PCSK9 inhibitors — Inclisiran (Leqvio) and Repatha (Evolocumab) — are the most powerful cholesterol-lowering medicines available today. Now available at Five Star Clinic, Adajan, supervised by a cardiologist.
PCSK9 is a protein in your liver that destroys LDL receptors — the docking stations that remove bad cholesterol from your blood. When PCSK9 is blocked, your liver can clear far more LDL cholesterol. The result is a dramatic, sustained drop in your cholesterol level.
ACC guidelines identify six patient groups who benefit most from PCSK9 inhibitor therapy.
On 13 March 2026, the American College of Cardiology (ACC) and the American Heart Association — the two most respected heart health organisations in the world — published the brand new "2026 Guideline on the Management of Dyslipidemia." This replaces the older 2018 guidelines and is the most up-to-date, evidence-based guidance available anywhere in the world today.
Here is exactly what the brand new 2026 ACC/AHA Guideline on Dyslipidemia says — explained in plain English so you can understand what it means for you.
Both medicines dramatically lower LDL cholesterol. They work through different mechanisms — here's what you need to know about each.
Every patient goes through a structured, cardiologist-supervised pathway — from assessment to long-term cholesterol control.
| Inclisiran (Leqvio) | Repatha (Evolocumab) | |
|---|---|---|
| Mechanism | RNA interference — silences PCSK9 gene inside liver cells | Monoclonal antibody — blocks PCSK9 protein in bloodstream |
| LDL Reduction | ~50% from baseline | 50–60%, up to 70% in some patients |
| Dosing Frequency | 2× per year (after loading doses) | Every 2 weeks or once monthly |
| Where injected | At the clinic — no home injection needed | Can self-inject at home (auto-injector pen) |
| Speed of action | Gradual — sustained over months | Rapid — LDL drops within days |
| FH approved | Yes — heterozygous FH (HeFH) | Yes — both HeFH and HoFH |
| Cardiovascular outcome data | ORION-4 trial ongoing (results expected) | FOURIER trial — proven 15% CV event reduction |
| Tolerability | Excellent — mild injection site reactions only | Very good — mild injection site reactions |
| Best for | Adherence challenges, clinic-administered preference | Rapid LDL lowering, HoFH, self-injectors |
High cholesterol is a cardiac disease. Managing it with the most advanced medicines available requires a cardiologist — not just a general physician.
📍 Five Star Clinic & Day Care Centre · 59, Shiven Square, Pal, Adajan, Surat — 395009
📞 093131 84681 · 🌐 fivestar.clinic · Mon–Sat · 10 AM – 7 PM
Familial hypercholesterolaemia (FH) is a genetic condition that affects 1 in 250 people worldwide, causing very high LDL cholesterol from birth. It is dramatically underdiagnosed in India. Signs include: LDL above 190 mg/dL despite diet and statins, a family history of early heart attacks (before age 55 in men or 60 in women), or cholesterol deposits in tendons (xanthomas) or around the eyes (xanthelasma). Dr. Wankhede uses the Simon Broome and Dutch Lipid Clinic criteria to diagnose FH clinically. PCSK9 inhibitors are highly effective for FH and are a primary indication for their use.
Not necessarily — but you might. According to ACC guidelines, patients who remain above their LDL target (typically 70 mg/dL for high-risk and 55 mg/dL for very high-risk) despite being on the maximum tolerated dose of statin plus ezetimibe should be considered for a PCSK9 inhibitor. If you have had a heart attack, stroke, stenting, bypass, or have familial hypercholesterolaemia, the LDL targets are lower and the threshold for adding a PCSK9 inhibitor is reached sooner. Dr. Wankhede will review your lipid panel and risk profile to determine if this is appropriate for you.
Both medicines lower LDL by 50–60% but work differently. Inclisiran (Leqvio) uses RNA interference to stop the liver from producing PCSK9, and only needs to be injected twice a year — at the clinic, not at home. Repatha (Evolocumab) is a monoclonal antibody injected every 2 weeks or monthly, and can be self-administered at home. Dr. Wankhede will recommend the right one based on your clinical profile, your LDL target, how quickly you need cholesterol lowered, and your preference for dosing frequency.
Both medicines have excellent safety profiles demonstrated across large clinical trials involving tens of thousands of patients. The most common side effect for both is mild, temporary redness or discomfort at the injection site — typically resolving within a day or two. Unlike statins, PCSK9 inhibitors do not cause muscle pain or liver enzyme elevations. Serious allergic reactions are very rare. There is no defined lower limit of LDL below which safety is compromised — trials have taken LDL below 20 mg/dL without adverse effects. Dr. Wankhede monitors your response at every visit.
Yes. PCSK9 inhibitors work through a completely different mechanism from statins and do not cause statin-related muscle pain or liver side effects. The ACC pathway explicitly recommends PCSK9 inhibitors for statin-intolerant patients with cardiovascular disease or LDL above 190 mg/dL. In this situation, PCSK9 inhibitors can be used alone or combined with ezetimibe to achieve significant LDL lowering without statins.
If you choose Inclisiran (Leqvio), all injections are administered at Five Star Clinic by Dr. Wankhede or clinic staff. After an initial dose at Day 1 and Day 90, you only need to visit for an injection every 6 months — perfectly coinciding with your cardiology review appointment. No home self-injection is required. Repatha can also be administered at the clinic if you prefer, though it requires more frequent visits.
Repatha begins lowering LDL within days of the first injection, with maximum effect at around 2 weeks. Inclisiran's effect builds more gradually, reaching its full impact (approximately 50% LDL reduction) by Day 180. Dr. Wankhede will check your lipid panel at 6–12 weeks after starting treatment to confirm your response and assess whether any adjustment is needed.
If you are diagnosed with familial hypercholesterolaemia, yes — cascade screening of first-degree relatives (parents, siblings, children) is strongly recommended by all international guidelines. FH is inherited in an autosomal dominant pattern, meaning each first-degree relative has a 50% chance of having inherited the same condition. Early diagnosis and treatment in family members can prevent premature heart attacks. Dr. Wankhede can advise on screening protocols for your family.
Book a consultation with Dr. Avinash Wankhede at Five Star Clinic, Adajan. We will review your lipid panel, assess your cardiovascular risk, and determine whether PCSK9 inhibitor therapy is right for you.
📍 59 Shiven Square, Pal, Adajan, Surat · Mon–Sat 10AM–7PM · Prior appointment preferred