Lp(a)-Lowering Therapy Tracker

Your Lipid Context

Phenotype

Discordant monitor

High ApoB / non-HDL-C with CAC = 0 (Aug 2024)

Lp(a) status

Elevated target

Drives genetic ASCVD risk — Repatha alone insufficient

Current Rx leverage

PCSK9i (Repatha)

~25–30% incidental Lp(a) drop — bridge only

Age vs. trial windows

48 yrs edge case

Many CV-outcome trials require age ≥50–55 OR established ASCVD

Pipeline at a Glance

Peak Lp(a) Reduction (% from baseline)

Best-reported placebo-adjusted reduction from completed Phase 2/3 data.

Readiness Timeline

Expected milestone year for either readout or first-market approval.

Therapy Watchlist

Repatha (evolocumab)

Marketed

Lp(a) reduction

~27% (median)

Mechanism

Indirect (LDLR upreg)

CVOT result

VESALIUS-CV −25% MACE

Access

Insurance / cash

Bambos relevance: Currently the only approved option that touches Lp(a). A ~25–30% Lp(a) drop is not enough to clear high-risk thresholds (>125 nmol/L), but VESALIUS-CV (n=12,257, reported AHA 2025 / full data 2026) now proves benefit in primary prevention — his exact stratum.

NEW — VESALIUS-CV (updated 1 Jul 2026)

First PCSK9i primary-prevention CVOT: −25% first 3-point MACE overall and −31% in patients without known significant atherosclerosis (Bambos's category — CAC = 0, no events); −36% first MI; LDL-C driven to ~1.16 mmol/L (45 mg/dL); nominal −32% CV death, −24% all-cause mortality. A dedicated Lp(a) sub-analysis (Monguillon, EAS 2026) examined benefit across Lp(a) strata. Reframes Repatha from "bridge only" to RCT-proven risk reduction in his profile — discuss adherence/dose optimisation with Dr. Iffath rather than treating it as a placeholder.

Obicetrapib

EMA review · Launch H2 2026

Lp(a) reduction

~30–40%

LDL-C reduction

~33–41% (Ph3)

EU decision

H2 2026

Outcomes data

PREVAIL interim Q4 2026

EMA, MHRA and Swissmedic decisions expected H2 2026. Potential commercial launch via Menarini in Germany / UK by Q4 2026. PREVAIL CVOT (n=9,541) hits pre-specified interim at Q4 2026.

For your phenotype

Strategic dual-hit: meaningful Lp(a) AND ApoB / LDL-C lowering in a single oral. Likely the first new tool you could actually access — but US FDA approval timing is the unknown. Worth asking Dr. Iffath about expanded access / EU prescription routes once approved.

Pelacarsen (TQJ230)

Ph3 readout H1 2026 · imminent

Lp(a) reduction

~80% (Ph2)

CVOT

Lp(a) HORIZON (n=8,325)

Readout

1H 2026 (event-driven)

Filing

2H 2026 planned

First-ever cardiovascular outcomes trial for an Lp(a)-targeted therapy. The readout will define the field — if positive, it validates Lp(a) as a causal target and accelerates the entire siRNA cohort.

For your phenotype

Highest near-term signal. A positive HORIZON readout + 2H 2026 filing → potential US approval mid-2027. Best candidate to discuss for secondary prevention if your imaging picture evolves.

Olpasiran

Ph3 — readout late 2026/2027

Lp(a) reduction

>95% (Ph2)

CVOT

OCEAN(a) (NCT05581303)

Primary prev. trial

OCEAN(a)-PreEvent (NCT07136012)

End date

Dec 2026

Quarterly dosing is the clinical edge. Phase 2 OCEAN(a)-DOSE: Lp(a) still 40–50% below baseline nearly a year after stopping. New primary-prevention trial (OCEAN(a)-PreEvent) is critical for someone with CAC = 0.

For your phenotype

OCEAN(a)-PreEvent is the most relevant Phase 3 trial for you — designed for primary prevention patients with elevated Lp(a). However, current entry: ages 50–105. You're 48 — re-check eligibility in 2027.

NEW (Jul 2026): Amgen registered OCEAN(a)-CCTA (NCT07293260), a 406-patient imaging trial with a non-calcified plaque volume endpoint — the exact soft-plaque metric that matters for CAC = 0. Age floor is 35 (you clear it), Lp(a) ≥ 200 nmol/L, but it requires prior MI or PCI → not eligible (no established ASCVD). No Bay Area site yet.

Lepodisiran

Ph3 recruiting · readout 2029+

Lp(a) reduction

~94% (Ph2)

CVOT

ACCLAIM-Lp(a) (NCT06292013)

Enrollment

17,300 participants

Treatment dur.

~4 yrs avg

Sixth-monthly dosing potentially the most convenient profile in class. First Lp(a) trial to include primary prevention patients alongside secondary prevention.

For your phenotype

ACCLAIM eligibility: age 18+ with established ASCVD or age 55+ with risk factors. Your CAC = 0 makes the "established ASCVD" pathway uncertain. Stanford site currently not recruiting; UC system is. Worth asking Dr. Iffath about referral if you want trial access.

