Recent clinical trials of new heart disease medications, particularly the Lp(a) lowering drug Pelacarsen developed by Novartis, have resulted in unexpected failures, disappointing cardiologists and raising concerns within the medical community. Despite initial hopes that Pelacarsen would effectively reduce the risk of heart attacks and strokes by significantly lowering lipoprotein(a) levels, trials, including the Lp(a) HORIZON study, indicated no substantial benefits in preventing major cardiovascular events. Other trials involving competing drugs from Novo Nordisk also faced similar disappointing outcomes, leaving experts puzzled about the efficacy of these genetic cholesterol-targeting therapies.