Novartis and Ionis developed pelacarsen, an experimental antisense oligonucleotide targeting elevated Lp(a) in patients with established cardiovascular disease. The Lp(a)HORIZON Phase 3 trial, a closely watched pivotal study, failed to meet its primary endpoint on major adverse cardiovascular events. Analyses from progressive, conservative, and libertarian perspectives interpret the outcome differently, while a devil's advocate view highlights unexamined trial details and regulatory factors.