New lipid-lowering drugs in hypercholesterolemia

Which patients with hypercholesterolemia may be offered new lipid-lowering drugs, including proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors?

Ian Graham: These would mostly be people at extremely high cardiovascular risk and those with familial hyperlipidemia, particularly familial hyperlipidemia which cannot get the target on statin treatment. Occasionally, high-risk people who cannot take a statin may also be candidates for PCSK9 inhibitors. These are essentially people at the highest risk, particularly those with familial hyperlipidemia in whom you cannot get to the low-density lipoprotein (LDL) target with statins alone or those who are statin intolerant. But there is a problem here, because these are very expensive drugs and will not be available in all cultures.