Lipoprotein(a), or Lp(a), is an inherited cholesterol-like particle that raises the risk of heart attack, stroke, and aortic valve disease — independently of LDL. About 1 in 5 people have elevated levels, but no drug has ever meaningfully lowered it. That is changing: the first dedicated Lp(a)-lowering medicines are now in late-stage trials.
What's actually going on in research
Several first-in-class drugs that switch off Lp(a) production are in Phase 3 trials, including pelacarsen (a monthly injection from Novartis), olpasiran (a longer-acting injection from Amgen), and muvalaplin (the first oral option, from Eli Lilly). These trials are measuring whether driving Lp(a) down by 70-90% actually prevents heart attacks and strokes — the answer over the next 1-2 years will reshape cardiovascular prevention. Smaller studies are exploring gene-editing approaches and the role of Lp(a) in aortic stenosis.
First Lp(a)-lowering drugs
Pelacarsen, olpasiran, and the oral pill muvalaplin are all in Phase 3 trials and have shown they can drive Lp(a) levels down by 70-90% in earlier studies. The next 1-2 years will reveal whether that translates into fewer heart attacks and strokes.
Oral options
Muvalaplin is the first pill that meaningfully lowers Lp(a) — a major step beyond the injectable approach, since most patients will likely need lifelong treatment. Other oral candidates are in earlier trials.
Cardiovascular outcomes data
Researchers are testing whether lowering Lp(a) prevents real-world cardiovascular events, not just lab values. The pelacarsen Phase 3 trial (Lp(a)HORIZON) and the muvalaplin Phase 3 trial are both designed to answer this question for people with established heart disease and high Lp(a).
What to know before you search
Eligibility usually depends on Lp(a) level (often above 70-90 mg/dL or 150-200 nmol/L), a history of cardiovascular disease, and current LDL-lowering medication.
What types of trials are currently open
- Treatment trials — Testing new Lp(a)-lowering drugs — both injections and pills — in people with elevated Lp(a).
- Cardiovascular outcomes trials — Measuring whether lowering Lp(a) actually reduces heart attacks, strokes, and other cardiovascular events.
- Screening studies — Identifying people with high Lp(a) earlier, often through family-history-driven testing or routine cholesterol panels.
- Observational studies — Tracking long-term cardiovascular outcomes in people with elevated Lp(a) to better understand how risk evolves.
- Combination trials — Testing Lp(a)-lowering drugs alongside existing cholesterol or blood-pressure treatments to see if combined strategies improve outcomes.
Recently added Lipoprotein(a) trials
Low-carbohydrate Diet and Low-Density Lipoprotein - Cholesterol (LDL-c) Interindividual Variability
Ketogenic diets are very low-carbohydrate diets that increase hepatic production of ketone bodies, which have several effects as substrates and signals. Ketogenic diets are used to manage some conditions (e.g., drug-resistant epilepsy), and their potential for managing many other conditions (e.g., cancer) is being actively explored. Indeed, the British Dietetic Association acknowledge the potential for ketogenic diets to improve glycaemic control to a greater extent than some other diets in people with type 2 diabetes. A lower fasting glucose is also relevant to future mortality in people without diabetes. Ketogenic diets are popular in the general population, with up to 15% of the UK following a low-carbohydrate diet. There is, therefore, great interest in ketogenic diets amongst people with and without health conditions. However, although the diet shows promising results in improving blood sugar levels, it has also shown to increase low-density lipoprotein-cholesterol (LDL-c) in some individuals, which has been linked to increased cardiovascular health risks. The aim of this project is to find the potential for personalised use of (or guidance to avoid) ketogenic diets for cardiovascular disease risk. To do that the investigators will ask participants to replicate 24 hours of a ketogenic diet and a control diet thrice each. This will allow the investigators to find variability between responses and have a better idea of individuals who could benefit (or not) from following the ketogenic diet.
Take an injection to reduce plaque buildup in your heart arteries
Lipoprotein(a), also known as Lp(a), is a protein that carries cholesterol and proteins in your blood. People with high Lp(a) have a higher risk for heart disease. The main purpose of the study is to investigate how lepodisiran, compared to a placebo, affects the amount and type of plaque in the heart's vessels using an imaging technology known as Coronary Computed Tomography Angiography (CCTA) in adults who have high levels of Lp(a). Participation will last about 120 weeks.
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