From Men's Health · Christopher Kelly M.D. · · 1m 30s
The Lp(a) Drug That Missed
A blockbuster cholesterol drug just failed its big trial, and it may mean we've been aiming at the wrong target.
In brief
A blockbuster cholesterol drug just failed its big trial, and it may mean we've been aiming at the wrong target. Lipoprotein(a) predicts heart risk, but lowering it may not reduce it. Until better data arrives, the boring basics still do the work. Originally reported by Men's Health.
The drug everyone bet on
On September 4, Novartis said pelacarsen failed to cut cardiovascular death, heart attack, or stroke. One of cardiology's most anticipated drugs came up empty.
“A clinical trial rocked the cardiology community this week, not for what it showed, but for what it didn't.”
Why Lp(a) got the spotlight
New AHA and ACC guidelines this year say every adult should have lipoprotein(a) checked once. It's genetically set, barely moved by diet or exercise, and strongly predicts heart attack and stroke.
Lowering it by 80 percent
Pelacarsen, olpasiran, and lepodisiran all drop Lp(a) levels by 80 percent or more. Nobody had proven that the number going down meant fewer heart attacks.
What the trial actually did
Lp(a)HORIZON enrolled over 8,300 patients with existing heart disease and high Lp(a), randomized them to drug or placebo on top of standard care, and followed them for years.
Alarm, not the fire
The miss raises a hard possibility: Lp(a) may mark risk without causing it. Cardiology has been here before, when niacin raised good cholesterol but prevented nothing.
“we might be turning off the fire alarm rather than extinguishing the fire”
What to do this week
Only top-line data is out, and other Lp(a) drugs are still in trials. Meanwhile: control blood pressure, cholesterol and blood sugar, eat plants, move often, skip tobacco, limit alcohol, sleep well.
The key point
Lipoprotein(a) predicts heart risk, but lowering it may not reduce it. Until better data arrives, the boring basics still do the work.
