About 1 in 5 people walk around with a heart attack risk that diet and gym time cannot fix.
The risk is called Lp(a). It is a bad kind of cholesterol that clogs the arteries and helps form blood clots at the same time.
Doctors first found the link to heart attacks back in 1963. They did not have a fix then, and they still do not.
Three big drugmakers want to change that. The first real proof point lands this summer.
Novartis, Amgen and Eli Lilly each have a drug in Phase 3 testing. All three have shown they can cut Lp(a) by more than 80%.
The big test now is whether that cut keeps people from heart attacks and strokes. Genes say yes, but the trial has to prove it.
Novartis goes first with a drug called pelacarsen. It runs with partner Ionis in the Horizon trial led by Cleveland Clinic's Dr. Steve Nissen.
The firm hopes to share data in the middle of the year. The trial took an extra year because people in the study had fewer heart events than planned.
CEO Vas Narasimhan said the drug could form a whole new class of meds for patients with no other choice.
Goldman Sachs analyst Asad Haider said the Novartis read is the moment that sets the tone for the whole class of drugs.
Amgen's drug olpasiran was set for late this year or early next, but the firm now says it will share a fresh date in early 2027. Lilly's drug lepodisiran is not due until 2029.
Lilly is not waiting around. It is also testing a daily Lp(a) pill, and it bought a small firm that wants to use gene tools as a one-shot fix.
The total prize, per Evaluate, is $5.6 billion in sales each year by 2032.
That number is not a sure thing. Morningstar analyst Jay Lee said the class will take time to build up since the first drug will likely be used only on people with high Lp(a) who already had a heart event.
Even with three drugs in the works, doctors are barely testing for the risk they would treat. Less than 1% of US adults had Lp(a) checked in 2024.
Heart groups have started to push for testing all adults at least once. The Family Heart Foundation, run by Katherine Wilemon, wants Lp(a) added to the standard cholesterol panel doctors order.
The test itself is not new. It is a routine blood draw, just like the one used for LDL or total cholesterol.
The hold-up has been simple. Doctors did not want to flag a problem they could not treat.
A new drug class would change that math.
Drug approvals are one piece, and building a real market is the other. That part starts with a blood test most people have never heard of.
If Novartis hits this summer, that talk gets a lot louder.
