Management answerMyrtle GordonExecutive Vice President and Chief Commercial Officer
Thanks for the question, Jeff. We're really excited about what's happening in primary care. As you'll recall, we expanded the promotion and coverage of our primary care sales team at the beginning of last year. We expanded our medical teams in anticipation, of course, of some of the news flow that we've seen, new data from the Vesalius CV trial that we presented last November at the AAG meeting. And then, as Jay mentioned, the subsequent sub-study in diabetes patients without atherosclerosis also showing significant benefit with a 31% reduction in three-point MACE and a 31% reduction in four-point MACE. So, we have a clear opportunity to help these patients who are in the care of the primary care physician. You know, the average... diabetes patient without documented atherosclerosis is someone who's not being referred to a cardiologist. And so since the change in our label, which occurred actually just prior to the Vesalius trial being presented, we've been out there talking to primary care physicians. We've seen really, really good uptake. In the quarter, we had you know, strong overall growth in Repatha globally. But if you look at new-to-brand prescription evolution in the U.S., we were up 44% in the quarter. And that's being driven by increased depth of prescribing by cardiologists and increased breadth of prescribing by primary care physicians. So, very strong foundation. very pleased with the momentum, but we still have a huge opportunity ahead of us in primary prevention promotion of Repatha, the only PCSK9 with that data generation now. So, real opportunity for us. Now, when we look at LP little a, the one thing I will say that helps us is the new treatment guidelines that came out from the AHACC. They have recommended that everyone who is at risk of cardiovascular disease be tested. As you know, this is a genetically determined level, so you really only need to do the test once. It's affordable. It's accessible. And so, that bodes well for having some population of patients who will know their LP little a level. And I do think that primary care physicians will play a significant role in treating those patients in lowering their LP little a levels with hopefully a product like Opacern should the data bear out. Okay, good. Let's move on to the next question.