Pharma bets a little-known form of cholesterol will underpin its next blockbuster heart drugs

novartis, amgen, and eli lilly are in late-stage trials for drugs that cut lp(a) — a little-known, genetic form of cholesterol that clogs arteries and promotes blood clots at the same time. about one in five people worldwide have elevated lp(a), and lifestyle changes like diet and exercise don't lower it. the first major readout comes from novartis later this year. the drugs have already been shown to slash lp(a) by more than 80%. but the key question is whether that translates into fewer heart attacks. novartis' phase 3 horizon trial was delayed a year because participants weren't having events as fast as expected — possibly because researchers were managing other risk factors. amgen's pivotal trial was also pushed back; the company now says it'll update timing in early 2027. lilly's phase 3 data isn't expected until 2029. less than 1% of u.s. adults were tested for lp(a) in 2024, per one study. some doctors don't screen because there's no approved drug to offer yet. if novartis' drug works, consensus estimates from evaluate project the class could hit $5.6 billion in annual sales by 2032. but goldman sachs analyst asad haider said investors are skeptical — nervous about the delays and whether the drugs will ever become mega-blockbusters.