Opinion: STAT+: A moment of reckoning for preventive cardiology and the precision medicine revolution

The item is a STAT opinion column by Vishal Khetpal, a preventive cardiologist and assistant professor of medicine at Northwestern University Feinberg School of Medicine, who writes The Workup, a STAT column about cardiology. Published Sept. 24, 2026, it frames recent trial news as a moment of reckoning for preventive cardiology and the precision medicine revolution.

Earlier this month, Novartis released top-line results from Lp(a) HORIZON, its highly anticipated Phase 3 trial of pelacarsen. Pelacarsen held promise as potentially the first approved therapeutic targeting lipoprotein(a), a genetically determined cholesterol particle strongly associated with heart attack and stroke risk. The study did show pelacarsen successfully lowered lipoprotein(a) levels, but it did not move the needle when it came to reducing cardiovascular events.

The announcement comes just weeks after the letdown of ZEUS, a Phase 3 trial evaluating Novo Nordisk's ziltivekimab, a monoclonal antibody targeting IL-6 as an anti-inflammatory agent. That trial was also successful in impacting its biological target without making a difference in clinical outcomes.

Together, the two results illustrate a gap between target engagement and hard clinical benefit in cardiovascular prevention, the central problem Khetpal explores. The full article is exclusive to STAT+ subscribers, so the available excerpt does not include his full proposed path forward.