Written and medically reviewed by Dorcas Morak, Pharm.D
Effectively managing high cholesterol often involves choosing between two powerful medications: statins and PCSK9 inhibitors. Both are designed to lower LDL cholesterol levels and reduce the risk of heart disease, but they work in different ways. Here’s what you need to know to determine which option is best for managing your high cholesterol and related health issues.
What are Statins and How Do They Work?
Statins are a class of cholesterol-lowering medications that work by inhibiting an enzyme in the liver called HMG-CoA reductase, thus reducing cholesterol production. Statins like atorvastatin (Lipitor), rosuvastatin (Crestor), and simvastatin (Zocor) are commonly prescribed and come in various formulations to suit different patient needs.
What Conditions are Statins Approved to Treat?
FDA approves statins for managing cholesterol and reducing heart attack and stroke risk. They are also used for familial hypercholesterolemia, a genetic disorder characterized by high cholesterol levels from birth, and some type 2 diabetes cases to prevent heart issues.
What are PCSK9 Inhibitors and How Do They Work?
PCSK9 inhibitors are a class of medications approved by the FDA in 2015. They are primarily for individuals unable to reach their LDL goals with statins or other cholesterol-lowering drugs. These biologic drugs, including Repatha (evolocumab) and Praluent (alirocumab), function by targeting PCSK9 proteins, which otherwise hinder the liver's ability to remove LDL cholesterol from the bloodstream efficiently. There are currently no generics available.
What Conditions are PCSK9 Inhibitors Approved to Treat?
PCSK9 inhibitors are approved to treat high cholesterol, heart disease, and related genetic conditions like familial hypercholesterolemia, lowering LDL cholesterol and reducing heart attack and stroke risks in adults.
How Effective are PCSK9 Inhibitors and Statins for Treating High Cholesterol?
Studies have shown that PCSK9 inhibitors and statins effectively lower LDL cholesterol levels. PCSK9 inhibitors can reduce LDL cholesterol by 45% to 70%, while high-intensity statins can reduce 50% or more. Moreover, both classes of drugs exhibit ancillary benefits like lowering triglycerides (type of fat found in your blood) and raising HDL ("good") cholesterol. However, statins have demonstrated an additional advantage by reducing cardiovascular-related deaths, a benefit not yet observed with PCSK9 inhibitors.
How are PCSK9 Inhibitors and Statins Administered?
Statins are typically administered orally, once daily, and come in various forms. In contrast, PCSK9 inhibitors are injectable medications given subcutaneously once or twice a month. While statins offer convenience in administration, PCSK9 inhibitors provide a longer duration of action, potentially reducing the frequency of dosing.
Can PCSK9 Inhibitors and Statins Be Used Together?
In some cases, healthcare providers may prescribe PCSK9 inhibitors in combination with statins to further reduce LDL cholesterol levels, especially in individuals with severely high cholesterol or those at high cardiovascular risk. This combination therapy can benefit cholesterol management and reduce cardiovascular risk.
What are the Costs of PCSK9 Inhibitors Compared to Statins?
The costs of PCSK9 inhibitors and statins differ significantly. PCSK9 inhibitors are generally much more expensive, with annual costs around $6,000. In contrast, statins are more budget-friendly, with prices for generic versions ranging from less than $50 to over $350 per month. Discounts available through RxLess can further reduce the cost of statins to just a few dollars monthly, depending on the pharmacy. For the most accurate and current discounts, join the RxLess Assurance Plan by downloading our free app.
