Study of Long-Term Efficacy and Safety of LIB003 in CVD or High Risk for CVD Patients Needing Further LDL-C Reduction

Inclusion Criteria:

• Provision of written and signed informed consent prior to any study-specificprocedure;
• Weight of ≥40 kg (88 lb) and body mass index (BMI) ≥17 and ≤42 kg/m2;
• History of CVD, (including cerebrovascular or peripheral arterial disease) orvery-high risk for CVD as defined in the 2019 ESC/EAS Guidelines or
• High risk for CVD as defined in the 2019 ESC/EAS Guidelines
• At Screening or post Washout/Stabilization, LDL-C ≥70 mg/dL and TG ≤400 mg/dL while onstable lipid-lowering oral drug therapy (i.e., maximally tolerated statin with orwithout ezetimibe); Patients unable to tolerate approved doses of a statin may takelower than approved doses and dose less frequently than daily as long as the dose anddosing frequency is consistent; Patients with documentation of inability to tolerateany statin at any dose, or history of rhabdomyolysis, may also participate;
• Stable diet and lipid-lowering oral therapies (such as statins, ezetimibe, bile-acidsequestrants, OM-3 compounds, fenofibrate, bezafibrate, nicotinic acid, and bempedoicacid) or combinations thereof for at least 4 weeks
• Patients on a PCSK9 mAb at a dose of 75 mg, 140 mg, or 150 mg Q2W must undergo awashout period of ≥4 weeks after the last dose; for those on 300 mg or 420 mg Q4W (≤31days) the washout period is ≥8 weeks following last dose;
• Females of childbearing potential must be using a highly effective form of birthcontrol if sexually active and have a negative urine pregnancy test at the lastScreening Visit;

Exclusion Criteria:

• Use of prohibited oral lipid-lowering agents mipomersen or lomitapide within 6 monthsof screening, gemfibrozil within 6 weeks of screening, apheresis within 2 months priorto randomization; received other investigational agent(s) such as PCSK9 or Lp(a) siRNAor locked nucleic acid-reducing agents within 12 months of the Screening Visit;
• Documented history of HoFH defined clinically or genetically
• History of any prior or active clinical condition or acute and/or unstable systemicdisease compromising patient inclusion, at the discretion of the Investigator
• Females of childbearing potential who are sexually active, not using or unwilling touse a highly effective form of contraception, pregnant or breastfeeding, or who have apositive urine pregnancy test at the last Screening Visit;
• Moderate to severe renal dysfunction, defined as an eGFR <30 mL/min/1.73m2
• Active liver disease or hepatic dysfunction, history of liver transplant, and/or ALTor AST >2.5 × the ULN as determined by central laboratory analysis at screening
• Uncontrolled thyroid disease: hyperthyroidism or hypothyroidism
• Uncontrolled Type 1 or Type 2 DM, defined as FBS ≥200 mg/dL or HbA1C ≥9%;
• Uncontrolled serious cardiac arrhythmia, MI, unstable angina, PCI, CABG, placement ofimplantable cardioverter defibrillator or biventricular pacemaker, aortic valvesurgery, or stroke within 3 months prior to the Screening Visit;
• Planned cardiac surgery or revascularization;
• New York Heart Association class III-IV heart failure