Until recently, cardiologists believed they were nearing a breakthrough in heart disease treatment. Three companies were running extensive clinical trials to test drugs that reduce the levels of a blood protein known as Lp(a), associated with heart attacks and strokes. Doctors were optimistic, hoping this new drug would be as significant as statins.

However, when Novartis, the first to finish its trial, announced its findings, cardiologists were taken aback. Despite the drug’s ability to lower Lp(a) levels by 80 percent, it did not prevent heart attacks and strokes. Dr. John Alexander, a cardiologist at Duke, commented, “There’s something we don’t understand here.”

Cardiologists often encounter patients who suffer heart attacks despite having low cholesterol and blood pressure. These patients usually don’t have diabetes, obesity, or smoke. Yet, they frequently have elevated Lp(a) levels. Around 20 percent of Americans have high levels of this protein; the highest levels can double or even triple heart attack risk.

The significance of Lp(a) was clear. Cardiologists hoped a drug that reduces this protein could help those patients protect themselves from heart disease.