This Week in Cardiology July 24 2026 This Week in Cardiology
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Jul 24, 2026 Discussion of the first oral PCSK9 inhibitor and its potential impact on cholesterol management. Review of safe MRI protocols for patients with nonconditional cardiac devices. Examination of the PFA-SHAM trial and its implications for atrial fibrillation treatment. Debate about orthopedic injuries and radiation protection practices in cath labs.
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First Oral PCSK9 Approved Without Outcomes Data
- FDA approved enlissatide (Lipfendra) as the first oral PCSK9 inhibitor for hypercholesterolemia with ~57% LDL lowering versus placebo.
- The drug uses a macrocyclic peptide mechanism but lacks completed cardiovascular outcomes data until the Coral Reef Outcomes Trial finishes in 2029.
LDL Drops But Outcomes Still Unknown
- Enlissatide produced 57–58% LDL reductions in the CORALreef lipid and HeFH trials but has no demonstrated effect on clinical cardiovascular outcomes yet.
- The Coral Reef Outcomes Trial enrolled ~15,000 patients and completes in 2029, so efficacy on MACE remains unknown.
Frustration When Patients Are Denied MRI
- John Mandrola describes frustration when patients with CIEDs are denied MRIs by rigid institutional policies despite evidence supporting scanning.
- He cites his coauthorship on the 2017 HRS consensus recommending protocols to safely scan non-conditional devices.