The European Society of Cardiology (ESC) Congress 2026 occurred in Munich from August 28 to 31, with new scientific trial outcomes offered throughout heart problems. From main section 3 successes and failures to earlier-stage packages, we chosen a few of the readouts that stood out to us.
Aficamten succeeds in non-obstructive HCM
Cytokinetics’ aficamten has turn out to be the primary cardiac myosin inhibitor to achieve a section 3 trial in non-obstructive hypertrophic cardiomyopathy (HCM), probably opening a brand new remedy possibility for a type of the illness with no focused remedy. The corporate plans to file for an expanded U.S. approval within the fourth quarter of 2026.
HCM causes the center muscle to thicken and may make it tougher for the center to fill and pump blood. Myosin inhibitors equivalent to aficamten cut back extreme contraction of the center muscle and have already confirmed efficient in obstructive HCM, the place thickened muscle additionally restricts blood leaving the center. Whether or not the strategy may work with out that obstruction was much less clear.
Bristol Myers Squibb’s mavacamten raised additional doubts final 12 months when it failed the section 3 ODYSSEY-HCM trial in non-obstructive HCM. The drug improved train capability and patient-reported well being scores numerically, nevertheless it didn’t attain its main endpoint.
ACACIA-HCM has now produced a distinct final result. Amongst 517 sufferers, aficamten improved the Kansas Metropolis Cardiomyopathy Questionnaire (KCCQ) rating by 11.4 factors after 36 weeks, in contrast with 8.4 factors for placebo. Peak oxygen uptake, a measure of train capability, elevated by 0.64 mL/kg/min with aficamten and was basically unchanged with placebo.
The variations aren’t dramatically bigger than these seen with mavacamten, nevertheless it nonetheless is the primary section 3 proof that inhibiting cardiac myosin can profit sufferers with non-obstructive HCM. Further analyses offered at ESC additionally discovered enhancements in measures of how nicely the center relaxes and fills.
The profit additionally got here with a discount in cardiac operate in some sufferers. Left ventricular ejection fraction fell under 50% in 10.5% of sufferers receiving aficamten versus 0.8% on placebo, though these reductions have been reversible.
Aficamten is just not the one sarcomere-targeting strategy transferring ahead in HCM. Edgewise Therapeutics offered 12-week section 2 information for EDG-7500, a cardiac sarcomere modulator designed to enhance contraction and rest whereas preserving systolic operate. The small, open-label examine reported enhancements in biomarkers and signs.
Plozasiran cuts triglycerides and pancreatitis in section 3
Arrowhead Prescription drugs’ plozasiran delivered one of many clearest RNAi successes at ESC 2026. In two section 3 trials, the drug lowered triglycerides in individuals with extreme hypertriglyceridemia and lower the speed of acute pancreatitis.
Plozasiran targets APOC3, a protein made within the liver that slows the breakdown and clearance of triglyceride-rich particles from the blood. By silencing the APOC3 gene, the drug removes that brake on triglyceride clearance. It’s already accredited as Redemplo for familial chylomicronemia syndrome, a uncommon type of extreme hypertriglyceridemia, however Arrowhead is now making an attempt to broaden it to the broader extreme hypertriglyceridemia inhabitants.
Within the SHASTA-3 and SHASTA-4 trials, 757 sufferers obtained plozasiran or placebo as soon as each three months. After a 12 months, median triglyceride ranges had fallen by 79% and 81% within the two research. Greater than 90% of handled sufferers introduced their triglycerides under 500 mg/dL, the brink used to outline extreme hypertriglyceridemia.
Plozasiran lowered the speed of acute pancreatitis occasions by 78% in contrast with placebo, akin to a 4.1% threat discount over one 12 months. In sufferers with a earlier historical past of pancreatitis, who’re at significantly excessive threat of one other assault, the discount reached 91%.
Security was broadly comparable between teams, though worsening glycemic management was reported extra usually with plozasiran, in 14.3% of handled sufferers versus 8.7% on placebo.
Arrowhead plans to file for U.S. approval in extreme hypertriglyceridemia earlier than the top of 2026. On the similar time, the sector is already pushing towards even much less frequent dosing. Ionis offered section 1 information for ION775, one other APOC3-targeting siRNA, displaying {that a} single dose lowered triglycerides by as a lot as 68.4% at six months, with the impact of the upper doses nonetheless seen at 12 months. The examine included solely 40 members, however Ionis is now testing the drug in section 2, aiming to deal with each six months or much less.
