Beyond Lp(a), the next few years bring an oral PCSK9 pill, a resurrected drug class that finally targets the right axis, and even one-shot gene editing. None is a reason to wait — today's proven tools already work — but the direction is unmistakable: cheaper, more powerful, less frequent.
Merck's enlicitide (MK-0616) is an oral PCSK9 inhibitor — a once-daily pill delivering a ~50–60% LDL drop, the kind of lowering that until now required an injection. Its Phase 3 programme (CORALreef) reads out around 2025–26. If it lands, it could make PCSK9-level lowering cheap, oral, and mainstream.
Earlier CETP inhibitors failed because they chased HDL. Obicetrapib is different: it's an oral, once-daily drug that meaningfully lowers LDL/ApoB (~50%) and Lp(a) — the axes that actually matter — with Phase 3 outcome data pending. A class left for dead may return by targeting the right thing.
VERVE-101/102 use a single CRISPR base-editing infusion to permanently switch off PCSK9 (or ANGPTL3) in the liver — the prospect of lifelong LDL lowering from one treatment. It's in very early human trials; if it proves safe and durable, it would be transformative. This is the frontier of the frontier — years away, and to be judged on long-term safety.
ANGPTL3 inhibitors (evinacumab is already approved for the rare, severe familial form; siRNA versions like zodasiran target high triglycerides) and better single-pill combinations round out the near-term pipeline. The theme across all of it: get ApoB lower, keep it there, and make doing so easier.
Promising — but no reason to wait
Most of these are one to three years from routine use, and none is a reason to postpone acting. Today's proven tools — lowering ApoB/LDL and the lifestyle levers in the next sections — already work. The pipeline makes the future cheaper and easier; it doesn't change what helps you now.
The Cholesterol Guide