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540-day follow up of lepodisiran in patients with elevated lipoprotein(a) (Lp(A)) shows the extended duration of action of lepodisiran will allow infrequent dosing in the ongoing cardiovascular outcome trial. Dr Steven Nissen (Cleveland Clinic, Cleveland, US) joins us onsite at ACC to discuss the ALPACA phase 2 trial (NCT05565742), investigating the safety and efficacy of lepodisiran, an extended duration small-interfering RNA for elevated lipoprotein(a). The primary outcome measure was the percent change from baseline in time averaged Lp(a). Findings showed that lepodisiran reduced time-averaged Lp(a) by 93.9% from day 60 to 180 following a dose of 400mg with no major safety concerns. Lp(A) reduction from days 30 to 360 was 88.5% after a single dose, and 94.8% after 2 doses (at baseline and day 180). Lp(A) levels remained 53.4% below baseline at 540 days after a single dose, and 74.2% at 360 days following a second dose. Interview Questions: 1. What is the reasoning behind the ALPACA phase 2 trial? 2. What was the study design and patient population? 3. What were the key findings? 4. What are the take-home messages for practice? 5. What further research is needed in this area? Recorded on-site at ACC in Chicago, 2025. Support: This is an independent interview produced by Radcliffe Cardiology. Visit Radcliffe Cardiology: https://www.radcliffecardiology.com/ This content is intended for healthcare professionals only. Radcliffe brings medical knowledge, insight and innovation to life for CV clinicians around the world, using our communications & creative expertise, our platforms and connections across the community to help transform theory into practice faster. Like us on Facebook: / radcliffecardiology Follow us on X: https://x.com/radcliffeCARDIO