The first Lp(a) drug failed its outcomes trial. Now what?

A note from Dr. Goel

Here's what's new at Peak Human this week. The headline is cardiovascular: the first drug built to lower lipoprotein(a) has reported its outcomes trial, and the result was not what many of us hoped for. I also published two evidence reviews on protein.

— Dr. Sanjeev Goel

Your Lp(a) is high and the first drug failed

Novartis announced on Sept 4, 2026 that pelacarsen did not meet the primary endpoint of Lp(a)HORIZON (8,323 patients with elevated Lp(a) and established CVD). Hazard ratios and the size of Lp(a) reduction were not yet published; full data expected at AHA in November. In UK Biobank (Cesaro et al., 2026; n=237,729), Lp(a) ≥105 nmol/L was associated with more revascularisation (recurrent-event HR 1.50, 95% CI 1.42-1.60).

My take: A single negative outcomes trial with full data pending is a reason to hold judgment, not abandon testing. Measure Lp(a) once and intensify ApoB, blood pressure, smoking, fitness and glucose management.

How much protein to build muscle?

The 1.6 g/kg/day figure comes from Morton et al. 2018 (49 trials, 1,863 people); the breakpoint 95% CI was 1.03-2.20 and not statistically significant. Tagawa et al. 2021 (105 trials) saw diminishing returns above ~1.3 g/kg. PROT-AGE (2013): at least 1.0-1.2 g/kg/day for older adults.

Protein timing: does when you eat it matter?

Schoenfeld 2013 meta-analysis of 23 trials: timing effect size 0.24 fell to 0.16 (p=0.18) after adjusting for total intake. Trommelen 2023: ~40% higher muscle protein synthesis with 100 g vs 25 g.

⚕️ Important disclaimer

This newsletter is for educational purposes for licensed healthcare professionals and is not medical advice for any individual patient. It summarizes published research and does not constitute a recommendation for or against any treatment. Investigational therapies discussed are not approved for the uses described. Clinical decisions should reflect your own judgment, patient circumstances and current guidelines.