Bad Cholesterol, Gene Therapy, and Eli Lilly Stock: The $1.3 Billion Bet That Could Change Medicine

Many of my friends over 40 have already experienced the “joys” of high cholesterol firsthand: the risk of atherosclerosis and the prospect of taking statins for life with all their lovely side effects. 

But what if I told you there might be a way to fix this problem forever with just one shot?

In June, Eli Lilly (one of the key holdings in my portfolio) acquired biotech Verve Therapeutics for ~$1.3 billion. 

The goal? A revolutionary drug that could permanently lower cholesterol and eliminate the need for lifelong statin therapy.

The Problem with Current Solutions

Let's be honest about statins. They work - there's no question about that. They've saved millions of lives by lowering cholesterol and reducing heart attacks. But they come with a catch: you have to take them every day for the rest of your life.

The side effects aren't fun either. Muscle pain, fatigue, potential liver issues, and for some unlucky folks, cognitive effects that make you feel like you're thinking through fog. Plus, there's the psychological burden of being tethered to a daily pill regimen that screams "you're getting old and your body is failing you."

Even worse, not everyone responds well to statins. Some people need increasingly aggressive treatments, multiple medications, or expensive PCSK9 inhibitors that can cost thousands per month.

VERVE-102: A One-Shot Solution

This is where Verve Therapeutics' approach gets fascinating. VERVE-102 is a one-time gene therapy that uses base editing technology to make a precise mutation in liver cells, effectively turning off the PCSK9 gene.

Here's the beautiful part: this isn't some wild scientific experiment. Nature already ran this trial for us. There are people walking around right now who were born with this gene switched off. They have very low levels of bad cholesterol throughout their entire lives and are naturally protected from atherosclerosis - without any side effects or complications.

These genetic lottery winners essentially have built-in cardiovascular protection from birth. What Verve figured out is how to give the rest of us that same protection with a single treatment.

The base editing technology is remarkably precise. Unlike older gene therapies that could be somewhat crude, base editing allows scientists to make exact, single-letter changes to DNA.

The Clinical Results So Far

In early human trials, the results have been impressive. A single infusion of VERVE-102 reduced LDL cholesterol by an average of ~50%, with some patients seeing reductions up to 69%. All without serious adverse effects.

In practice it means that instead of taking a pill every day, you could walk into a clinic once, get an infusion, and potentially never worry about cholesterol again. If bigger trials confirm it’s safe, this could end up being a true “one-and-done” solution.

The therapy essentially teaches your liver cells to make less PCSK9, letting your body clear extra LDL cholesterol on its own - almost like a built-in upgrade for your heart and arteries.

For Investors

From a pure investment perspective, the Verve acquisition tells an interesting story about both the sellers and the buyer.

Early investors who put ~$215 million into Verve pre-IPO walked away with ~$1.0 billion upfront - a clean 4-5× multiple. 

If you include the potential contingent value rights (CVRs), that multiple could reach 5-6×. 

Google Ventures (GV) did even better, turning their early $15-20 million investment into roughly 8-11× returns. These are the kinds of multiples that make biotech investing so attractive, despite the obvious risks.

But here's what's really interesting: Eli Lilly was willing to pay $1.3 billion for a technology that won't hit the market until the 2030s at the earliest. That's a massive bet on the future of gene therapy and a signal that Big Pharma sees this space as the next frontier.

Eli Lilly: The Bull and Bear Case

Why LLY Could Keep Running:

Lilly sits on what might be two of the most valuable franchises in modern medicine. Their GLP-1 portfolio (Mounjaro/Zepbound plus pipeline candidates like retatrutide and orforglipron) is growing at over 40% year-over-year in a market projected to hit $150 billion by 2030. The obesity epidemic isn't going away, and Lilly has arguably the best drugs to treat it.

The margins are attractive too. Despite the current premium valuation, the forward P/E of ~35 (compared to 62 trailing) suggests strong earnings growth ahead, with a PEG ratio around 1.2 indicating reasonable growth-adjusted valuation.

The Verve acquisition also shows strategic thinking beyond their current cash cows. By moving into gene therapy and cardiology, they're diversifying into what could be the next mega-category in medicine.

Why the Stock Might Be Getting Ahead of Itself:

Expensive valuation: LLY trades at 2–2.5× premium to Big Pharma company (which trades around 13× earnings).

The risks are real. VERVE-102 won't reach patients until the 2030s at the earliest, and gene therapy remains notoriously difficult to commercialize. Meanwhile, competition in the GLP-1 space is heating up, with Novo Nordisk and Roche breathing down their necks.

Perhaps most concerning is that the current $700+ billion market cap essentially assumes Lilly becomes the Apple of pharmaceuticals. That's a high bar to clear, even for a company with two blockbuster franchises.

The Bigger Picture

What's happening at Lilly reflects a broader shift in how we think about medicine. We're moving from daily management of chronic conditions to potential permanent cures through gene and cell therapy.

Cardiovascular medicine is ready for a shake-up. Heart disease is still the world’s top killer, and today’s therapies - though helpful - demand lifelong use and carry downsides.

If VERVE-102 delivers, it could pave the way for one-and-done treatments that replace daily pills. The same idea might someday address diabetes, high blood pressure, or even certain cancers.

The market opportunity is staggering.

The Bottom Line

Lilly stock is strong but undeniably expensive. It's a play for investors who believe in the long GLP-1 supercycle and want exposure to the future of gene therapy. Lilly is doing well, but its stock is already pricey. For investors willing to pay a premium for innovative medicines, the company offers fast growth now from its GLP-1 drugs and the potential for greater returns later from gene therapy. Just remember it won’t be cheap, and the path could be volatile as these treatments move through testing. The Verve deal looks costly today, but if it truly shapes the future of heart care, it might prove a bargain.Time will tell whether Lilly's $1.3 billion bet pays off - but the science behind it is undeniably exciting.