Ziltivekimab

Not approved by any regulator. Ziltivekimab is an investigational biologic being studied in Phase 3 cardiovascular outcomes trials; it has no FDA, EMA or other marketing authorization for any indication. Its lead Phase 3 trial (ZEUS) missed its primary endpoint in July 2026, and two further outcomes trials (HERMES in heart failure and ARTEMIS after acute myocardial infarction) remain ongoing with readouts expected in the first half of 2027. Any product marketed to consumers as 'ziltivekimab' outside a regulated clinical trial is unverified and unsafe.

An approved, twice-yearly subcutaneous GalNAc-conjugated small interfering RNA (siRNA) from Novartis (originally discovered by Alnylam) that lowers LDL cholesterol by silencing PCSK9 (proprotein convertase subtilisin/kexin type 9), the liver protein that destroys LDL receptors. By switching off PCSK9 production inside hepatocytes, inclisiran leaves more LDL receptors on the liver surface to pull LDL cholesterol out of the blood - achieving roughly a 50% LDL reduction with an injection given only twice a year after a loading dose. Marketed as Leqvio, it was the first siRNA medicine approved for a chronic cardiovascular condition: the EU cleared it in December 2020 and the FDA in December 2021, and in July 2025 the FDA expanded the U.S. label to first-line monotherapy, dropping the requirement that it be added on top of a statin. Its Phase 3 ORION-9, ORION-10 and ORION-11 trials established the LDL benefit; a large cardiovascular outcomes program (VICTORION-2-PREVENT and others) is still running to test whether that LDL lowering prevents heart attacks and strokes. Inclisiran is the approved, real-world proof-of-concept for the GalNAc-siRNA cardiometabolic platform that newer investigational agents like zodasiran, solbinsiran, olpasiran and plozasiran build on.

An investigational, long-duration injectable small interfering RNA (siRNA) from Eli Lilly that lowers lipoprotein(a) [Lp(a)] by nearly 94% by silencing the LPA gene in the liver. A single dose keeps Lp(a) suppressed for a year or more, and its Phase 3 ACCLAIM-Lp(a) trial (~12,500 patients) is the first Lp(a) outcomes trial to include people who have not yet had a cardiovascular event.

The first oral, small-molecule inhibitor of lipoprotein(a) [Lp(a)] formation, from Eli Lilly. Instead of silencing a gene, muvalaplin is a once-daily pill that physically blocks apolipoprotein(a) from binding apolipoprotein B — the first step in building an Lp(a) particle. In its Phase 2 KRAKEN trial (published in JAMA, 2024) it cut Lp(a) by up to ~86% (placebo-adjusted) and, as of 2026, is the only Lp(a)-lowering drug that is both oral and already enrolling a large Phase 3 cardiovascular outcomes trial (MOVE-Lp(a)).

An investigational once-daily oral, highly selective CETP (cholesteryl ester transfer protein) inhibitor from NewAmsterdam Pharma (European partner Menarini) that lowers LDL cholesterol and lipoprotein(a) [Lp(a)] in a single pill. Unlike the failed first-generation CETP inhibitors, obicetrapib is valued for LDL and Lp(a) lowering rather than HDL raising. In Phase 3 it cut LDL-C by about a third as monotherapy (BROADWAY) and by roughly half combined with ezetimibe (TANDEM), and reduced Lp(a) by ~33% - published in NEJM and The Lancet (2025). It received a positive EMA CHMP opinion in July 2026 (as Ubeslo and Evlarco), with the PREVAIL cardiovascular outcomes trial due to report in 2026.

An FDA-approved subcutaneous antisense oligonucleotide (ASO) from Ionis Pharmaceuticals, branded Tryngolza, that lowers triglycerides by silencing the messenger RNA for apolipoprotein C-III (apoC-III). Self-injected once a month, it was the first-ever therapy approved for familial chylomicronemia syndrome (FCS) on December 19, 2024, and on June 24, 2026 it became the first and only treatment approved to reduce both triglycerides and the risk of acute pancreatitis in the far larger severe hypertriglyceridemia (sHTG) population.

An investigational, once-every-12-weeks injectable small interfering RNA (siRNA) from Amgen that lowers lipoprotein(a) [Lp(a)] by up to ~97% by silencing the LPA gene in the liver. Its Phase 3 OCEAN(a)-Outcomes cardiovascular outcomes trial (~7,000 patients) is one of the pivotal readouts — due December 2026 — that will help decide whether lowering Lp(a) prevents heart attacks and strokes.

