觉中国 （来源：上观新闻） 血脂异常是导致心血管疾病的主要危险因素之一。在心血管疾病的高发季节，控制好血脂显得格外重 要。 有关降血脂的疑问总是层出不穷，笔者总结了以下三个最常见的问题，也是患者最常见的认识误区。 图源：视 吃素为什么不能降血脂 "医生，我已经吃素一年了，蛋黄、油都不敢碰，怎么胆固醇不降反升了？"王阿姨拿着体检报告，一脸 困惑。与很多人一样，她认为胆固醇全是"吃出来"的。 其实，血液里的胆固醇就好比是一个"合资企业"的产物，"吃进去"的只是"小股东"。人体内有一座24小 时运转的精密"胆固醇工厂"，它通过两条生产线工作。 一条是外源性"采购线"，产量占总量的20%到30%。吃进去的鸡蛋、动物内脏等食物中的胆固醇，就像 从外部采购的"原材料"，控制"采购"，就能减少这部分胆固醇的产量。 二是内源性"自主生产线"，产量占总产量的70%到80%。这才是"胆固醇工厂"的"主营业务"。这条生产 线的效率和产量，很大程度上是由遗传基因决定的。 关键问题来了，有些人天生遗传了高效率的"生产图纸"，或者负责回收胆固醇成品的"物流系统"（LDL 受体）效率偏低。这就导致哪怕完全断绝了外部"采购"，吃得极其清淡， ...

君实生物目前的估值非常便宜，公司正处于一个多方位的转折点。首先，在管 理层面，公司整体管理水平有所提升；其次，在销售方面，产品销售增长迅速； 最后，在研发管线推进方面也取得了显著进展。公司现有四款正在销售的产品， 包括 PD-1 特瑞普利单抗、TNF-α 药物、新冠药 VV116 和 PCSK9 抑制剂。这 些产品预计可实现 75 亿人民币的销售峰值，我们给予 3 倍 PS，对应 240 亿港 币左右的估值。目前君实生物在港股市场上的市值仅反映了现有产品的价值， 而未充分体现其研发管线潜力。 君实生物有哪些主要在售产品及其市场表现预期？ 君实生物目前有四款主要在售产品：PD-1 特瑞普利单抗、TNF-α 药物、新冠 药 VV116 和 PCSK9 抑制剂。其中，特瑞普利单抗今年（2025 年）的预计销 售额为 20 亿元，明年（2026 年）预计同比增长 35%至 40%。后年的增长将 更多依赖于皮下注射形式获批后的放量，整体峰值预计在 50 亿至 60 亿元人民 币之间。其他三款药品合计销售峰值为 75 亿元人民币。 君实生物 20251230 摘要 君实生物现有四款在售产品，包括 PD-1 特瑞普利单抗、 ...

Core Viewpoint - The increasing prevalence of chronic diseases in China, driven by an aging population and changing lifestyles, has led to a situation where chronic diseases are now a "normal part of life," creating significant health and economic burdens [1][2]. Group 1: Current Challenges in Chronic Disease Management - Chronic disease prevention and control in China faces a "high incidence, high mortality, high economic burden" and "low screening, low treatment, low compliance" dilemma, with 91% of total deaths attributed to chronic non-communicable diseases such as cardiovascular diseases, diabetes, and respiratory diseases [1]. - There is a growing demand for comprehensive management of chronic diseases, as patients experience co-morbidities and require integrated treatment approaches, yet investment in chronic disease management has decreased in recent years [2][3]. Group 2: Innovations in Treatment Approaches - AstraZeneca is focusing on breaking through the bottlenecks of single-point treatments by adopting a holistic view to address the interconnections between diseases, aiming to improve patient outcomes through innovative therapies and systematic treatment plans [4]. - The company has presented over 80 studies at major international conferences, covering cardiovascular, renal, metabolic, respiratory, and autoimmune treatment areas, providing new targets and ideas for clinical treatment [4]. Group 3: Future Directions and Strategic Initiatives - AstraZeneca plans to expand its product pipeline with over 40 new products and indications in chronic disease treatment, including areas such as amyloidosis, weight management, liver diseases, and systemic lupus erythematosus, creating a robust and diverse treatment matrix [8]. - The company is also enhancing grassroots diagnostic capabilities and leveraging technology, such as AR-assisted lung function testing, to improve screening rates and treatment efficiency for chronic respiratory diseases [10]. Group 4: Collaborative Models for Chronic Disease Management - The establishment of a graded diagnosis and treatment system is extending chronic disease management from hospitals to communities and homes, aiming for comprehensive coverage and improved management efficiency [9]. - AstraZeneca is promoting collaborative models, such as the "hospital-community linkage" approach, to provide standardized, integrated, and continuous chronic disease management services across various healthcare settings [9][10].

