Novartis’ pelacarsen failed to meet its primary goal in a pivotal Phase 3 outcomes study, as the company said the drug did not reduce cardiovascular death or emergencies such as heart attack or stroke compared with placebo. Pelacarsen is designed to lower lipoprotein(a) [Lp(a)], a genetically linked risk factor implicated in atherosclerotic events. The readout intensifies debate about whether Lp(a) reduction alone translates into measurable event prevention, despite earlier trials showing substantial biomarker effects. The failure also highlights continued uncertainty for the emerging class of cardiovascular therapies targeting Lp(a) biology. For biotech and big pharma alike, the HORIZON result is a high-visibility caution: even when pharmacology drives Lp(a) lower, translating that change into hard clinical outcomes remains difficult.