Lepodisiran: From genetic targeting to cardiovascular promise: A detailed narrative review of the literature.

Elevated lipoprotein(a) [Lp(a)] is a major independent risk factor for atherosclerotic cardiovascular disease (ASCVD), with limited response to traditional lipid-lowering therapies. Lepodisiran, a novel N-acetylgalactosamine-conjugated small interfering RNA, targets hepatic message RNA to reduce apolipoprotein(a) production. Early-phase trials demonstrated > 90% sustained Lp(a) reduction with excellent safety and tolerability. The phase 2 ALPACA trial confirmed durable effects lasting up to one year after biannual dosing. Compared to other therapies, lepodisiran offers longer duration, high efficacy, and minimal side effects. Ongoing phase 3 studies aim to determine its impact on cardiovascular outcomes, potentially establishing a new standard in precise ASCVD risk management.