Cholesterol Injections Singapore: PCSK9 & Inclisiran | Dr Chan Po Fun
- Dr Chan Po Fun
- Sep 9, 2025
- 8 min read
By Dr Chan Po Fun
Female Consultant Cardiologist | Lipid Specialist | Gleneagles & Mount Alvernia, Singapore
This article explains why LDL can remain elevated despite treatment, what the newer injectable therapies are, how they work, and importantly, who may genuinely benefit from them.
I want to start with something I tell patients in my clinic regularly.
Statins are excellent medications. For most people, they work well, are well-tolerated, and significantly reduce cardiovascular risk. I prescribe them often and I believe in them.
But for some patients, and this group is larger than most people realise, statins alone are not enough.
Their LDL remains high despite treatment. Or they cannot tolerate statins at all. Or their overall cardiovascular risk is so significant that they need LDL brought far lower than any statin can achieve.
For these patients, newer injectable cholesterol therapies have been a genuine breakthrough. This article explains what they are, how they work, who they are for, and what to expect if you are considering them in Singapore.
What are "cholesterol injections"?
"Cholesterol injections" is the term many of my patients use when they first hear about these treatments. It is a reasonable shorthand for two types of therapy that work by injection rather than as daily tablets:
PCSK9 inhibitors — monoclonal antibody injections given every 2 to 4 weeks
Inclisiran (siRNA therapy) — gene-silencing injections given twice a year after the initial doses
Both work by dramatically reducing LDL cholesterol — typically by 50 to 60% on top of whatever a statin is already achieving. For patients who need to get LDL below 1.4 mmol/L or even below 1.0 mmol/L, these therapies make that achievable where statins alone cannot.
Why Does LDL Stay High Despite Statins?
Before discussing newer treatments, it helps to understand why some patients don't reach their LDL targets on statins alone.
LDL targets are not the same for everyone
This is one of the most important things I explain to patients. There is no single "normal" LDL. Your target depends entirely on your overall cardiovascular risk.
For a healthy 35-year-old with no risk factors, LDL below 3.0 mmol/L may be perfectly acceptable. But for a patient with established coronary artery disease, diabetes, or a prior heart attack, guidelines recommend LDL below 1.4 mmol/L; and for very high-risk patients, below 1.0 mmol/L. Statins alone often cannot get there.
FH is an inherited condition where the liver cannot clear LDL efficiently from the blood. LDL levels are typically very high from birth (often above 5.0 or 6.0 mmol/L) and even maximum-dose statins may leave LDL significantly above target.
FH affects around 1 in 200 to 1 in 300 people in Singapore and is significantly underdiagnosed. Many patients find out they have it only when they present with early heart disease.
A meaningful proportion of patients experience muscle pain, aches, or weakness on statins — a condition called statin myalgia. When this limits the dose a patient can take, so is the LDL reduction they can achieve. For these patients, non-statin options become essential.
Residual cardiovascular risk
Even when LDL appears treated, some patients carry ongoing risk from elevated Lipoprotein(a), inflammation, or existing plaque. Driving LDL lower in these patients, sometimes far below conventional targets, confers real clinical benefit.
Not sure if you need a cholesterol injection?
Book a lipid review with Dr Chan Po Fun — no referral needed.
PCSK9 inhibitors — how they work
To understand PCSK9 inhibitors, you need to understand PCSK9 itself.
PCSK9 is a protein produced by the liver. Its job is to destroy LDL receptors, the mechanism by which the liver clears LDL from the bloodstream. More LDL receptors means more LDL cleared. PCSK9 reduces the number of these receptors, effectively limiting how efficiently your body can remove LDL.
PCSK9 inhibitors work by blocking PCSK9, allowing LDL receptors to survive longer and work more effectively. The result is a dramatic reduction in circulating LDL, typically 50 to 60% on top of statin therapy.
