Circulation

AHA 2025: PCSK9 inhibitor fails to halt transplant vascular disease

November 18, 2025

In the CAVIAR trial, 114 adult heart transplant recipients were randomized to alirocumab or placebo plus rosuvastatin within six months post-transplant. According to findings presented at the American Heart Association Scientific Sessions, after one year, LDL-C fell by >50% with alirocumab (to ~31 mg/dL) vs. no change in controls (~69 mg/dL), yet intravascular ultrasound showed similar plaque progression between groups (P=.86). Both regimens were safe and well tolerated. Investigators note low baseline LDL-C and minimal plaque accrual may have limited power.

Clinical takeaway: PCSK9 inhibition safely achieves profound LDL-C lowering post-transplant but doesn’t prevent short-term cardiac allograft vasculopathy progression; longer-term studies are warranted.

Source:

Fearon WF, et al. (2025, November 10). Circulation. Cardiac Allograft Vasculopathy Inhibition with Alirocumab: The CAVIAR Trial. https://pubmed.ncbi.nlm.nih.gov/41212178/