ESC Congress 2026 🇩🇪 | My Top 20 Lipidology Highlights After an intense few days in Munich — including the opportunity to present our own work — here is my personal selection of the 20 lipid studies and concepts that caught my attention at ESC 2026. 1- VESALIUS-CV | Evolocumab — Earlier, sustained LDL-C lowering translated into clinical benefit, with an important mortality signal. 2- STAREE | Atorvastatin — In adults ≥70, MACE ↓ 30%. Age alone should not justify undertreatment. 3- SHASTA-3/4 | Plozasiran — TG ↓ ~80%, with fewer acute pancreatitis events. 4- AMUNDSEN | Evolocumab — Immediate post-MI initiation: LDL-C goal achieved in 82% vs 40%. 5- KYLO-11 | Lp(a) — One siRNA dose: Lp(a) ↓ up to ~97%, sustained almost one year. 6- CTX310 | ANGPTL3 — One-time CRISPR editing: LDL-C and TG ↓ ~50%. 7- VICTORION-CHALLENGE — Inclisiran substantially outperformed bempedoic acid for LDL-C lowering. 8- CORALreef | Enlicitide — Potent oral PCSK9 inhibition across CV risk and Lp(a) strata. 9- Lepodisiran — Profound Lp(a) lowering plus reductions in OxPL-apo(a)/OxPL-apoB. 10- ION775 | APOC3 — One dose provided sustained apoC-III and TG lowering. 11- HRS-5346 — Oral small-molecule Lp(a) lowering: an exciting new approach. 12- BRIDGE — Structured combination therapy after ACS markedly improved LDL-C goal attainment. 13- Rivocibart | ANGPTL3 — A promising approach for HoFH. 14- AAV8 gene therapy | HoFH — Striking early LDL-C reductions with gene replacement. 15- PROSPECT II | Lp(a) — New links between Lp(a), lipid composition and high-risk coronary plaque. 16- Lp(a) variability — Lp(a) may be less “static” than traditionally assumed. 17- Remnants/TGRL — More evidence linking remnant cholesterol with residual ASCVD risk. 18- Lp(a) & plaque vulnerability — Imaging further connected Lp(a) with vulnerable plaque phenotypes. 19- Lp(a) after ACS — Timing and clinical context may influence Lp(a) interpretation. 20- Precision lipidology — LDL-C, apoB, Lp(a), APOC3, ANGPTL3 and remnants are becoming therapeutic targets. My take-home from Munich? For today: treat earlier, lower and for longer. Use combination therapy when needed. For tomorrow: pills → combination therapy → RNA therapeutics → potentially one-time gene editing. Different technologies. Different targets. Same biology: Cumulative exposure to atherogenic lipoproteins drives atherosclerosis. Reduce exposure earlier, prevent disease earlier. @society_eas @escardio