Lp(a)HORIZON topline results: pelacarsen lowered Lp(a) but did not reduce cardiovascular events, in a trial where background risk was exceptionally well controlled (mean LDL-C around 66 mg/dL). novartis.com/news/media-rele… There are many lessons here for future trials. Clinically, not all Lp(a) elevation is created equal. We need to know whether isoform differences drive risk and personalize management accordingly. Lp(a) also does not act in isolation. As we argued in our European Heart Journal editorial "Two to Tango" (academic.oup.com/eurheartj/a…), it is the interplay among risk factors that ultimately leads to cardiovascular events. Many researchers have shown that controlling modifiable risk factors substantially lowers risk in patients with elevated Lp(a), so knowing your number remains a powerful driver of prevention, even without a targeted therapy. This result changes nothing about the enormous burden of Lp(a) or the case for universal screening and public education. It sharpens the questions we must answer: who is at greatest risk, why, and how best to protect them. Preventive cardiology owes a great deal to Lp(a). It has unlocked the potential of prevention and CV risk modification. @hsbhatia @CMichaelGibson @MWilkinsonMD @DrMarthaGulati @DavidLBrownMD @kaulcsmc @RonBlankstein @Drroxmehran @DrEugeneYang @ProfKausikRay @VietHeartPA @drpablocorral @JohnKastelein @CBallantyneMD @Drroxmehran @escardio @ACCinTouch @hmkyale @ASPCardio @AnnMarieNavar @DrMichaelShapir @mdavidsonmd @EugeniaGianos @BudoffMd @MattRamsisMD @pnatarajanmd @EricTopol @EricAdler17 @society_eas