Investment Rating - The report maintains an "Outperform" rating for the industry [1] Core Insights - ASCVD (Atherosclerotic Cardiovascular Disease) is a leading cause of death globally, with significant mortality rates in both the US and China. In 2022, approximately 370,000 deaths from coronary heart disease and 160,000 from stroke were reported in the US, while China saw around 1.96 million deaths from ischemic heart disease and 2.3 million from stroke in 2021 [2][5][26] - The report highlights the increasing focus of multinational pharmaceutical companies (MNCs) on cardiovascular treatments, particularly targeting PCSK9 and Lp(a). The global market for PCSK9 is projected to reach between $11 billion and $19 billion, while the Lp(a) inhibitor market is expected to reach $3 billion to $7 billion [2][3] - Upcoming Phase 3 clinical trials for cardiovascular endpoints are anticipated to yield significant data in the coming years, with several studies scheduled for completion between 2025 and 2029 [2][3] Summary by Sections ASCVD Disease Burden - ASCVD encompasses a range of conditions including coronary artery disease, cerebrovascular disease, and peripheral artery disease. It is associated with significant mortality and morbidity, with controllable risk factors such as dyslipidemia, diabetes, hypertension, and smoking [5][6] LDL-C: Unmet Needs Post-Statin Therapy - Despite the widespread use of statins, a substantial proportion of patients do not achieve target LDL-C levels, indicating a significant unmet need in the market for additional therapies [26] Lp(a): An Independent Risk Factor - Lp(a) is identified as an emerging risk factor for ASCVD, independent of LDL-C levels. Its levels are primarily genetically determined and show a skewed distribution in the population, with a notable percentage of individuals having elevated levels that correlate with increased cardiovascular risk [35][40] Investment Recommendations - The report identifies key companies involved in the development of Lp(a) inhibitors, including Hengrui Medicine and CSPC Pharmaceutical Group, which have entered into licensing agreements with major pharmaceutical companies for their respective Lp(a) small molecule inhibitors [2][3]

Core Insights - The article highlights the increasing prevalence of coronary heart disease (CHD) in China, particularly among younger individuals, driven by unhealthy lifestyle choices and societal pressures [1][2][3]. Group 1: Prevalence and Trends - Coronary heart disease patients in China have exceeded 11 million, growing at an annual rate of approximately 2.5% [1]. - There is a concerning trend of younger individuals being diagnosed with CHD, attributed to unhealthy lifestyles and various environmental and psychological factors [1][2][3]. Group 2: Lifestyle Factors - Unhealthy lifestyle choices, such as a Westernized diet high in calories, fats, and sugars, along with reduced physical activity, are significant contributors to the rising rates of CHD among the youth [2][3]. - Factors like prolonged sitting, lack of exercise, sleep deprivation, and high stress levels further exacerbate the risk of developing cardiovascular diseases [3][4]. Group 3: Prevention and Management - Emphasis is placed on preventive measures for individuals under 35, including adopting healthy habits, regular health check-ups, and maintaining a balanced diet [2][4]. - Key recommendations for prevention include low-salt and low-fat diets, regular exercise, weight management, and stress control [2][4][5]. Group 4: Treatment Approaches - Drug therapy is considered the cornerstone of CHD treatment, aimed at alleviating symptoms, slowing plaque progression, and preventing thrombosis [7][8]. - Surgical options include percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG), with the choice depending on the severity and extent of the disease [7][9]. Group 5: Advances in Treatment - New drug developments, such as PCSK9 inhibitors, show promise in significantly lowering lipid levels and improving patient outcomes compared to traditional statins [8][9]. - The integration of advanced technologies, including AI and imaging techniques, is enhancing the precision of CHD diagnosis and treatment [9].

