Triglyceride Drug Fails to Reduce Artery Plaque in Year

Olezarsen lowered triglycerides but did not affect non-calcified coronary plaque volume in high-risk patients.

Mar. 31, 2026 at 5:40am

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A highly detailed, translucent X-ray photograph of the intricate structure of a human coronary artery, with ghostly white and grey lines representing the blood vessels and plaque buildup.An X-ray view of the complex inner workings of the coronary arteries, highlighting the challenge of reducing plaque buildup through triglyceride-lowering drugs alone.New Orleans Today

Despite experiencing significant reductions in triglycerides, patients with triglycerides over 150 mg/dL and a high risk of atherosclerosis did not experience any significant change in the amount of non-calcified plaque in their coronary arteries after taking the triglyceride-lowering drug olezarsen, in a one-year sub-study presented at the American College of Cardiology's Annual Scientific Session (ACC.26).

Why it matters

Triglycerides are linked to increased cardiovascular risk, but therapies designed to lower triglycerides have not delivered clear benefits in reducing the risk of serious cardiac events. This study suggests that lowering triglycerides alone may not be enough to slow or reverse plaque buildup in the arteries.

The details

The study included 468 participants who underwent coronary computed tomography angiography (CCTA) at baseline and 12 months after randomization. Participants were randomly assigned to receive olezarsen at either 50 mg or 80 mg per day or a placebo. While olezarsen significantly lowered triglycerides and apolipoprotein B, it did not affect the volume of non-calcified plaque in the coronary arteries compared to placebo.

  • The study's 12-month follow-up is relatively short, although researchers said that this length of time should have been long enough to observe differences in plaque volume.
  • The study was presented at the American College of Cardiology's Annual Scientific Session (ACC.26) on March 30, 2026.

The players

Nicholas Marston

A cardiologist and assistant professor of medicine at Brigham and Women's Hospital and Harvard Medical School in Boston, and the study's lead author.

Ionis Pharmaceuticals

The maker of olezarsen, the triglyceride-lowering drug used in the study.

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What they’re saying

“Treatment with olezarsen on top of standard of care lipid-lowering therapy in patients with largely moderate hypertriglyceridemia substantially lowers triglycerides and remnant cholesterol and modestly lowers ApoB, but did not affect non-calcified coronary plaque volume at 12 months.”

— Nicholas Marston, Cardiologist and lead author

“Ultimately, a cardiovascular outcomes trial would need to be performed to determine the cardiovascular benefit of long-term ApoC3 inhibition, tested either as a monotherapy or in combination with another lipid-lowering therapy.”

— Nicholas Marston, Cardiologist and lead author

What’s next

Researchers said that more studies are needed with longer duration to fully understand the relationship between triglyceride-lowering and plaque reduction.

The takeaway

This study suggests that lowering triglycerides alone may not be enough to slow or reverse plaque buildup in the arteries, and that a more comprehensive approach targeting multiple lipid markers may be necessary to see measurable effects on cardiovascular health.