NEW (Jul 2026): Lilly registered ACCLAIM-CTA (NCT07613294), a Phase 3 coronary-plaque imaging trial (Lp(a) ≥ 175 nmol/L). Same gate: 18+ with established ASCVD, or 55+ with documented CAD/carotid/PAD. At 48 with CAC = 0 you clear neither arm → not eligible. Status: not-yet-recruiting; listed sites are San Diego-area (~750 km), no Bay Area presence.

Muvalaplin

Ph3 just launched (MOVE-Lp(a))

Lp(a) reduction

~85% (Ph2 intact)

CVOT

MOVE-Lp(a) (NCT07157774)

Enrollment

2,708 participants

Route

Oral (vs. all siRNAs SC)

Mechanistically distinct: disrupts the kringle-IV interaction that forms the Lp(a) particle. Oral route is a major adherence advantage. KRAKEN Phase 2 showed ~85% reduction by intact-Lp(a) assay.

For your phenotype

The most "lifestyle-compatible" candidate — daily pill, no injections. If MOVE-Lp(a) reads positive, this could be the long-term default. Track UCLA as the closest currently-listed site.

Zerlasiran (SLN360)

Phase 3 on hold (no partner)

Lp(a) reduction

~85% (Ph2 ALPACAR-360)

Dosing

Every 16–24 weeks

Status

Awaiting big-pharma partner

Readout

N/A until restart

Strong Phase 2 efficacy and infrequent dosing, but Silence has paused Ph3 CVOT until they secure a development partner. Watch for partnership news as the trigger event.

For your phenotype

Lowest priority for now. Monitor only — significant timeline risk. Restart announcement would be the trigger to upgrade this card.

Bay Area Trial Access (within ~50 km of Palo Alto)

Trial	NCT ID	Drug	Bay Area Site(s)	Status	Bambos Eligible?	Notes
Lp(a)FRONTIERS CAVS	NCT05646381	Pelacarsen	Stanford Healthcare · UCSF	Recruiting	No	Ages 50–80; requires calcific aortic valve stenosis
OCEAN(a)-PreEvent	NCT07136012	Olpasiran	UC Health system (UCSF/UCSD listed)	Recruiting	No	Ages 50–105; primary prevention focus — best fit when you turn 50 (Feb 2028)
OCEAN(a) Outcomes	NCT05581303	Olpasiran	UCSD	Recruiting	No	Requires established ASCVD; your CAC = 0 likely disqualifies
ACCLAIM-Lp(a)	NCT06292013	Lepodisiran	UC system (Stanford = NOT recruiting)	Recruiting (UC only)	Possibly	18+ with established ASCVD OR 55+ with risk factors. Ambiguous given CAC = 0; ask Dr. Iffath
MOVE-Lp(a)	NCT07157774	Muvalaplin	UCLA (closest currently listed)	Recruiting	Possibly	Verify CV-risk criteria; UCLA = ~560 km, only consider if eligibility opens
Pelacarsen + Inclisiran	NCT06813911	Pelacarsen	Site list pending	Recruiting	Possibly	Established ASCVD requirement; useful to monitor for new Bay Area sites

Optimization Protocol

Prioritized Actions

HIGH — Act on VESALIUS-CV (new): Repatha now has RCT-grade primary-prevention data (−31% first MACE in patients without established atherosclerosis) plus an EAS 2026 Lp(a) sub-analysis. Bring this to Dr. Iffath — it justifies treating Repatha as active protection, not a placeholder, and supports insurance coverage under the primary-prevention label.
HIGH — Watch HORIZON readout (now overdue): Pelacarsen Phase 3 topline was expected 1H 2026; that window has now elapsed with no announcement — readout is imminent. A positive result reshapes the entire risk-management conversation with Dr. Iffath.
HIGH — Track obicetrapib EU launch (Q4 2026): Likely the first new drug actually reachable. Discuss EU prescription / expanded-access pathways now so you're ready.
HIGH — Lock baseline Lp(a) in nmol/L (not mg/dL): Trial entry thresholds (≥175 nmol/L, ≥200 nmol/L) are stated in nmol/L. Request Quest reflex to LC-MS or isoform-independent assay at next draw.
MEDIUM — Re-evaluate ACCLAIM-Lp(a) eligibility: Stanford not recruiting; UCSF/UCSD are. The 18+ established-ASCVD arm is the only realistic pathway. Discuss with Dr. Iffath whether your discordant phenotype + family history could meet criteria.
MEDIUM — Consider advanced imaging: CCTA with plaque characterization would resolve the "established ASCVD?" ambiguity that gates several trials. CAC = 0 doesn't rule out non-calcified soft plaque — the exact phenotype Lp(a) drives.
LOW — Bookmark OCEAN(a)-PreEvent for Feb 2028: When you turn 50 you become eligible for the only major primary prevention Lp(a) outcomes trial. Set a calendar reminder.
LOW — Monitor Zerlasiran partnership news: A partnership announcement = trigger to upgrade this card and explore Ph3 entry.