Available PCSK9 inhibitors in Singapore
Evolocumab (brand name: Repatha) Given by subcutaneous injection every 2 weeks (140mg) or once monthly (420mg). Can be self-administered at home with a pre-filled auto-injector. Reduces LDL by approximately 55 to 60%.
Alirocumab (brand name: Praluent) Given every 2 weeks by subcutaneous injection. Similar mechanism and efficacy to evolocumab. Also self-administered.
Both have been studied in large cardiovascular outcome trials and have demonstrated not just LDL reduction but actual reduction in heart attacks and strokes in high-risk patients.
Inclisiran — how it works and why it is different
Inclisiran (brand name: Leqvio) represents a genuinely different approach to cholesterol treatment.
Where PCSK9 inhibitors work by neutralising PCSK9 protein after it has been produced, Inclisiran works earlier. It prevents PCSK9 from being produced in the first place.
Inclisiran is an siRNA therapy (small interfering RNA). It works by silencing the gene in liver cells responsible for producing PCSK9. Less PCSK9 produced means more LDL receptors survive means more LDL cleared from the blood.
Why the dosing schedule matters
This is the feature that makes Inclisiran particularly valuable for long-term management.
After two initial injections given three months apart, Inclisiran is administered just twice a year — once every six months.
For patients managing a chronic condition, this is a significant practical advantage. Instead of a daily tablet or a fortnightly injection, you come in twice a year for a clinic-administered injection. Adherence is essentially guaranteed, which matters enormously for long-term cardiovascular risk reduction.
LDL reduction with Inclisiran is approximately 50%, sustained consistently between doses.
Types of PCSK9-Targeting Therapy
Evolocumab (Repatha) | Alirocumab (Praluent) | Inclisiran (Leqvio) | |
How it works | Blocks PCSK9 protein | Blocks PCSK9 protein | Silences PCSK9 gene |
LDL reduction | 55–60% | 50–60% | ~50% |
Dosing | Every 2–4 weeks | Every 2 weeks | Twice yearly |
Given by | Self-injection at home | Self-injection at home | Clinic injection |
Who May Be a Candidate for These Therapies?
These therapies are not for everyone. They are typically appropriate for patients who:
Have LDL above their personalised target despite maximally tolerated statin therapy
Have established atherosclerotic cardiovascular disease — prior heart attack, coronary artery disease, stroke, or peripheral artery disease — and require aggressive LDL reduction below 1.4 mmol/L
Have familial hypercholesterolaemia, particularly where LDL remains very high despite statins
Cannot tolerate adequate statin doses due to muscle side effects
Have elevated Lipoprotein(a) alongside high LDL, especially with a strong family history of early heart disease
Have had recurrent cardiovascular events despite treatment and require LDL driven to very low levels
A single cholesterol number is never sufficient to determine candidacy. The decision requires a full cardiovascular risk assessment — your LDL trajectory, prior treatments tried, existing plaque burden, family history, and personal circumstances all factor into the recommendation.
Cost and insurance coverage in Singapore
This is one of the most common questions I receive, so I will address it directly.
PCSK9 inhibitors and Inclisiran are specialist medications and carry a meaningful cost. The exact cost varies depending on the specific drug, dosing frequency, and whether you are on a subsidised or private pathway.
Corporate insurance: Some plans Singapore will cover these medications if there is documented clinical indication — familial hypercholesterolaemia, inadequate response to statins, or statin intolerance.
Shield plans: They may cover these medications post-discharge if there is documented clinical indication — established cardiovascular disease with inadequate response to statins or statin intolerance. Pre-authorisation from your insurer is usually required before starting treatment.
Paying patients: Patient programmes are available to help offset some of the cost.
I always recommend clarifying coverage before starting treatment. Our team will help you navigate this. There should be no financial surprises.
What to Expect at a Consultation
If you are being considered for advanced lipid therapy, your consultation with me will typically cover:
Review of your cholesterol history
Your LDL results over time, current and past medications, statin doses tried, any side effects experienced.
Cardiovascular risk assessment
Your overall risk score, any prior cardiac imaging or stress tests, Lipoprotein(a) if not previously measured, family history.
