VIEWPOINT: Which Patient Is a VESALIUS-CV Patient? Rethinking Primary and Secondary Prevention.

The VESALIUS-CV trial appeared too late to inform recent multi-society dyslipidemia guidelines, and its findings have already prompted consideration of whether the boundary between primary and secondary prevention no longer holds when an LDL-C goal is being set. If that concession is granted, the harder question is an operational one that remains unanswered: at the bedside, which patient is a VESALIUS-CV patient? Herein we set the primary-secondary distinction aside altogether and offer a practical worksheet for identifying the subjects who merit more aggressive lipid lowering, and access to PCSK9 inhibitors when necessary to reach new and lower LDL-C goals.