Inclisiran (Leqvio) and PCSK9 Inhibitors: A Simple Guide to Managing High LDL Cholesterol | Dr Chan Po Fun, Women’s Heart Health & Lipid Specialist, Singapore
- Dr Chan Po Fun
- Sep 9
- 3 min read
Updated: Sep 16
High LDL cholesterol can persist despite healthy lifestyle changes and statins, increasing the long-term risk of heart disease and stroke. For patients seeking effective, convenient, and modern treatment options, PCSK9 inhibitors, including Inclisiran (Leqvio), are increasingly considered.
Many patients ask: “How do these work?” or “Could this be suitable for me?”
Let's explore these new treatment options.
How PCSK9 Inhibitors Work
Think of your liver as a factory removing LDL cholesterol. PCSK9 proteins act like brakes, slowing down LDL removal. PCSK9 inhibitors release these brakes, allowing the liver to clear cholesterol more efficiently.
PCSK9 inhibitors target a protein in your liver called PCSK9, which regulates LDL cholesterol removal from the bloodstream. By modifying this process, these therapies can help lower LDL cholesterol levels more effectively when statins alone are insufficient.
Inclisiran is unique: just two injections per year, like a semi-annual “tune-up” for your heart.
Other PCSK9 inhibitors, such as Evolocumab (Repatha®) or Alirocumab (Praluent®), are injected more frequently.
These therapies are typically used alongside statins, or in patients who cannot tolerate statins.
Who Might Benefit?
PCSK9 inhibitors may be considered for patients who:
Have persistently high LDL cholesterol despite statins
Have familial hypercholesterolemia (genetic high cholesterol)
Require intensive cholesterol lowering due to high cardiovascular risk
Note: Only a doctor can assess whether a PCSK9 inhibitor is appropriate for your individual health situation.
Available Options (PCSK9 inhibitors - Inclisiran, Evolocumab, Alirocumab) in Singapore
Medication | Type | Dosing | Typical Use Case |
Inclisiran (Leqvio) | siRNA therapy | 2 injections/year | Convenient, long-lasting LDL reduction |
Evolocumab (Repatha®) | Monoclonal antibody | Every 2–4 weeks | Strong LDL reduction, well-studied in outcomes trials |
Alirocumab (Praluent®) | Monoclonal antibody | Every 2 weeks or monthly | Effective LDL lowering |
Medication choice depends on cholesterol levels, cardiovascular risk, lifestyle, and personal preference.
Safety and Monitoring
PCSK9 inhibitors are generally well-tolerated. Some patients may experience mild injection-site reactions, flu-like symptoms, or fatigue.
Before starting therapy, your doctor will typically:
Review your cholesterol and heart risk profile
Conduct blood tests to assess liver and kidney function
Monitor response to treatment and adjust therapy as needed
Think of it as ongoing maintenance for your cardiovascular system, with minimal disruption to your life.
Case Studies: Real-Life Examples
Case Study 1: Ms Lim, 55
History: High LDL despite statins, family history of early heart disease
Challenge: Wanted minimal disruption to daily routine
Outcome: Two-injection schedule integrated seamlessly, LDL improved, less anxiety about daily pills
Case Study 2: Mr Tan, 60
History: Statin intolerance, high cardiovascular risk
Challenge: Needed effective LDL-lowering without daily pills
Outcome: Semi-annual PCSK9 therapy option considered, combined with diet and exercise, LDL improved, no daily pill burden
Case Study 3: Ms Wong, 48
History: Familial hypercholesterolemia, LDL stubbornly high despite maximal statin therapy
Challenge: Concerned about long-term heart risk
Outcome: Cardiologist reviewed options, tailored a plan with PCSK9 therapy and close monitoring, giving confidence in heart protection
These examples highlight how convenience, efficacy, and personalization can make this therapy attractive for patients willing to invest in heart health.
FAQs: PCSK9 Inhibitors
Q: How quickly do PCSK9 inhibitors work?
A: Significant reductions in LDL cholesterol are seen within the first 4 to 12 weeks, with blood levels of LDL-C decreasing by over 50% in many patients within one month
Q: Are they safe long-term?
A: They are generally well-tolerated. Some patients may experience mild injection-site reactions, flu-like symptoms, or fatigue.
Q: Can they be combined with statins?
A: They are often used in combination with statins for additive LDL lowering. They are used alone, instead of statins, in certain circumstances.
Q: Who is eligible?
A: Patients with high LDL despite statins, familial hypercholesterolemia, or statin intolerance.
Q. How often are follow-ups required?
A: This depends on your medical condition and your cholesterol response. Follow-ups are typically made every few months.
Disclaimer: This information is for educational purposes only. Treatment decisions should always be made in consultation with a qualified healthcare professional.
How I Can Help
As a cardiologist specialising in lipid management, I provide:
Comprehensive cholesterol and heart risk assessment
Guidance on treatment options, including PCSK9 inhibitors
Ongoing monitoring and support for safety and efficacy
Advice on lifestyle, diet, and complementary therapies
“Your heart health is unique. Together, we can explore options to help manage cholesterol effectively and safely.”
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.
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