PCSK9 Inhibitors

A newer class of cholesterol-lowering drugs

Usually prescribed when statins aren't enough or aren't tolerated

Given as injections every 2 to 4 weeks

Lower LDL far beyond what statins alone can do

Reduce risk of heart attacks and strokes

Generally well-tolerated however it is possible to get side effects such as injection site irritation or Flu-like symptoms

Unlike statins, there are no known liver or kidney toxicity and very few people need to stop because of side effects

Expensive and not always covered by insurance

Requires a clear reason to prescribe (e.g., proven heart disease, statin intolerance)

Block a protein called PCSK9, which breaks down LDL receptors in the liver

More receptors = more LDL pulled out of the blood

Result: massive drop in LDL—up to 60%

Also lower ApoB and Lp(a) in some people

People with familial hypercholesterolemia

Those with atherosclerosis who still have high LDL despite statins

People who can’t tolerate statins

South Asians often face high heart risk even with "normal" LDL—especially if ApoB or Lp(a) are elevated

Helpful for people with high genetic risk and/or can’t reach target LDL with statins