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What a better lab number is worth: Lp(a), inflammation, BP — 4 stories

ResearchDigest · 4 storiesMedicine and treatment

4 stories this week: inherited cholesterol, inflammation in heart and kidney disease, blood pressure after a stroke and anaesthesia in young children. Three large trials from the American Heart Association meeting and one children's trial, each with who was studied and what it does not show.

In a phase 3 trial, a drug lowered lipoprotein(a) by 78%, yet heart attacks and strokes did not fall

An open laboratory centrifuge holding tubes of pale yellow serum beside a pipette stand

On 7 November 2026, at the American Heart Association Scientific Sessions in Chicago, investigators presented Lp(a) HORIZON, a double-blind, placebo-controlled phase 3 trial of pelacarsen, published the same day in the New England Journal of Medicine. Lipoprotein(a) is a cholesterol-carrying particle whose level is set mostly by genes and barely moves with diet, exercise or statins. The trial enrolled 8,323 adults at 797 sites in 42 countries. All had established cardiovascular disease, 82% had had a heart attack, and their lipoprotein(a) was at least 70 mg/dL (about 148 nmol/L), roughly the top fifth of the population. They received pelacarsen, an antisense drug that blocks production of the particle in the liver, or placebo as a monthly injection under the skin, on top of usual care; 77–78% were taking high-intensity statins.

Lipoprotein(a) fell by an average of 78% on pelacarsen. The time to a first heart attack, stroke, urgent procedure to reopen a heart artery or cardiovascular death did not differ from placebo, and the result was the same in people with levels of 90 mg/dL or more and for death from any cause. Serious adverse events were reported in 37.3% on the drug and 41.1% on placebo, but flu-like symptoms, injection-site reactions and allergic reactions were more common on pelacarsen, with anaphylaxis in 19 people and none on placebo. About 21% on the drug and just over 7% on placebo stopped treatment because of side effects.

The senior author called the result neutral across every analysis and stressed that it does not make lipoprotein(a) irrelevant as a risk marker; three outcome trials of drugs that lower it in other ways are still running. According to the American Heart Association, there is no FDA-approved treatment to lower lipoprotein(a). The trial was funded by Novartis.

An anti-inflammatory injection cut CRP by 64% in people with heart and kidney disease, without fewer heart attacks or strokes

An open hospital refrigerator with white cartons and trays of prefilled syringes in cool light

The same morning ZEUS was presented and published in the New England Journal of Medicine. It tested ziltivekimab, an investigational monoclonal antibody that blocks interleukin-6, a signalling protein that drives inflammation. The trial enrolled 6,376 adults at 757 sites in 38 countries. All had atherosclerotic cardiovascular disease, clinically significant chronic kidney disease and high-sensitivity C-reactive protein of at least 2 mg/L. Their average age was 69.4 years, 27.5% were women, 92% had high blood pressure, about 66% had type 2 diabetes and 42% had heart failure. They received a monthly injection of ziltivekimab or placebo in addition to usual care, for a median of 29.1 months.

Compared with placebo, the drug lowered C-reactive protein by 64% and interleukin-6 by 76%. A heart attack, stroke or cardiovascular death occurred in 561 people on ziltivekimab and 565 on placebo. Overall side effects were similar, but serious infections were more common on the drug, 20% against 18%. People who started with higher inflammation markers stayed at higher risk throughout the trial.

The lead author suggested that the disease in this group may have been too advanced for the drug to help, and noted that earlier trials of other anti-inflammatory approaches did reduce cardiovascular events in other groups of patients. Next trials will test interleukin-6 blockade earlier in the disease and drugs that act further upstream, on the NLRP3 inflammasome. The trial was funded by Novo Nordisk, which develops the drug.

After an ischaemic stroke, a systolic target below 120 instead of 140 mm Hg lowered major cardiovascular events by about a fifth

A home blood pressure monitor and cuff on a wooden kitchen table next to a glass of water and a notebook in the morning

OPTIMAL-STROKE, presented on 7 November at the same meeting and published in the New England Journal of Medicine, is the first trial large enough to test how low blood pressure should be treated after an ischaemic stroke or a transient ischaemic attack. At 30 centres in Brazil, between 2019 and 2022, it enrolled 4,368 adults with high blood pressure who had had such an event and had been clinically stable for at least 48 hours. Their average age was 64, 47.9% were women and their average blood pressure at entry was 146.7/81.6 mm Hg. In an open-label design with blinded assessment of outcomes, they were randomly assigned to a systolic target below 120 or below 140 mm Hg, reached with existing blood pressure medicines.

The average systolic pressure achieved was 122 against 135.2 mm Hg, a difference of 13.1 mm Hg. Over a median of 3.9 years, cardiovascular death, a non-fatal heart attack or stroke, or a hospital stay for unstable angina or heart failure occurred in 10.9% (236 people) with the lower target and 13.5% (297) with the standard one, a hazard ratio of 0.79 (95% CI 0.67 to 0.94). Repeat strokes occurred in 4.7% against 6.4%, mostly because there were fewer ischaemic strokes. Serious adverse events were similar.

Kidney events were more frequent with the lower target, 3.9% against 2.2%, mainly a sustained drop in kidney function, with no increase in dialysis or kidney deaths. Not everyone in the intensive group reached the target, the trial was open-label and was run only in Brazil. The authors stress that a lower target needs medical supervision and monitoring of kidney function, so a personal target is a question to discuss with a doctor. Funding sources are listed in the publication; several investigators report ties to Bayer and Boehringer Ingelheim.

In young children having tonsils and adenoids removed, a laryngeal mask cut breathing complications from 58% to 23%

Children's airway masks on a green sterile drape in an empty operating room in front of an anaesthesia machine

On 4 November 2026 The BMJ published a randomised trial from four large hospitals in China, carried out in 2023–24. It included 400 children aged 2 to under 7 years, 4.7 years on average, who were having their adenoids and tonsils removed under general anaesthesia. During the operation they breathed either through a laryngeal mask, which sits above the vocal cords, or through an endotracheal tube, which passes between them, 200 children in each group. The main outcome was any breathing complication around the operation: spasm of the vocal cords or airways, a drop in blood oxygen, airway obstruction, severe cough or noisy breathing.

Such complications occurred in 22.5% of children with the mask and 57.5% with the tube, a difference of 35.0 percentage points (95% CI 25.7 to 43.5). The gap was largest after the operation, 16.5% against 49.5%. Severe cough affected 10.5% against 42.0% of children, a drop in oxygen 15.0% against 28.0%, airway obstruction 3.5% against 12.5%, and spasm of the vocal cords 0% against 3.0%. In three children the mask was replaced with a tube. There were no serious adverse events in either group.

The masks were placed by experienced anaesthesiologists in specialist centres, the trial ran in one country and it measured events in the hours around surgery, not long-term results. The choice of airway stays with the anaesthesia team, and parents can ask which one is planned and why. The trial was funded by the National Natural Science Foundation of China and a Shanghai research programme.

This article is for information only and does not replace a consultation with a doctor. Nothing in it is a recommendation to start, stop or change treatment.

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