Kevin Lutz, MD, FACP
Aug 1 2022

There is a new kid on the cholesterol-lowering medications block. 

Circulatory SystemEndocrine SystemHeart HealthMedicationsMen’s HealthWomen’s Health

Most people are familiar with the class of medications called “statins.” If you have heard of Zocor, Lipitor and Crestor then you have heard about statins. For almost 30 years, statins have been the primary choice for lowering undesirable LDL cholesterol and (to a lesser extent) raising beneficial HDL. Despite what is written on Facebook Journal  of Medicine, statins are highly effective at lowering cholesterol with very uncommon side effects. In the perpetual quest for newer, and sometimes better, medications a new class of cholesterol medications has been invented. 

The newest addition to our toolbox of cholesterol medications is PCSK9 inhibitors. “PCSK9 inhibitor” is a mouthful and an improvement on “proprotein convertase subtilisin/kexin type 9 inhibitor.” They enhance the body’s ability to break down LDL molecules. PCSK9 inhibitors decrease your LDL cholesterol by up to 70%. They can cut the risk of a heart attack by almost one-third. Those are pretty impressive results. This compares to statins which reduce LDL up to 50% and the risk of heart attack by 25%. PCSK9 inhibitors can be used alone or in combination with statins. They are generally prescribed when statins alone are not adequately lowering LDL. 

This all sounds great, right? Surely there are some downsides to PCSK9 inhibitors. There are two big drawbacks. The first disadvantage is that both FDA-approved drugs currently available – Alirocumab (Praluent) and Evolocumab (Repatha) – are administered by injection. This can be done at the doctor’s office or at home every 2 – 4 weeks. The other problem is cost. With discount programs like GoodRx (discussed in my prior blog), both medications cost about $500 monthly. This is why they are not prescribed as first-line therapy for most patients. Like statins, possible side effects include muscle aches and weakness, fatigue, and less commonly liver and kidney problems. Also like statins, regular blood tests are necessary to monitor the effectiveness of the treatment. And, again like statins, treatment is life-long. 

This could scarcely be a blog from me if I didn’t emphasize the importance of life-style as the other important component in lowering LDL cholesterol and reducing the risks of heart attack and stroke. Eating a healthy diet, aerobic exercise multiple times a week, managing stress, sleeping at least seven to eight hours nightly, and avoiding all tobacco products are the keys to a good life.