, Georgia, USA