Group 1 - Cholesterol is an essential substance for the human body, playing a critical role in synthesizing hormones and vitamin D, and forming cell membranes [3][4] - Cholesterol levels can be influenced by both internal factors (genetics, diseases) and external factors (lifestyle habits such as diet and exercise) [4] - There are two types of cholesterol: high-density lipoprotein (HDL-C) known as "good cholesterol" and low-density lipoprotein (LDL-C) known as "bad cholesterol" [5][6] Group 2 - High levels of LDL-C can lead to serious health issues such as coronary heart disease and stroke, while HDL-C helps to remove excess cholesterol from the bloodstream [6][7] - It is important to assess cholesterol health through a comprehensive analysis of various blood lipid indicators, not just total cholesterol [8][10] - Individual cholesterol levels can vary based on personal health history, age, and lifestyle, making it essential to consider these factors when evaluating cholesterol [7][8] Group 3 - Dietary recommendations for lowering cholesterol include increasing intake of whole grains and high-quality fats while avoiding saturated and trans fats [10][12][14] - Regular physical activity is advised, with recommendations for at least 150 minutes of moderate-intensity aerobic exercise per week [22] - If lifestyle changes are insufficient, medication may be necessary, with common options including statins and cholesterol absorption inhibitors [24][25]

Core Insights - Sanofi has confirmed the cessation of the promotion of its PCSK9 inhibitor, Alirocumab, in the Chinese market due to global supply issues and a strategic upgrade in its cardiovascular product line [2][3] - The exit of Alirocumab from the market has opened opportunities for domestic pharmaceutical companies to enter the PCSK9 inhibitor space [1][3] Industry Overview - PCSK9 inhibitors are considered a milestone in lipid-lowering therapies, with significant implications for managing high LDL cholesterol levels, which are primarily influenced by genetic factors [1][3] - The understanding of lipoprotein(a) [Lp(a)] in cardiovascular diseases has led to increased interest in developing new lipid-lowering drugs targeting this specific marker [1][7] Market Dynamics - The market for lipid-lowering medications is competitive, with established statin drugs and newer PCSK9 inhibitors being used in combination for optimal patient outcomes [4][5] - There are currently seven approved PCSK9 inhibitors in China, including both imported and domestic products, with ongoing developments from various companies [5][6] Emerging Opportunities - Companies are actively pursuing the development of alternative medications in light of Alirocumab's market exit, indicating a robust interest in the PCSK9 inhibitor segment [3][6] - The market is also seeing advancements in therapies targeting Lp(a), with several multinational corporations engaged in clinical trials for new drugs aimed at lowering Lp(a) levels [7]

Core Viewpoint - The increasing levels of blood lipids and the prevalence of dyslipidemia among Chinese individuals highlight the need for better management of low-density lipoprotein cholesterol (LDL-C) to reduce the risk of atherosclerotic cardiovascular disease (ASCVD) [1][2][3] Group 1: Importance of LDL-C Management - LDL-C is identified as a major contributor to high blood lipids and a significant risk factor for ASCVD, emphasizing the importance of lowering LDL-C levels to reduce morbidity and mortality associated with cardiovascular diseases [1][2] - Experts advocate for a targeted and stratified approach to blood lipid management, stressing the need for public awareness and education regarding the significance of monitoring LDL-C levels [1][2] Group 2: Lifestyle and Treatment Recommendations - Lifestyle modifications, including dietary control and physical activity, are crucial as approximately two-thirds of LDL-C comes from external sources [2][3] - Regular monitoring and risk assessment of LDL-C levels are essential, especially for high-risk populations, who may require more stringent control and treatment of underlying conditions like hypertension and diabetes [2][3] Group 3: Misconceptions and Long-term Treatment - There is a prevalent misconception among patients that achieving target LDL-C levels means discontinuing medication, which can lead to adverse cardiovascular events [3][4] - Continuous and scientifically guided lipid-lowering therapy is vital for stabilizing LDL-C levels and preventing cardiovascular incidents, particularly in patients with existing ASCVD [3][4] Group 4: Current Treatment Landscape - The treatment rates and achievement rates for lipid-lowering therapy among ASCVD patients need improvement, with many still relying on traditional statin medications [4] - While statins are effective, some patients may have contraindications, necessitating the use of non-statin alternatives for optimal LDL-C management [4]