CRISPR Therapeutics’ CTX310 reveals sturdy lipid decreasing
CRISPR Therapeutics goals to transcend plozasiran and ION775 by modifying the related gene as soon as and making the impact everlasting.
CTX310 is an in vivo CRISPR-Cas9 remedy concentrating on ANGPTL3, a protein produced by the liver that regulates triglycerides and ldl cholesterol. Folks carrying naturally occurring loss-of-function variants in ANGPTL3 are likely to have decrease triglyceride and LDL levels of cholesterol, and people variants have additionally been related to a decrease threat of coronary artery illness. Regeneron’s antibody evinacumab, which blocks ANGPTL3, is already accredited for homozygous familial hypercholesterolemia.
CTX310 tries to breed that protecting genetic state instantly. It makes use of lipid nanoparticles to ship CRISPR-Cas9 elements to liver cells, the place they disable ANGPTL3.
The section 1a examine remains to be very small. Fifteen individuals with difficult-to-control excessive ldl cholesterol, excessive triglycerides, or each obtained a single intravenous dose of CTX310 on prime of their present lipid-lowering remedy. Earlier outcomes had already proven robust reductions in ANGPTL3 and blood lipids. At ESC, the main target was on sturdiness, and the consequences have been nonetheless current after one 12 months.
On the highest dose, circulating ANGPTL3 was lowered by a median of 79%, whereas triglycerides fell by 48% and LDL ldl cholesterol by 53%. The most important reductions seen in particular person sufferers reached 89%, 78%, and 84%, respectively. CRISPR Therapeutics reported no treatment-related severe antagonistic occasions.
The examine was designed primarily to evaluate security, and the small variety of members means for much longer follow-up will probably be wanted to know the dangers of completely switching off ANGPTL3.
CRISPR Therapeutics has now moved CTX310 into section 1b, specializing in extreme hypertriglyceridemia and refractory hypercholesterolemia. This system remains to be early-stage, however CTX310 may finally deal with some lipid problems with a single genetic intervention.
SRD-002 revisits cardiac gene remedy in HFpEF
Medera offered 12-month information at ESC for SRD-002, a one-time gene remedy aiming to enhance how the center relaxes in sufferers with coronary heart failure with preserved ejection fraction (HFpEF). The primary-in-human examine included solely ten sufferers, however the physiological results continued and, in some instances, elevated a 12 months after remedy.
HFpEF is characterised partially by the center turning into much less capable of chill out and fill usually although its pumping capability stays preserved. SRD-002 targets SERCA2a, a calcium pump inside coronary heart muscle cells that helps take away calcium after every contraction so the muscle can chill out. SERCA2a exercise is impaired in coronary heart failure, and Medera makes use of an AAV1 vector to ship an extra copy of the gene on to the center by way of a single infusion.
In the section 1/2a trial, 5 sufferers obtained a decrease dose and 5 a better dose. At 12 months, eight of the ten sufferers met a prespecified threshold for normalization of cardiac filling stress, whereas common pulmonary capillary wedge stress throughout peak train fell by round 30%. This stress rises when the center struggles to fill correctly and is among the physiological abnormalities in HFpEF. The reductions have been usually larger at 12 months than at six months and at the larger dose. The common KCCQ rating additionally elevated by 17.8 factors, whereas 5 of six sufferers who entered the trial with NYHA class 3 signs improved to class 2.
SRD-002 is just not the primary try to deal with coronary heart failure by restoring SERCA2a. The identical goal and AAV1 vector strategy have been beforehand examined in sufferers with coronary heart failure with lowered ejection fraction (HFrEF), the place the coronary heart’s pumping capability is impaired. Early research produced encouraging indicators, however the subsequent randomized 250-patient CUPID 2 trial failed because the gene remedy didn’t cut back recurrent coronary heart failure occasions in contrast with placebo.
Nonetheless, Medera is testing the strategy in a distinct type of coronary heart failure. The trial remains to be far too small to set up that restoring SERCA2a adjustments the scientific course of HFpEF. With ten sufferers, no placebo group, and endpoints centered on physiology and signs, the enhancements may look very completely different in a randomized trial. Medera plans to maneuver SRD-002 right into a randomized section 2b examine, which ought to present a way more significant take a look at.
