Abstract:
In 2015, we celebrated PCSK9 inhibitors. In 2026, we're potentially approving FOUR revolutionary drug classes simultaneously. But will they succeed where others failed?"
First, we examine Factor XI/XIa inhibition as a strategy to uncouple thrombosis from haemostasis, highlighting key phase II–III programmes in atrial fibrillation and atherothrombotic disease and their potential to redefine long-term anticoagulation in patients at high bleeding risk.
Second, we discuss aldosterone synthase inhibition as a more selective approach to renin–angiotensin–aldosterone system modulation, with implications for resistant hypertension, heart failure, and cardiorenal protection, where current mineralocorticoid receptor antagonists are limited by hyperkalaemia and off?target effects.
Third, we review nucleic acid–based and siRNA therapies targeting Lp(a) and angiotensinogen, which promise durable, infrequent dosing and powerful risk modification in genetically determined dyslipidaemias.
Fourth, we revisit CETP inhibition in light of obicetrapib and other agents that, unlike earlier compounds, appear capable of lowering LDL?C and apolipoprotein B while enhancing high-density lipoprotein functionality, potentially translating into event reduction.
• Factor XIa Inhibitors - The anticoagulation safety revolution (milvexian, abelacimab)
• Aldosterone Synthase Inhibitors - Overcoming MRA limitations (vicadrostat, baxdrostat)
• Lp(a)-Targeted Therapies - Finally addressing the 'undrugable' target (pelacarsen 80% reduction, olpasiran >95%)
• CETP Inhibitors Reborn - Obicetrapib learning from past failures
Conclusion: Position these as complementary, not competing - a patient could theoretically need ALL four drug classes
Biography:
Dr. N. Kumar is a European Board Certified Cardiac electrophysiologist (ECES) with his doctorate thesis in cardiology on Atrial fibrillation ablation from Maastricht University Medical Centre, Netherlands(ranked among the top 50 clinical universities worldwide). He is also a program chair for an International cardiology program and a visiting professor- Cardiology for EDU( Germany, Malta). His primary interest is atrial fibrillation, arrhythmia management, Heart failure, and cardiovascular economics. He has extensive experience with ablation procedures and complex device implantation with >70 publications (and >600 citations) in reputed journals, including JACC and Heart rhythm journal. He has more than a decade of experience in Cardiology.
Awards
-- Erasmus Scholarship 2015
-- NRI of the Year award" 2018 for academics by Times group.
-- American Heart Rhythm Society scholarship 2018 for advanced heart arrhythmia training at St Luke's medical center, USA.
-- American College of Cardiology 2019 travel award.
-- EHRA 2021 - Educational Grant
-- India UK Achievers Honours 2023 at UK parliament for contribution to Science, Education, and Innovation
He was trained earlier at some of the best hospitals across the USA, UK, Germany, and the Netherlands.
He is a fellow of
1] Royal College of Physicians, Edinburg UK (FRCP)
2] European Society of Cardiology (FESC)
3] American College of Cardiology (FACC)
4) Indian College of Cardiodiabetology and Metabolic Disease (FICCMD)
His two papers, including the "ATSCA study," have been referenced in the 2017 expert consensus on atrial fibrillation ablation guidelines. He has also worked as a reviewer for journals such as The Lancet and a global consultant for various studies such as Discovery, Painfree-sst, and ImproveSCA. He graduated in Health economics and cardiovascular management from the London School of Economics.
He is also responsible for approving the “World’s first catheter for epicardial ventricular tachycardia ablation” from TGA for Abbott(USA).
