Except for patients who cannot tolerate statins, Asst Prof Jack Tan, Deputy Head and Senior Consultant, Department of Cardiology, NHCS, said the preferred way to use both drugs is in combination with a statin, because they complement statins and produce better results when paired up.

The new cholesterol medicines are also given to people with an inherited condition called homozygous familial hypercholesterolemia, where  LDL cholesterol is so high that even the strongest doses of statins cannot reduce it to target levels.

One in 300 to 500 people have this condition in the milder heterozygous form. “From young, their baseline cholesterol is very high. So they have heart attacks earlier in life. If their condition is more severe, they can have heart attacks as young as in their 20s because their cholesterol is sky-high,” said Asst Prof Tan.

The two main considerations patients have regarding the two new drugs are:

• Cost, and the
• Drugs have to be injected, which some find off-putting, although the jabs are convenient and almost painless

One month’s treatment with alirocumab or evolocumab is about $600 at NHCS, as subsidies are not available for these non-standard drugs. Comparatively, the high dose of the generic statin, atorvastatin, costs $18 per month before subsidy, and $4.50 on a 75 per cent subsidy.

Ref: M19