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

The VESALIUS-CV trial appeared too late to inform recent multisociety dyslipidemia guidelines, and its findings have already prompted consideration of whether the boundary between primary and secondary prevention no longer holds when a low-density lipoprotein cholesterol goal is being set. If that concession is granted, the more difficult 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 proprotein convertase subtilisin/kexin type 9 inhibitors when necessary to reach new and lower low-density lipoprotein cholesterol goals.