A cardiologist writing for the New England Journal of Medicine says the results of a major cholesterol-related trial are “vindicating” — but the trial did not meet its primary endpoint, and the argument turns on reasoning that differs from the most straightforward reading of the data.
The New England Journal of Medicine posted a new entry to its NEJM Voices blog after the Lp(a)HORIZON trial results were presented at the American Heart Association’s 2026 scientific sessions, known as AHA26. The post was written by Dr M K Ittleson, who argues the findings carry a meaning that may surprise those who followed the trial closely.
Lipoprotein(a) — usually shortened to Lp(a) — is a fatty particle in the blood that research has long linked to a raised risk of heart disease and stroke. The Lp(a)HORIZON trial was designed to test whether lowering Lp(a) levels in the blood reduces that risk in practice. The trial did not meet its primary endpoint: pelacarsen did not significantly reduce major adverse cardiovascular events compared with placebo, despite substantially lowering Lp(a) levels — reportedly by around 78%. Dr Ittleson’s piece, published on the NEJM platform, describes the trial’s results as “vindicating” a particular position, though that characterisation reflects Dr Ittleson’s own commentary framing rather than the neutral primary outcome of the trial.
The full trial paper was published simultaneously in the NEJM alongside the AHA26 presentation. The NEJM Voices blog post is a commentary piece, with a link to the original trial publication offered as further reading alongside it.
Detailed results from the Lp(a)HORIZON trial were publicly reported alongside the presentation, including the extent of Lp(a) reduction achieved and the neutral cardiovascular event outcome. Readers wanting the full detail can consult the original trial paper via the NEJM directly.
Anyone with concerns about their cardiovascular (heart and blood vessel) health, including questions about cholesterol or inherited conditions affecting blood fats, should speak to their GP in the first instance. NHS 111 is available around the clock for health queries that can’t wait for a GP appointment.
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Source: @NEJM