Eplontersen fails to enhance outcomes in ATTR-CM regardless of decreasing TTR
AstraZeneca and Ionis had already disclosed in July that eplontersen had failed the section 3 CARDIO-TTRansform trial in transthyretin amyloid cardiomyopathy (ATTR-CM). At ESC, the total outcomes confirmed why the miss is significantly attention-grabbing: the drug efficiently suppressed its supposed goal, however that didn’t translate into a major discount in cardiovascular occasions or deaths.
ATTR-CM develops when misfolded transthyretin (TTR) accumulates within the coronary heart and step by step impairs its operate. TTR stabilizers equivalent to tafamidis are designed to cease the protein from misfolding, whereas gene-silencing medicine cut back manufacturing of TTR within the liver. Eplontersen is a gene-silencing antisense oligonucleotide already accredited for hereditary ATTR polyneuropathy.
CARDIO-TTRansform enrolled over 1,400 sufferers and in contrast eplontersen with placebo for as much as 140 weeks. The first endpoint mixed cardiovascular deaths with recurrent cardiovascular occasions equivalent to coronary heart failure episodes. There have been 381 occasions within the eplontersen group and 392 with placebo, and cardiovascular deaths have been additionally nearly equivalent, at 74 with eplontersen and 70 with placebo.
The drug, nevertheless, hit its goal and produced a sustained discount in circulating TTR. Sufferers additionally deteriorated much less quickly on some measures of bodily operate and high quality of life. After 140 weeks, six-minute strolling distance had fallen by 27.5 meters with eplontersen in contrast with 47.3 meters on placebo, whereas the decline in KCCQ health-status scores was additionally smaller.
Within the trial, 57% of sufferers have been already taking a TTR stabilizer after they entered the examine, largely tafamidis, and one other 24% began one throughout the trial. Amongst sufferers who weren’t receiving a stabilizer at baseline, eplontersen was related to a 29% decrease charge of the first endpoint. Amongst these already taking one, there was no proof of profit.
Security was not a difficulty, as severe antagonistic occasions occurred in 57.8% of sufferers receiving eplontersen and 59.4% receiving placebo, with fewer remedy discontinuations because of antagonistic occasions within the eplontersen group.
BMS and J&J’s Milvexian fails in section 3
Milvexian was testing a beautiful concept in anticoagulation: blocking issue XIa to forestall harmful clots with out inflicting the identical bleeding issues as standard anticoagulants. The section 3 outcomes offered at ESC 2026 confirmed that Milvexian didn’t improve essentially the most severe types of bleeding, and additionally failed to cut back cardiovascular occasions.
The concept of concentrating on issue XIa comes from its position in thrombosis, as issue XI seems to be much less vital for regular hemostasis, suggesting that inhibiting it may separate antithrombotic efficacy from bleeding threat.
The section 3 trial enrolled about 14,000 sufferers inside seven days of an acute coronary syndrome occasion. All obtained normal antiplatelet remedy and have been randomized to milvexian or placebo. Bristol Myers Squibb and Johnson & Johnson had already stopped the trial for futility in November 2025, however the full ESC information gave extra perception into how the trial missed the mark. After a median follow-up of 12.2 months, cardiovascular loss of life, myocardial infarction, or ischemic stroke occurred in 5.4% of sufferers taking milvexian and 5.1% receiving placebo.
LIBREXIA-ACS examined the drug on prime of antiplatelet remedy after acute coronary syndrome, the place sufferers already obtain intensive antithrombotic remedy. Two different massive section 3 trials stay in progress: LIBREXIA-STROKE, testing milvexian for secondary prevention after ischemic stroke or high-risk transient ischemic assault, and LIBREXIA-AF, evaluating it with apixaban in atrial fibrillation.
Novartis’ pacibekitug delivers sustained reductions in cardiovascular irritation
Pacibekitug solely joined Novartis’ pipeline lately. The pharma acquired the anti-IL-6 antibody by way of its $1.4 billion takeover of Tourmaline Bio in 2025, betting that decreasing persistent irritation may deal with cardiovascular threat.