A first-in-class, once-monthly injectable antisense oligonucleotide (ASO) from Ionis and Novartis that lowers lipoprotein(a) [Lp(a)] by shutting down apolipoprotein(a) production in the liver. Its pivotal Lp(a)HORIZON trial (8,323 patients) is the first-ever cardiovascular outcomes trial for any Lp(a)-lowering drug, with a landmark topline readout due in 2026.

An approved subcutaneous RNA interference (RNAi) therapy from Arrowhead Pharmaceuticals, branded Redemplo, that silences the gene for apolipoprotein C-III (apoC-III) to lower triglycerides. Given once every three months, it cut triglycerides by roughly 80% in familial chylomicronemia syndrome (FCS) and sharply reduced acute pancreatitis events. The FDA approved it on November 18, 2025 for FCS, and Phase 3 SHASTA-3 and SHASTA-4 (reported July 2026) extended those results to the far larger severe hypertriglyceridemia population.

A GLP-1 receptor agonist FDA-approved for type 2 diabetes and chronic weight management.

An investigational, once-weekly injectable long-acting analogue of the human hormone relaxin-2 from Eli Lilly, engineered as a selective agonist of the relaxin family peptide receptor 1 (RXFP1) and studied for chronic kidney disease and heart failure. Natural relaxin is a peptide hormone with vasodilatory, anti-inflammatory and anti-fibrotic effects, but it clears from the body within hours; volenrelaxin fuses relaxin-2 to an albumin-binding VHH (single-domain antibody) fragment that latches onto serum albumin to extend its half-life beyond ~40 hours in animals, allowing once-weekly subcutaneous dosing. In a randomized Phase 1 trial it increased effective renal plasma flow (a marker of kidney perfusion) by roughly 44-50% versus placebo, supporting development in chronic kidney disease and heart failure. However, in the Phase 2 RELAXIN-LA trial (n=332) in people with worsening heart failure with preserved ejection fraction (HFpEF), the program hit a wall: although the lowest 25 mg dose modestly improved the primary imaging endpoint (left atrial reservoir strain), the pooled higher doses were associated with WORSENING congestion - rising NT-proBNP, more estimated plasma volume, and a numerically higher rate of heart-failure hospitalizations - prompting the sponsor to stop the trial early, and the authors concluded the data do NOT support further evaluation of volenrelaxin in worsening HFpEF. Volenrelaxin is an investigational prescription-stage medicine studied only in clinical trials - it is not approved anywhere and is not a supplement or research chemical.

An investigational, long-acting injectable small interfering RNA (siRNA) from Silence Therapeutics that lowers lipoprotein(a) [Lp(a)] by more than 80% by silencing the LPA gene in the liver. Dosed only every 16–24 weeks, it produced durable ~90% reductions in its Phase 2 ALPACAR-360 trial (published in JAMA, 2024); as of 2026 the company is seeking a partner before starting its Phase 3 cardiovascular outcomes study.

Abelacimab (development code MAA868) is an investigational fully human monoclonal antibody being developed as a new kind of blood thinner (anticoagulant). It works by targeting Factor XI, a clotting protein that sits high in the coagulation 'cascade.' Abelacimab is described as a dual inhibitor: it binds the catalytic domain of Factor XI and locks the protein in its inactive (zymogen) shape, so it blocks both Factor XI itself and its activated form, Factor XIa, preventing the enzyme from being switched on by upstream triggers such as Factor XIIa or thrombin. The appeal of the Factor XI target is a long-standing observation in human biology: Factor XI contributes strongly to pathological clot formation (thrombosis) but only modestly to normal wound-sealing (hemostasis), so blocking it may prevent strokes and clots while causing much less bleeding than standard anticoagulants. Abelacimab is given as a once-monthly subcutaneous injection (with an intravenous loading option in some settings) and has a long duration of action. Its lead uses are stroke prevention in atrial fibrillation and the treatment and prevention of cancer-associated blood clots (venous thromboembolism, VTE). In the Phase 2b AZALEA-TIMI 71 trial, abelacimab reduced bleeding dramatically compared with the direct oral anticoagulant rivaroxaban - so much so that the study was stopped early - and it is now in Phase 3 development. Abelacimab was developed by Anthos Therapeutics, which Novartis originally helped launch and then reacquired in 2025. It is an investigational prescription biologic administered under medical supervision; it is not approved, and it is not a supplement, nootropic or research chemical.