LDL Still High Despite Statins? Advanced Cholesterol Treatments in Singapore
- Dr Chan Po Fun
- Mar 8
- 6 min read
Updated: 4 days ago
Many patients are surprised to find that their LDL cholesterol is still high despite taking statins.
“In clinical practice, I frequently see patients whose LDL cholesterol remains above target despite appropriate treatment,” says Dr Chan Po Fun, Consultant Cardiologist in Singapore.
Dr Chan Po Fun is a cardiologist in Singapore specialising in cholesterol management, particularly in patients whose LDL cholesterol remains above target despite treatment.
Statins are the first-line treatment for lowering cholesterol, but in some people they may not be enough to reach recommended LDL targets, particularly if cardiovascular risk is high.
This situation is more common than many realise.
Today, several advanced cholesterol treatments are available in Singapore, including PCSK9 inhibitors (Inclisiran [Leqvio], Evolocumab [Repatha]), which can significantly lower LDL cholesterol when statins alone are insufficient.
"When LDL cholesterol remains above target despite statins, additional therapies may be needed to adequately reduce cardiovascular risk,” says Dr Chan Po Fun
Some patients are surprised to learn that modern cholesterol therapies can now lower LDL cholesterol to levels that were previously difficult to achieve with statins alone.
Could This Apply to You?
You may benefit from further cholesterol evaluation if:
your LDL cholesterol remains above target despite statins
your doctor has told you your cholesterol is difficult to control
you have coronary artery disease or prior stents
you have a strong family history of early heart disease
you have been told you may have familial hypercholesterolaemia
you cannot tolerate higher doses of statins
Dr Chan Po Fun regularly evaluates patients in these situations to determine whether treatment can be optimised further.
Consultation with Dr Chan Po Fun is available in Singapore for patients seeking further evaluation of cholesterol control.
Why is my LDL still high despite statins?
There are several reasons why cholesterol levels may remain elevated even with appropriate statin therapy.
1. Very High Baseline LDL Cholesterol
Some patients start with extremely high LDL levels. Even with strong statins, the reduction may not be enough to reach target levels.
2. Genetic Cholesterol Conditions
Conditions such as familial hypercholesterolaemia (FH) cause the body to maintain high cholesterol levels due to inherited genetic factors. These patients often require combination therapy.
3. High Cardiovascular Risk
Patients with existing heart disease, such as previous heart attack, coronary artery disease, or stroke, require very aggressive LDL lowering. The recommended LDL targets in these patients are much lower than in the general population.
4. Statin Intolerance
Some individuals experience side effects with statins, such as muscle ache, which limit how much medication they can tolerate.
“When LDL remains above target, it often means the current treatment is not sufficient for that patient’s level of cardiovascular risk,” explains Dr Chan Po Fun.
Are You At Your Target LDL Level?
Many patients are unaware that LDL targets depend on cardiovascular risk.
Cardiovascular Risk | Recommended LDL Target |
Moderate risk | <2.6 mmol/L |
High risk | <1.8 mmol/L |
Very high risk | <1.4 mmol/L |
Patients with coronary artery disease, prior heart attack, stroke, or diabetes often require very aggressive LDL reduction.
If LDL remains above target despite treatment, further therapy may be necessary.
Additional Treatments When Statins Are Not Enough
If LDL cholesterol remains elevated despite statins, doctors may recommend additional therapies. These treatments work through different mechanisms to further reduce cholesterol levels.
Ezetimibe
Ezetimibe works by reducing cholesterol absorption from the intestine. It is commonly added when statins alone do not achieve LDL targets.
PCSK9 Inhibitors
PCSK9 inhibitors are one of the most effective treatments available for lowering cardiovascular risk that significantly lower LDL cholesterol by improving the liver’s ability to remove cholesterol from the blood.
These medications can reduce LDL cholesterol by 50–60% and are commonly used in patients with:
existing coronary artery disease
familial hypercholesterolaemia
persistently elevated LDL despite medication
Examples of PCSK9 inhibitors include evolocumab (Repatha) and alirocumab (Praluent).
Inclisiran (Leqvio) is a siRNA that suppresses PCSK9 production. One advantage of is its twice-yearly dosing schedule after the initial loading doses, making it a convenient option for long-term LDL control.
In clinical practice, Dr Chan Po Fun frequently evaluates patients whose LDL cholesterol remains elevated despite standard therapy, and determines whether additional treatment is required based on individual cardiovascular risk.
If your LDL cholesterol remains above target despite medication, a consultation can help determine whether additional therapies may be appropriate.
