Latest High Cholesterol Treatments: How the New Lipfendra Pill Compares to Statins and More
Learn how the meds work, the results you can expect and which might be right for you
Key Takeaways
- Lipfendra is the first FDA-approved oral PCSK9 inhibitor for lowering LDL cholesterol levels.
- Newer medications like Zetia, Nexletol and Leqvio offer additional options beyond statins.
- Treating high cholesterol early can help lower your risk of heart attack and stroke over time.
While tried-and-true high cholesterol treatments like statins are an important way to protect your heart if you have elevated readings, there are also many newer cholesterol medications available, including Lipfendra, a cholesterol-lowering pill from Merck that received FDA approval yesterday. But with more options also come more decisions. So if you’re not quite sure what the latest cholesterol meds are or how they differ, we asked doctors to break it all down, whether you’re newly diagnosed or simply looking for better options.
What is high cholesterol?
“High cholesterol is when you have an excess of a fatty substance called cholesterol in your blood,” explains Nate Lebowitz, MD, FACC, a board-certified cardiologist with the Advanced Cardiology Institute and affiliated with Hackensack University Medical Center. “While your body needs cholesterol to build healthy cells, having too much can lead to a buildup of plaque in your arteries, a condition called atherosclerosis. This buildup can narrow your arteries and increase your risk for heart attack and stroke.”
What is the new high cholesterol treatment Lipfendra?
If you’ve been keeping up with health news, you may have heard that the FDA approved Lipfendra, a PCSK9 inhibitor pill. If you’re familiar with statins, which help lower “bad” cholesterol (LDL), you may be wondering what PCSK9 inhibitors are and how the two compare.
Woman's World Answers
“PCSK9 inhibitors target a protein made by the liver called PCSK9,” says Kardie Tobb, DO, MS, FASPC, FACC, a board‑certified preventive cardiologist and the medical director for the Cone Health HeartCare Women’s Heart Health and Cardio-Obstetrics Clinic. “Normally, your liver removes LDL cholesterol from the bloodstream using LDL receptors. PCSK9 destroys many of those receptors. When you block PCSK9, more LDL receptors stay on the surface of liver cells, allowing the liver to clear much more LDL cholesterol from the blood. It’s a very targeted way of lowering cholesterol.”
PCSK9 inhibitors aren’t new. In fact, popular options like Repatha were first approved in 2015. So why is everyone talking about Lipfendra? “Until now, every FDA-approved PCSK9 inhibitor has required an injection, either every two weeks, monthly or every six months,” explains Dr. Tobb. “Lipfendra (enlicitide) is the first oral PCSK9 inhibitor, meaning patients can take it as a once-daily pill instead of receiving injections. That’s a significant advance because many patients prefer pills over injections, and improving convenience often improves adherence.”
The latest cholesterol treatments
While Lipfendra is dominating health news, it’s not the only newer cholesterol medication available. Below, Dr. Tobb and Dr. Lebowitz share three of the latest treatment options worth knowing about.
Ezetimibe (Zetia)
Ezetimibe is an oral medication that has been used for years and helps lower cholesterol by reducing how much is absorbed through the intestines, says Dr. Lebowitz. “It’s often used in combination with a statin to further lower LDL cholesterol,” he adds. “It is a good fit for patients who need additional LDL lowering on top of a statin or those who cannot tolerate statins. It is generally well-tolerated.”
Dr. Tobb says ezetimibe can be a good option for people who need a small additional drop in LDL cholesterol or aren’t able to take higher doses of statins, but it may not be enough for people who need to dramatically lower their LDL levels.
Bempedoic acid (Nexletol)
Bempedoic acid was approved in 2020 and is an oral medication that helps block the liver from producing cholesterol through a different pathway than statins, explains Dr. Lebowitz. “It’s a good option for patients who experience muscle pain related side effects from statins or who need additional LDL lowering. Bempedoic acid is an adenosine triphosphate-citrate lyase (ACL) inhibitor,” he continues. It may be used with other cholesterol-lowering medications to help further lower LDL in adults.”
Dr. Tobb says bempedoic acid can be a good option for people who can’t tolerate statins or need extra help lowering their LDL cholesterol, but it may not be the right choice for people with uric acid levels that are higher than normal or gout.
Inclisiran (Leqvio)
Like Repatha and Praluent, inclisiran is designed to lower LDL cholesterol by targeting the PCSK9 protein, but it works by preventing the liver from making PCSK9 proteins, explains Dr. Lebowitz. This is important because PCSK9 normally interferes with the body’s ability to clear LDL cholesterol. “It is also an injection, but it is given less frequently, typically twice a year after the initial doses,” says Dr. Lebowitz.
Dr. Tobb says inclisiran can be a good option for people who don’t want to remember to take a daily cholesterol medication since it’s only given twice a year after the initial doses, but it may not be the best fit for people who would rather take a pill or who have trouble getting to injection appointments.
How high cholesterol treatments can work together
Of course, following a heart-healthy diet and getting regular physical activity are important lifestyle changes that help boost your HDL “good” cholesterol and lower your LDL and total cholesterol. If your numbers are still elevated, your healthcare professional will most likely recommend statins to start.
“For most people, statins remain first-line therapy because they have the strongest evidence for reducing heart attacks and strokes,” says Dr. Tobb. “If LDL remains above goal, we often add ezetimibe. If that’s still not enough, PCSK9-targeted therapies including injectable medications or now Lipfendra may be appropriate.”
“One of the biggest misconceptions is that needing cholesterol medication means you’ve failed,” adds Dr. Tobb. “That’s simply not true. Many people inherit high cholesterol. Others have such a high cardiovascular risk that even an excellent diet and regular exercise aren’t enough to lower LDL to safe levels. Lifestyle remains the foundation, but medication often provides protection that lifestyle alone cannot achieve.”
Why managing high cholesterol is so important
“High cholesterol is dangerous because it usually causes no symptoms,” says Dr. Tobb. “Plaque builds silently inside arteries over decades. The first sign may unfortunately be a heart attack, a stroke or sudden cardiac death. The encouraging news is that lowering LDL cholesterol slows plaque progression, stabilizes existing plaque and substantially reduces future cardiovascular events. The earlier we intervene, the more heart attacks and strokes we can prevent.”
The bottom line on high cholesterol treatments
Whether lifestyle changes alone are enough, statins end up working well for you or your doctor recommends one of the newer cholesterol medications, finding the right treatment plan can take time. The important thing is not ignoring high cholesterol. Talk to your doctor to find an approach that fits your health needs.
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