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By Peter A. McCullough, MD, MPHMeasurement of lipoprotein (a) is standard of care in clinical lipidology. For decades we have been waiting for drugs that can effectively lower rates of this independent risk factor for atherosclerotic cardiovascular disease.🧬 The Pelacarsen Paradox: When Lowering a Risk Factor Fails to Lower RiskSeptember 13, 2026.In a result that will reshape clinical lipidology for a decade, Novartis announced on September 4 that its flagship antisense oligonucleotide (ASO),pelacarsen, failed to meet its primary endpoint in the pivotal Lp(a)HORIZON trial. Across more than 8,300 patients with elevated Lp(a) and established cardiovascular disease, pelacarsendidlower lipoprotein(a) — potently, and as designed — but that reduction didnottranslate into fewer heart attacks, strokes, cardiovascular deaths, or urgent revascularizations.Subscribe nowRead more