Living dossier · Competitive landscape

Lp(a) in Atherosclerotic cardiovascular disease

Primary identifiers: 9
Sponsors tracked: 6
Evidence types: 2 of 3
Last refreshed: 2026-07-28 · daily

MightyRayn panel synthesis

OmniRayn’s reading of this landscape — our interpretation, not a registry fact

The largest bet in cardiovascular medicine currently resting on no outcome data at all. Lp(a) is an inherited, causal risk factor on genetic evidence, and these agents cut circulating levels by roughly 80 to 90 percent — but as of the reviews cited here, no therapy has been approved that specifically lowers Lp(a), and none has shown a reduction in cardiovascular events. The registry shows three outcome trials each enrolling on the order of ten thousand participants, which is the industry committing at enormous scale to a biomarker whose translation is modelled rather than demonstrated. Two things to watch. Modelling implies a large ABSOLUTE reduction is what matters, so percentage lowering may be the wrong yardstick and a patient's starting level may decide who benefits. And route is already separating the field: injectable antisense and siRNA agents dominate, while oral small molecules that block particle assembly have now reached Phase 3 — a materially different adherence profile for a lifelong preventive indication.

Programs and primary evidence

Sponsor	Asset	Phase	Mechanism	Primary source
Amgen	Olpasiran (OCEAN(a) Outcomes)	3	siRNA against apolipoprotein(a) synthesis	NCT05581303 — Outcome trial of major cardiovascular events in established disease with elevated Lp(a), enrolling over seven thousand participants
Amgen	Olpasiran (primary prevention)	3	siRNA against apolipoprotein(a), moved to primary prevention	NCT07136012 — Prevention of a FIRST major cardiovascular event in participants with elevated Lp(a), enrolling around eleven thousand
Amgen	Olpasiran (plaque imaging)	3	imaging endpoint rather than an event endpoint	NCT07293260 — Effect on coronary artery plaque burden by CT angiography in stable disease with elevated Lp(a)
Novartis Pharmaceuticals	Pelacarsen with background inclisiran	3	antisense oligonucleotide against apo(a), on top of an LDL-lowering siRNA	NCT06813911 — In participants with established disease and elevated LDL-C and Lp(a) — testing the combination rather than the agent alone
Eli Lilly and Company	Muvalaplin (oral)	3	oral small molecule blocking Lp(a) particle formation	NCT07157774 — Outcome trial in secondary and primary prevention, enrolling over ten thousand — the oral route entering at outcome scale
Novartis Pharmaceuticals	DII235	2	second Lp(a)-lowering agent from the same sponsor	NCT07235046 — Dose-finding study in adults with elevated Lp(a)
Shenzhen Salubris Pharmaceuticals	SAL0137 (oral)	2	oral agent for elevated Lp(a)	NCT07729475 — Phase 2 in adults with elevated Lp(a) and increased cardiovascular risk — a second oral entrant
Qassim University	review	—	apo(a) synthesis inhibition and particle-assembly inhibition	10.3389/fmed.2025.1727918 — States that NO therapy has yet been approved that specifically lowers Lp(a) or demonstrated a reduction in cardiovascular events, despite reductions of roughly 80-90 percent in circulating levels; modelling suggests a large ABSOLUTE reduction is required for meaningful benefit
International Hellenic University	review	—	GalNAc-conjugated ASO and siRNA hepatocyte targeting; oral inhibitor of particle formation	10.3390/ph18050753 — Maps the modalities — pelacarsen as an antisense oligonucleotide, olpasiran, zerlasiran and lepodisiran as siRNA agents, muvalaplin as an oral small molecule — and notes no drug is officially approved for lowering Lp(a)

Method and limits

Programs are enumerated from primary registries (ClinicalTrials.gov, PubMed). A program appears here only if a primary record links this target to this indication as a therapeutic hypothesis — associations and risk markers are excluded by design.
Every claim above carries the identifier it rests on. We report what the record states; we do not assert efficacy, and computational findings are pending wet-lab confirmation.
Absence is not evidence of absence: unregistered, non-US and stealth-stage programs are not visible to these sources.
This page refreshes daily (new primary entity 1d ago — landscape still moving). Mechanism classifications are our reading of the public record and may be revised.

Want the analysis behind this landscape?

The public page is the map. The full dossier adds differentiation analysis, kill-tests and the whitespace read for this target — the parts we do not publish.

Request the full dossier All landscapes