Group 1 - The article discusses the ethical dilemma of the "Trolley Problem" and its application to real-world issues, particularly in the context of cardiovascular diseases [2][4][5] - It highlights that cardiovascular diseases are the leading cause of death globally, with nearly 20 million deaths annually, and in China, approximately 4.58 million deaths occur each year due to these diseases [8][9] - The article emphasizes the significant increase in cardiovascular disease cases over the past 40 years, primarily due to aging and unhealthy lifestyles [10][11] Group 2 - The main risk factors for cardiovascular diseases include high blood pressure, high cholesterol, diabetes, obesity, and smoking, with lifestyle choices being the primary contributor [11][21] - The article identifies atherosclerosis as the leading cause of cardiovascular diseases, which is a chronic process that can take decades to develop [16][18] - It states that lowering LDL-C (low-density lipoprotein cholesterol) is crucial for preventing atherosclerosis and related cardiovascular events, with a direct correlation between LDL-C levels and cardiovascular risk [22][30] Group 3 - The article presents practical recommendations for managing cardiovascular health, including setting LDL-C targets based on risk levels and emphasizing lifestyle changes [36][41] - It discusses the importance of early intervention and the need for individuals to take responsibility for their health, suggesting that proactive measures can significantly reduce the risk of cardiovascular diseases [33][54] - The article concludes by urging individuals to recognize their health status and take action to prevent becoming "passengers" on the metaphorical "Blue Sky" train of cardiovascular disease [56][58]

Industry Overview - The cholesterol-lowering drug industry is crucial for preventing and treating cardiovascular diseases, with a growing patient population due to aging and increasing rates of dyslipidemia [1][8] - The prevalence of dyslipidemia among the elderly is high, with 47% of individuals over 60 affected, while the rate among those aged 18 and above has risen from 18.6% in 2002 to 35.6% in 2023 [8][10] Market Development - The cholesterol-lowering drug market in China is projected to grow from CNY 252.94 billion in 2023 to CNY 265.95 billion in 2024, despite a slowdown due to national procurement policies [10][20] - Sales distribution shows that 57% of sales come from hospitals, while 43% are from retail markets [10] Drug Categories - Cholesterol-lowering drugs are categorized into statins, fibrates, niacin, bile acid sequestrants, PCSK9 inhibitors, and monoclonal antibodies targeting angiopoietin-like protein 3 [3][12] - Statins dominate the market with a 76.58% share, but innovative drugs like PCSK9 inhibitors are gaining traction [12][22] Competitive Landscape - The market is experiencing significant changes, with foreign companies like Pfizer and Sanofi leading the high-end market, while local firms like Yuyuan Health and Jingxin Pharmaceutical focus on mid to low-end markets [14][16] - Competition is shifting from price to efficacy, safety, and brand service, with an expected increase in market concentration through mergers and international collaborations [14][22] Company Highlights - Jingxin Pharmaceutical focuses on the development and sales of statins and is expanding into combination therapies and new drug targets [16] - Yuyuan Health has developed a PCSK9-targeting siRNA drug, YKYY015, which is in clinical trials and has received IND approval in the U.S. [18] - The revenue of Yuyuan Health is projected to decline by 9.9% in 2024, with cardiovascular drug sales down by 20.73% [18] Future Trends - The market for cholesterol-lowering drugs is expected to continue expanding due to an increasing patient population and unmet treatment needs, with projections indicating a compound annual growth rate above a certain percentage [20][21] - Innovation in drug development is on the rise, with companies investing in new targets like Lp(a) and PCSK9 inhibitors, enhancing treatment options for patients [21][22]