TL;DR
For years, cardiology's next big hope after "bad" cholesterol was a drug for lipoprotein(a), or Lp(a), a heart-risk particle whose level is set by genes. The first large test of that idea is in, and it missed. Novartis's pelacarsen lowered Lp(a) in 8,323 people with heart disease but did not significantly cut heart attacks, strokes, heart deaths or emergency artery procedures. That does not end the idea. Three rival drugs from Lilly, Amgen and Silence Therapeutics are still coming, and the trial's patients already had very low cholesterol, which may have left little room to help. But for now nobody can say that lowering this inherited particle prevents a single heart attack, and the day it becomes routine prevention has moved later.
Below the line, for paid subscribers: The full story: where it stands, how we got here and what's dated next; our Odds board on 5 milestones, starting with "Full Lp(a)HORIZON results, with event counts, are presented by 2027"; our labeled speculation on what it adds up to; and every source.