A corrective reanalysis of the alirocumab ODYSSEY trial reveals that approximately 70% of cardiovascular benefits stem from absolute reductions in lipoprotein(a) rather than LDL cholesterol lowering. This finding parallels prior evolocumab data showing 57% of benefit attributed to Lp(a) reduction, fundamentally challenging assumptions about how PCSK9 inhibitors work. The analysis suggests Lp(a) acts primarily during late-stage plaque destabilization rather than throughout atherosclerosis development like LDL-C, enabling shorter-term clinical benefits. Projections indicate targeted Lp(a) therapies could achieve unprecedented 50-60% reductions in major cardiovascular events, potentially benefiting 40% of secondary prevention patients versus the current 13-21% eligibility range. However, this preprint awaits peer review and its conclusions represent a significant departure from established cardiology paradigms. The methodology relies on post-hoc stratification of existing trial data, which introduces analytical limitations. If validated, these findings could reshape cardiovascular prevention strategies, suggesting that elevated Lp(a) may be a more actionable target than previously recognized, particularly for high-risk patients where dramatic risk reduction is needed.