New Therapies Emerge for High-Risk Patients with Elevated LDL and Triglycerides

Pharmacists are now equipped with a range of new therapies to help high-risk patients reach stricter LDL targets, below 55 mg/dL. According to Jeremy L. Johnson, PharmD, BCACP, CDCES, BC-ADM, professor of pharmacy practice at the Southwestern Oklahoma State University College of Pharmacy, statins remain the gold standard for atherosclerotic cardiovascular disease (ASCVD) risk reduction. However, new agents are emerging as add-ons for patients who cannot reach these targets.

The oral proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitor enlicitide (Lipfendra; Merck & Co.), approved last month in July 2026, is a daily capsule that has shown up to a 65% reduction in LDL. Another oral PCSK9 inhibitor, laroprovstat, is still under investigation but showing similar large LDL reductions.

Injectable options include lerodalcibep (Lerochol; LIB Therapeutics) and inclisiran (Leqvio; Novartis), which are given once monthly and every 6 months respectively. Johnson emphasized the importance of counseling patients on injection technique, storage, and monitoring for these newer therapies.

The American College of Cardiology (ACC)/American Heart Association (AHA) lipid guidelines now recommend universal screening for lipoprotein(a) [Lp(a)], which is an independent risk factor for atherosclerosis and heart disease. Johnson noted that several agents are in the pipeline to reduce Lp(a), including olpasiran, zerlasiran, lepodisiran, muvalaplin, and pelacarsen.

For patients with elevated triglycerides who may be at risk of pancreatitis, pharmacists can now consider olezarsen (Tryngolza; Ionis Pharmaceuticals) and plozasiran (Redemplo; Arrowhead Pharmaceuticals), which are subcutaneous injectable agents that lower triglyceride levels by 60-80%.