Current & upcoming therapies

Statin (HMG-CoA reductase inhibitor)

High-intensity statin, first-line therapy for most people with elevated LDL. Generic, widely available. TNT showed intensive atorvastatin dosing reduced major cardiovascular events versus lower-dose therapy.

Statin (HMG-CoA reductase inhibitor)

High-intensity statin, generic. JUPITER showed rosuvastatin reduced cardiovascular events in people with normal LDL but elevated CRP, broadening who statins are considered for.

Cholesterol absorption inhibitor

Usually added to a statin when LDL goals aren't met on statin alone. IMPROVE-IT showed adding ezetimibe to statin therapy further reduced cardiovascular events after acute coronary syndrome.

PCSK9 inhibitor (monoclonal antibody)

Injectable, typically every 2-4 weeks. Approved 2015. FOURIER showed evolocumab added to statin therapy further reduced cardiovascular events in people with established ASCVD.

PCSK9 inhibitor (monoclonal antibody)

Injectable, typically every 2-4 weeks. Approved 2015. ODYSSEY OUTCOMES showed alirocumab reduced cardiovascular events after a recent acute coronary syndrome.

siRNA (blocks PCSK9 production in the liver)

Injectable, only twice a year after the first two starter doses. Approved 2021. ORION trials showed sustained LDL reduction with infrequent dosing versus the every-2-4-week PCSK9 antibodies.

ATP-citrate lyase (ACL) inhibitor

Oral, once-daily pill, often used for statin-intolerant patients since it's not associated with the muscle-related side effects statins can cause. Approved 2020. CLEAR Outcomes showed reduced cardiovascular events in statin-intolerant patients.

PCSK9 inhibitor (third-generation, small recombinant fusion protein)

Once-monthly, self-administered injection, room-temperature stable for up to 3 months (most PCSK9 injectables need refrigeration). FDA-approved December 2025 for hypercholesterolemia including heterozygous FH, launched in the US in spring 2026 as a prefilled syringe, with an autoinjector following later in the year. A direct-to-patient cash program is available at $199/month.