Recent HORIZON results—discussed in parallel coverage with earlier conference presentations—underscored that lowering lipoprotein(a) does not necessarily translate into fewer major cardiovascular events. Despite pelacarsen’s marked reduction of Lp(a), the trial found no significant difference versus placebo for heart attacks, strokes, urgent coronary revascularization, or death over roughly five years. The implication for the sector is operational and strategic: developers targeting Lp(a) may face pressure to reassess endpoints, trial designs, and subgroup strategies even when biomarker reduction is substantial. Clinicians and investors will likely watch for how the field interprets the disconnect between Lp(a) reduction and hard outcomes for next-generation agents.