lipid.siteYour guide
Facts get you halfway. Your priorities cover the rest. Set the dials, and see which options fit.
Room 9 · The Compass
Which option fits me?
About 3 minutes
The Compass
Set the dials. The needle will swing to the option that fits what you say matters.
Bigger, brighter dots fit your dials better. It mirrors your answers, for you and your clinician to talk over.
What matters to you?
Turn each dial from “doesn't matter” to “very much”. Any answer works.
Fits what you said
Set at least one dial to rank the options. Until then they stand in hall order.
High-intensity statin pill, daily
On its own: about 84 mg/dL. To get under 55, usually combined: for example with a PCSK9 inhibitor (about 38).
Ezetimibe pill, daily
On its own: about 128 mg/dL. To get under 55, usually combined: for example with a statin and a PCSK9 inhibitor (about 29).
Repatha or Praluent shot every 2 weeks or monthly
On its own: about 76 mg/dL. To get under 55, usually combined: for example with a statin (about 38).
Lerochol shot once a month
On its own: about 76 mg/dL. To get under 55, usually combined: for example with a statin (about 38).
Lipfendra pill, daily, fasting
On its own: about 76 mg/dL. To get under 55, usually combined: for example with a statin (about 38).
Inclisiran shot at a clinic, twice a year
On its own: about 84 mg/dL. To get under 55, usually combined: for example with a statin (about 42).
Bempedoic acid pill, daily
On its own: about 134 mg/dL. To get under 55, usually combined: for example with a statin and a PCSK9 inhibitor (about 30).
How far does your LDL-C need to fall?
From 168 to under 55: about 67% lower. Your clinician sets your goal; 55 is the strictest common one.
- Statin (high dose)84
- Ezetimibe128
- PCSK9 inhibitor76
- Inclisiran84
- Bempedoic acid134
- Statin (high dose) + PCSK9 inhibitor✓ 38
- Statin (high dose) + Inclisiran✓ 42
Bars start from today's 168 mg/dL (the full width) and show the average result in trials, combined. No single medicine averages enough here, so the smallest combinations that do are shown. PCSK9 inhibitor means Repatha, Praluent, Lerochol or Lipfendra (same average drop). Inclisiran isn't combined with them: same target. Sample visitor: LDL-C 168 mg/dL.
How the compass scores (the full table)
Each option gets a score from 0 to 4 for each dial (4 fits best). Your dial setting multiplies it; the fit is the total divided by the most it could be. The scores come from the placards in the Medicine Hall: how it's taken, average LDL-C drop, cash price, outcome trials and what to watch for.
| Option | Avoiding a daily pill | Avoiding injections | Lowest monthly cost | Longest proven track record | Biggest LDL drop | Fewest side-effect worries | Fewest clinic visits | Cash price |
|---|---|---|---|---|---|---|---|---|
| High-intensity statin | 0 | 4 | 4 | 4 | 3.6 | 2 | 4 | about $5 to $15/mo |
| Ezetimibe | 0 | 4 | 4 | 3 | 1.7 | 4 | 4 | about $5 to $15/mo |
| Repatha or Praluent | 4 | 0 | 1.5 | 3 | 4 | 3 | 4 | $239/mo |
| Lerochol | 4 | 1 | 2 | 1 | 4 | 2 | 4 | $199/mo |
| Lipfendra | 0 | 4 | 1 | 1 | 4 | 2 | 4 | about $315 to $356/mo |
| Inclisiran | 4 | 3 | 0 | 1 | 3.6 | 2 | 1 | Mostly through insurance |
| Bempedoic acid | 0 | 4 | 0 | 2 | 1.5 | 2 | 4 | Varies |
This mirrors what matters to you. Bring it to your clinician.
The compass only sorts options by what you told the dials and by average facts from trials. Your clinician also weighs your overall risk, your other conditions and medicines, and what you've already tried. People reasonably choose differently.
Your dials stay in this browser for your take-home card. Back to the Medicine Hall to compare the placards again.
The short answer
The best option is the one that fits your risk, how far your LDL needs to fall, and what matters to you. Bring what you find here to your clinician.
Go deeper
- There's no single best medicine. Different people reasonably choose differently.
- Decision aids like Mayo Clinic's Statin Choice use the same idea: facts plus your values.
What other visitors said
- Maria_FL · Evolocumab (Repatha)ExampleStatin-intolerant · Well tolerated & effective
- Tom_WA · Evolocumab (Repatha)ExampleStatin-intolerant, ASCVD secondary prevention · Stopped-cost
Been through this? Share your story and help the next visitor.
Sources
For education, not medical advice. Talk with your clinician before starting or changing treatment.