ZEUS

Presented in LBS.01 at AHA 2026 (Saturday 7 November) by Paul Ridker and published simultaneously in NEJM. ZEUS randomised 6,376 patients (3,184 ziltivekimab, 3,192 placebo; mean age 69.4, 27.5 percent women, 65.8 percent diabetes, 42.2 percent heart failure, median hsCRP 4.5 mg/L, mean eGFR 44.5) with atherosclerotic cardiovascular disease, chronic kidney disease (eGFR 15 to under 60, or UACR 200 mg/g or more) and hsCRP of 2 mg/L or more at 757 sites in 38 countries to monthly subcutaneous ziltivekimab 15 mg or placebo. At 24 months free IL-6 was 76 points and hsCRP 64 points lower than placebo. Over a median 33 months the primary three-point MACE occurred in 561 (17.6 percent) versus 565 (17.7 percent), HR 0.99 (0.88 to 1.11), P=0.84; four-point MACE 18.4 versus 18.5 percent, all-cause death 16.9 versus 17.0 percent (538 versus 542 deaths), kidney composite 20.2 versus 19.3 percent (HR 1.05). Serious adverse events 54.6 versus 54.8 percent; serious infections 20.4 versus 17.9 percent, fatal infections 3.2 versus 2.5, cellulitis 2.9 versus 1.0, serious venous thromboembolism 1.6 versus 0.6, platelets under 100 in 7.4 versus 3.2 percent. The placebo event rate (6.8 per 100 patient-years) was half again that of CANTOS. Ridker: too little, too late in a population with very advanced disease; inflammation remains a target. Novo Nordisk halted HERMES and ATHENA in September; only ARTEMIS continues.