The drug targets interleukin-6 (IL-6), a protein concerned within the inflammatory response. Elevated irritation, measured by way of high-sensitivity C-reactive protein (hs-CRP), is related to elevated cardiovascular threat, and IL-6 sits upstream of CRP manufacturing. Pacibekitug blocks IL-6 itself and probably maintains that suppression with injections solely as soon as each three months.
At ESC 2026, the section 2 TRANQUILITY trial offered longer-term proof that the strategy can do what it’s designed to do. The examine enrolled just below 150 individuals with stage 3 or 4 power kidney illness and elevated hs-CRP, and in contrast three pacibekitug dosing regimens with placebo over six months.
Irritation fell quickly and remained suppressed all through the examine. Common hs-CRP ranges over six months decreased by 76% with 25 mg of pacibekitug each three months and by 85% with 50 mg each three months, in contrast with a 7% improve on placebo. Month-to-month dosing produced an 89% discount.
What TRANQUILITY can’t present is whether or not these biomarker enhancements translate into fewer coronary heart assaults, strokes or cardiovascular deaths. And that query brought about the failure of one other IL-6 antibody. In July, Novo Nordisk reported that ziltivekimab failed the section 3 ZEUS trial, regardless of efficiently suppressing IL-6 exercise and hs-CRP. Amongst greater than 6,300 sufferers with heart problems, power kidney illness, and irritation, ziltivekimab had basically no impact on main cardiovascular occasions in contrast with placebo.
The ESC outcomes present proof that pacibekitug can ship sturdy IL-6 inhibition, however after ZEUS, decreasing inflammatory biomarkers alone is just not sufficient to validate the strategy. The larger take a look at will probably be whether or not Novartis can flip these biomarker adjustments into an precise cardiovascular profit in a section 3 trial.
AZD5462 revives the relaxin strategy as an oral drug
AstraZeneca is revisiting a coronary heart failure mechanism that has already been examined and dropped as soon as. AZD5462 prompts RXFP1, the receptor for relaxin, a hormone that helps the cardiovascular system adapt throughout being pregnant. Relaxin signaling can widen blood vessels, cut back the resistance in opposition to which the center has to pump, improve renal blood stream, and probably promote favorable cardiac reworking.
Novartis beforehand developed serelaxin, a recombinant type of human relaxin-2, for acute coronary heart failure. Early information have been encouraging, however the drug later failed to cut back cardiovascular loss of life or worsening coronary heart failure in section 3. AZD5462 approaches the identical biology, however as a substitute of administering the relaxin protein intravenously throughout an acute episode, AstraZeneca has developed a small molecule that may activate RXFP1 orally.
The section 2b LUMINARA trial offered at ESC 2026 examined whether or not that translated into measurable results on coronary heart operate. The examine enrolled 375 sufferers already receiving normal coronary heart failure remedy and break up them into two teams in keeping with how nicely their hearts have been pumping.
In sufferers with extra severely lowered ejection fraction, the 20 mg dose lowered end-systolic quantity index, the quantity of blood left within the ventricle after it contracts, by 5.4 mL/m² greater than placebo. This means that the center is emptying extra successfully. The outcome narrowly missed standard statistical significance, and the upper doses didn’t produce a stronger impact.
The sign was clearer in sufferers with mildly lowered ejection fraction. Throughout all three doses, AZD5462 considerably lowered systemic vascular resistance, basically decreasing the resistance the center has to pump in opposition to. The drug was additionally usually nicely tolerated, with some delicate blood-pressure decreasing however no improve in clinically important hypotension versus placebo.
These outcomes usually are not sufficient to indicate that AZD5462 improves signs, reduces hospitalizations, or helps sufferers dwell longer, however the oral RXFP1 agonist did interact the relaxin pathway and produced the hemodynamic adjustments AstraZeneca was aiming for. Longer trials will probably be wanted to decide whether or not the physiological results translate into scientific profit.
Which ESC outcomes will maintain up?
A number of of the packages offered at ESC 2026 will now transfer into their subsequent checks. Aficamten and plozasiran have section 3 proof behind them, whereas CTX310, SRD-002 and pacibekitug stay a lot earlier in improvement.
The outcomes from eplontersen and milvexian additionally present why these later trials matter. Each entered section 3 with robust organic rationales and in the end failed their main endpoints. For the sooner packages offered at ESC, bigger trials will decide whether or not the indicators seen to this point translate into scientific profit.