Who May Benefit From Advanced Cholesterol Therapy?
You may benefit from further evaluation if:
Your LDL cholesterol remains above target despite statins
You have coronary artery disease
You have had a heart attack or stroke
You have familial hypercholesterolaemia
You cannot tolerate higher doses of statins
Your doctor has recommended more aggressive cholesterol lowering
A cardiologist can help determine whether combination therapy or advanced lipid treatments are appropriate.
Dr Chan Po Fun provides specialist assessment for patients requiring more advanced cholesterol management in Singapore.
Could New Cholesterol Injection Therapies Help You?
In recent years, new cholesterol-lowering injections have become available for patients whose LDL cholesterol remains high despite standard medication.
These treatments work differently from statins and can significantly lower LDL levels when additional cholesterol reduction is needed.
An important therapy currently used in Singapore is PCSK9 Inhibitors.
PCSK9 inhibitors are injectable medications that help the liver remove more LDL cholesterol from the bloodstream.
They can lower LDL cholesterol by around 50–60% and are often used in patients with:
established coronary artery disease
familial hypercholesterolaemia
persistently high LDL despite statins and other medications
Inclisiran is an example of a PCSK9 inhibitor. Its twice-yearly dosing schedule after the initial doses, makes it a convenient option for long-term cholesterol management.
“These therapies are not for everyone, but can be highly effective in the right patients,” says Dr Chan Po Fun.
How Cholesterol Treatment Is Personalised
Managing cholesterol is not simply about prescribing medication.
A proper evaluation with Dr Chan Po Fun often includes:
cardiovascular risk assessment
review of prior cholesterol results
assessment of statin tolerance
evaluation for genetic cholesterol disorders
imaging or testing for underlying coronary artery disease
Based on these factors, a personalised treatment plan can be developed to achieve optimal LDL reduction while minimising side effects.
The goal is to achieve optimal LDL reduction while minimising side effects.
In clinical practice, Dr Chan Po Fun focuses on patients whose LDL cholesterol remains above target despite standard treatment, and tailors therapy based on individual cardiovascular risk.
Cholesterol Treatment Options in Singapore
Several advanced cholesterol therapies are now available in Singapore for patients who require additional LDL reduction.
These include:
combination oral therapies
PCSK9 inhibitors
Choosing the most appropriate treatment depends on clinical risk, LDL levels, and prior medication response.
When to Seek Specialist Evaluation
If your cholesterol remains elevated despite medication, further assessment may be helpful.
This is particularly important if you have:
existing heart disease
strong family history of heart disease
genetic cholesterol conditions
persistently elevated LDL levels
Early optimisation of cholesterol treatment can significantly reduce the long-term risk of heart attack and stroke.
Specialist Care for Cholesterol Management in Singapore
Dr Chan Po Fun is a cardiologist in Singapore with a focus on:
Cholesterol management
Patients not reaching LDL targets
Preventive cardiology
Advanced lipid therapies
She regularly manages patients with:
persistent high LDL despite treatment
statin intolerance
familial hypercholesterolaemia
coronary artery disease requiring aggressive LDL lowering
In clinical practice, Dr Chan Po Fun focuses on patients whose LDL cholesterol remains above target despite standard treatment, and tailors therapy based on individual cardiovascular risk.
Book a Consultation
If your LDL cholesterol remains high despite statins, further evaluation may help clarify your next steps.
A consultation can determine whether:
Your current treatment is sufficient
Additional therapy is needed
Advanced options such as PCSK9-inhibitors are appropriate
FAQ
Why is my LDL still high despite taking statins?
LDL may remain elevated due to genetic factors, very high baseline levels, or stricter LDL targets based on cardiovascular risk. A specialist assessment can help determine whether additional therapy is needed.
What are PCSK9 inhibitors?
PCSK9 inhibitors are injectable medications that significantly lower LDL cholesterol by helping the liver remove more cholesterol from the bloodstream. Dr Chan Po Fun assesses whether these treatments are appropriate.
What is Inclisiran (Leqvio)?
Inclisiran is a newer cholesterol therapy that reduces the production of PCSK9 in the liver, allowing LDL cholesterol levels to decrease over time.
Can cholesterol injections replace statins?
In many cases, these therapies are used together with statins, although they may sometimes be used when statins cannot be tolerated.
When should I see a cardiologist for high cholesterol?
You should consider specialist evaluation if LDL cholesterol remains elevated despite medication or if you have high cardiovascular risk.
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