For more than a decade, lipoprotein(a) had stood as one of cardiovascular medicine's most tantalizing unsolved problems — a heritable risk factor for heart attack and stroke that diet and statins could not touch. Novartis and Ionis had staked years of development on pelacarsen, an antisense drug designed to silence the genetic machinery behind Lp(a), believing it could open a new frontier in heart disease prevention. When the Lp(a)HORIZON Phase 3 trial returned in early September 2026 without the reduction in cardiovascular events it had been designed to detect, it delivered a reminder as old