Treatment discussion
Whether your current LDL is at target for your specific risk level, whether additional therapy is clinically indicated, which option is most appropriate for your circumstances, dosing practicalities, and what monitoring is needed.
There is no pressure to start any treatment. The goal is clarity, so you leave understanding your risk, your options, and what the evidence says about your individual situation.
No referral needed. Same- or next-day appointments available at Gleneagles and Mount Alvernia.
FAQs: PCSK9 Inhibitors, SiRNA Therapy (Inclisiran)
What is a cholesterol injection and how does it work?
Cholesterol injections refer to PCSK9 inhibitors (such as Repatha/Evolocumab) and Inclisiran (Leqvio) — injectable therapies that lower LDL cholesterol by 50 to 60% by targeting the PCSK9 protein in the liver. They are used when statins alone are insufficient to reach LDL targets.
What is Inclisiran and is it available in Singapore?
Inclisiran (brand name Leqvio) is an siRNA therapy that silences the gene responsible for producing PCSK9 in liver cells. It is available in Singapore and is administered by a clinician twice yearly after the initial loading doses — making it one of the most convenient long-term cholesterol treatments available.
What is Repatha (Evolocumab) and how is it different from Inclisiran?
Both lower LDL by targeting PCSK9, but they work differently. Repatha is a monoclonal antibody that neutralises PCSK9 protein after it is produced, given every 2 to 4 weeks by self-injection at home. Inclisiran prevents PCSK9 from being produced at all, given twice yearly by a clinician. Efficacy is similar; the main differences are mechanism and dosing schedule.
Are cholesterol injections safe?
Both PCSK9 inhibitors and Inclisiran have been evaluated in large cardiovascular outcome trials involving tens of thousands of patients. They are generally well-tolerated. The most common side effect is mild injection site reactions. Current evidence does not show harm from the very low LDL levels these therapies achieve.
How quickly do cholesterol injections work?
Significant LDL reduction is typically seen within 4 to 8 weeks. Full effect is usually established within 3 months.
Is Inclisiran or Repatha covered by insurance in Singapore?
Coverage varies by insurer and policy. There are also patient programmes to for self-paying patients. Our clinic team will help clarify your specific coverage before any treatment decision.
Can I take these injections instead of statins?
In most cases they are used alongside statins for additive effect. In patients who cannot tolerate any statin, they may be used as primary therapy, often combined with ezetimibe. This decision is made case by case based on your full clinical picture.
Do I need a referral to discuss these treatments?
No referral is needed. You can book directly by calling or WhatsApp-ing +65 8899 5385.
Disclaimer: This information is for educational purposes only. Treatment decisions should always be made in consultation with a qualified healthcare professional.
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About the author
Dr Chan Po Fun
Female Consultant Cardiologist · Lipid Specialist · Women's Heart Health · Singapore
Dr Chan Po Fun is one of Singapore's few female consultant cardiologists, with a focused practice in lipid management, women's heart health, and longevity cardiology. She holds MBBS, MMed (Internal Medicine), MRCP, FRCP (UK), FAMS (Cardiology), and FESC.
Before private practice, she served as Clinical Lead for Heart Failure Services at Ng Teng Fong General Hospital and Director of its Cardiac Diagnostic Laboratory. She has been a member of the Ministry of Health's Heart Failure Services Improvement Sub-Committee and is a recognised speaker on women's cardiovascular health at the Singapore Cardiac Society and Singapore Heart Foundation.
She sees every patient personally, from first consultation to long-term follow-up, at Gleneagles Hospital and Mount Alvernia Hospital, Singapore.
Next Steps
If you have high LDL cholesterol or want to explore modern, effective options for long-term heart protection, schedule a consultation. Together, we can create a personalized plan tailored to your health needs and lifestyle.
Consultations are available at Gleneagles Hospital and Mount Alvernia Hospital. No referral is required. Same- or next-day appointments are generally available.
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