The branded cardiovascular market is forecast to grow at 11% a year between 2025 and 2032, well ahead of the 7% forecast for prescription drugs overall. That growth is fueled through new products across novel mechanisms and modalities, and the 2032 ranking of leading companies will look very different from today’s. Scrip’s Jessica Merrill and I cover the data behind the shift in the latest episode of Evaluate Spotlight.
Bristol-Myers Squibb is the largest cardiovascular company at $10.8 billion in 2025 sales, but Eliquis, which accounts for almost $9.5 billion of that, loses exclusivity in 2026. Meanwhile Merck is headed in the opposite direction. From sales of $2 billion in 2025, the company is forecast to reach $10.6 billion in 2032, making it the top company by cardiovascular sales in that year. Cytokinetics is also set to enter the top 10 on the strength of Myqorzo, and AstraZeneca is building around Baxfendy, the first new hypertension mechanism in around two decades.
In the pipeline, small molecules still account for around three-quarters of Phase 1-3 cardiovascular trials, and new activity is layering on top with PCSK9 inhibitors as the fastest-growing modality, and RNA not far behind.
The Lp(a) race is high stakes. Novartis’s Phase 3 data for pelacarsen showed lower Lp(a) levels without a reduction in cardiovascular events. Evaluate Pharma had forecast it as the leading Lp(a) therapy through 2030, and analysts have begun revising Novartis revenues downward. Outcomes data for other high-profile assets will show whether other mechanisms in the class fare differently. The gap between Phase 2 proof of concept and Phase 3 outcomes remains one of the big challenges in the space.
Deal activity tells a related story. Cardiovascular alliance deals fell from 46 in 2020 to 27 in 2025, in line with a broader industry pullback. Also, in line with the wider industry, deal structures are changing, with upfront share of total value falling and milestones carrying the added value. As some high-profile Phase 3 programs underwhelm, companies may be back at the dealmaking table sooner than expected.
The Evaluate Spotlight webinar and report on cardiovascular covers the forecasts, modality trends and deal data in full.
