Novartis’ pelacarsen failed to reduce cardiovascular death or emergencies such as heart attack or stroke in the Phase 3 HORIZON trial, dealing a blow to a closely watched strategy aimed at lowering Lp(a), a lipid-linked risk factor. The company said the drug did not meet the study’s objectives compared with placebo. The result marks another high-profile test of Lp(a) reduction in late-stage outcomes, and it will likely affect how sponsors prioritize the next generation of Lp(a)-targeting assets and trial designs. For the biotech pipeline, pelacarsen’s missed pivotal endpoint highlights how biomarker-driven narratives still face high hurdles when translating into hard clinical outcomes.