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Pelacarsen Lowers Lp(a) but Does Not Reduce Trial Events

lite News Desk 2 min read

Pelacarsen reduced Lp(a) levels without reducing the primary cardiovascular outcome in the Phase 3 Lp(a)HORIZON trial, according to results detailed by the American Heart Association. The full findings were presented in Chicago on November 7, 2026, during the association’s Scientific Sessions.

Pelacarsen remains investigational and uses an antisense oligonucleotide to reduce production of Lp(a) in the liver. According to the association, Lp(a) carries cholesterol, and genetics largely determine its level, which stays relatively constant throughout a person’s life.

Cleveland Clinic stated that the estimated reduction in Lp(a) with pelacarsen, compared with placebo, reached 77.7% at 12 months. For the primary cardiovascular outcome, however, the proportion was 12.3% among participants receiving pelacarsen, compared with 12.1% among those receiving placebo, over a median follow-up of 4.7 years. The hazard ratio reported for that comparison was 1.02, with a 95% confidence interval of 0.90–1.15.

The trial measured how long it took for a participant to experience the first of four events: death from cardiovascular causes, a heart attack that was not fatal, a nonfatal stroke, or urgent coronary revascularization that required hospitalization. Among participants whose starting Lp(a) level was at least 90 mg/dL, the primary outcome rate was identical in both groups, at 12.3%. The association stated that extended analyses also found no change in the other cardiovascular outcomes examined.

Enrollment totaled 8,323 adults across 42 countries and 797 sites, according to the association. Eligibility required established cardiovascular disease and an Lp(a) measurement of at least 70 mg/dL. Participants had experienced a cardiovascular event between three months and 10 years before screening.

Where needed, treatment for cardiovascular risk factors was optimized during a 30-to-90-day period before participants began monthly injections. The injections contained either 80 mg of pelacarsen or placebo.

According to study chair Steven Nissen, as reported by the American College of Cardiology, the findings concern pelacarsen use in people with established cardiovascular disease. Whether lowering Lp(a) prevents an initial cardiovascular event in a primary-prevention population was not tested in this study.

Novartis had announced on September 4, 2026, that the trial’s primary endpoint had not been met and that detailed findings would be presented at a subsequent medical congress. The American Heart Association’s November 7 release stated that The New England Journal of Medicine published the primary results, while NEJM Evidence published the extended analyses.

* This article is based on publicly available information at the time of writing.

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