Heart Health
Statins and Beyond: Your Options for Lowering Cholesterol
A simple guide to statins, ezetimibe, bempedoic acid, inclisiran, and PCSK9 inhibitor injections.
Patient information page | Last reviewed: June 2026
The quick answer
If your cholesterol is high, your doctor may suggest medicine to lower your risk of heart attack and stroke.
For many people, a statin is the usual first choice when medicine is needed. Some people need extra cholesterol lowering despite taking a statin. Others cannot tolerate a statin or need to discuss alternatives. In these situations, other medicines may be considered.
Medicine options at a glance
Statins
Usual first-choice tablets for many people.
Ezetimibe
Reduces cholesterol absorption from the gut.
Bempedoic acid
A liver-acting tablet option for some people.
Inclisiran
Injection after starter doses, then every 6 months.
PCSK9 inhibitors
Injection pen treatments for selected high-risk people.
- Why medicines are used
- Statins
- Ezetimibe
- Bempedoic acid
- Inclisiran
- PCSK9 inhibitors
- Compare options
- Safety
Why are cholesterol medicines used?
Cholesterol medicines are used to lower harmful cholesterol particles in the blood, especially LDL cholesterol and non-HDL cholesterol.
Lowering LDL cholesterol helps reduce the chance of fatty plaque building up inside the arteries. In people who already have artery disease, lowering LDL can also reduce the risk of future heart attack or stroke.
Medicine works best alongside lifestyle measures such as a heart-healthy diet, physical activity, stopping smoking, weight management, and diabetes control where relevant.
1. Statins
Statins are the most commonly used cholesterol-lowering medicines. They reduce how much cholesterol the liver makes and mainly lower LDL cholesterol.
Examples
Atorvastatin, rosuvastatin, simvastatin, and pravastatin.
How effective are they?
Stronger statins at higher doses can lower LDL cholesterol by 30 to 50% or more, depending on the medicine and dose.
Why they are usually first choice
Statins have strong evidence for reducing heart attack and stroke risk, especially in people with high cardiovascular risk or previous cardiovascular disease.
If side effects happen
Your doctor may check whether the statin is the cause, adjust the dose, change to another statin, or discuss a non-statin medicine.
2. Ezetimibe
Ezetimibe is a daily tablet that reduces cholesterol absorption in the small intestine. It lowers the amount of cholesterol entering the bloodstream from the gut.
How effective is it?
When used on its own, ezetimibe can lower LDL cholesterol by 15 to 22%. It can also be added to a statin for extra cholesterol lowering.
When might it be used?
It may be used if a statin is not enough, if a statin is not tolerated, or if extra LDL lowering is needed.
3. Bempedoic acid
Bempedoic acid is a newer daily tablet. Brand names vary by country. In some places, it is known as Nilemdo. A combination tablet with ezetimibe may be known as Nustendi.
It reduces cholesterol production in the liver. It works in a different part of the cholesterol-making pathway from statins and is activated mainly in the liver, not in most muscle tissue.
How effective is it?
Bempedoic acid can lower LDL cholesterol by 17 to 28%. Combined bempedoic acid and ezetimibe can lower LDL cholesterol by 38%.
Important side effects
It can increase uric acid in some people and may trigger gout. Rare tendon problems have also been reported. Tell your doctor if you have a history of gout or tendon problems.
4. Inclisiran
Inclisiran is an injection given under the skin. The brand name is Leqvio.
It is a gene-silencing treatment. It reduces the liver’s production of a protein called PCSK9. When PCSK9 is lower, the liver can remove more LDL cholesterol from the blood.
How is it given?
It is usually given by a doctor or nurse. After the first dose and an early follow-up dose, it is usually given every 6 months.
How effective is it?
Inclisiran can lower LDL cholesterol by 50%.
5. PCSK9 inhibitor injections
PCSK9 inhibitor medicines include evolocumab and alirocumab. Brand names include Repatha and Praluent.
They block a protein called PCSK9. This helps the liver keep more LDL receptors available, so it can remove more LDL cholesterol from the blood.
How are they given?
They are usually given as an injection under the skin using an injection pen. Depending on the medicine and dose, this may be every 2 weeks or monthly.
How effective are they?
PCSK9 inhibitors can lower LDL cholesterol by 50 to 60%.
Comparing the main options
| Medicine type | How it is usually taken | Main action | LDL reduction |
|---|---|---|---|
| Statin | Daily tablet | Reduces cholesterol production in the liver | 30 to 50% |
| Ezetimibe | Daily tablet | Reduces cholesterol absorption in the gut | 15 to 22% |
| Bempedoic acid | Daily tablet | Reduces cholesterol production in the liver | 17 to 28% |
| Bempedoic acid plus ezetimibe | Daily combination tablet | Reduces liver production and gut absorption | 38% |
| Inclisiran | Injection every 6 months after starter doses | Reduces PCSK9 production in the liver | 50% |
| PCSK9 inhibitors | Injection every 2 weeks or monthly | Blocks PCSK9 protein | 50 to 60% |
Individual response can vary
Your doctor will interpret your result with your cardiovascular risk, side effects, other conditions, pregnancy status, other medicines, and local treatment guidance.
What should I ask my doctor?
- What is my LDL cholesterol?
- What is my non-HDL cholesterol?
- What is my overall cardiovascular risk?
- Am I taking medicine for primary prevention or secondary prevention?
- What LDL target are we aiming for?
- Is a statin the best first option for me?
- What should I do if I get side effects?
- Could ezetimibe or another medicine be added?
- Are newer injections suitable for me?
- How soon should my cholesterol be rechecked?
Important safety notes
Do not stop cholesterol medicine suddenly without speaking to your doctor, especially if you have had a heart attack, stroke, stent, bypass surgery, or known artery disease.
Tell your doctor if you are pregnant, planning pregnancy, or breastfeeding. Some cholesterol medicines are not suitable during pregnancy or breastfeeding.
Seek urgent medical advice if you develop severe unexplained muscle pain or weakness, dark urine, yellowing of the skin or eyes, severe allergic symptoms, or severe abdominal pain.
Key message
Statins are the usual first-choice medicine for many people who need cholesterol treatment, but they are not the only option.
If one medicine does not suit you, or if your cholesterol remains high, your doctor may discuss other treatments such as ezetimibe, bempedoic acid, inclisiran, or PCSK9 inhibitor injections.
The best plan is the one that lowers your risk safely and fits your medical history, preferences, and local treatment options.
References
- NHS. Medicines for high cholesterol.
- British Heart Foundation. Statin alternatives.
- Heart UK. Ezetimibe.
- Heart UK. Bempedoic acid.
- British Heart Foundation. Inclisiran: what you need to know.
- European Medicines Agency. Nustendi.