Modern cardiology is going through a real revolution: new medications that are given just twice a year can dramatically lower “bad” cholesterol and reduce the risk of heart attack and stroke. We spoke with Professor Dirk Westermann, Medical Director of Cardiology at the University Heart Center Freiburg–Bad Krozingen, about what these so-called “cholesterol injections” actually are and who can truly benefit from them.

Professor Westermann, what exactly is meant by a “cholesterol injection”?

The term usually refers to modern medications that help the body lower levels of “bad” LDL cholesterol more effectively. They work on processes in the liver, which is responsible for removing excess cholesterol from the bloodstream.

Some of these drugs act like highly targeted antibodies. They block a protein called PCSK9, which normally prevents the liver from clearing LDL cholesterol efficiently. Other medications reduce the production of this protein directly inside liver cells.

As a result, the liver becomes much better at removing harmful cholesterol from the blood. LDL levels can drop significantly, which in turn lowers the risk of atherosclerosis, heart attack, and stroke.

How much can these medications lower cholesterol levels?

Quite dramatically. Depending on the patient’s starting point, LDL cholesterol can often be reduced by an additional 70–80 percent. The effect also appears relatively quickly — usually within the first few weeks of treatment. Some of these medications only need to be given once every six months, which many patients find very convenient.

Who is this type of treatment mainly intended for?

Primarily for people with a high or very high cardiovascular risk. This includes patients with atherosclerosis, previous heart attacks, significant coronary artery disease, or genetically high LDL cholesterol levels. It is important to understand that statins still remain the foundation of cholesterol treatment. However, if LDL targets are not reached despite standard therapy, or if a patient cannot tolerate statins well, then modern PCSK9 therapies may be added.

Are there any serious side effects?

Based on current data, these medications are generally very well tolerated. Some people may experience mild reactions at the injection site, such as redness, slight pain, or skin irritation. Serious complications are considered rare. European regulators currently regard the safety profile of these drugs as favorable.

Could these injections completely replace cholesterol tablets in the future?

Probably not. For most patients, statins will continue to be the cornerstone of treatment because they are supported by decades of evidence, widely available, and effective.

The future is more likely to involve a personalized approach: tablets for most patients, with injectable therapies used as an additional option for high-risk individuals or for those who cannot otherwise achieve safe LDL levels.

One especially promising medication is Inclisiran, which only needs to be administered twice a year. This also makes it easier for patients to stay consistent with treatment.

What do we know about the long-term effects — for example after 10–15 years?

So far, there is no evidence that these medications lose effectiveness over time. In most cases, they are viewed as a long-term — often lifelong — and reliable therapy.

Some people argue that high cholesterol does not need treatment at all. What is your view?

From a scientific perspective, that is incorrect. Elevated LDL cholesterol is one of the key drivers of atherosclerosis, heart attack, and stroke. Of course, not everyone automatically needs medication. We always assess each patient individually, taking into account age, other medical conditions, vascular health, and LDL levels. However, for patients at high risk — or for those who already have vascular disease — lowering LDL cholesterol is one of the most important ways to prevent serious complications and prolong life. This applies to nearly all patients with coronary artery disease.

Modern injectable cholesterol-lowering therapies are among the most important breakthroughs in cardiology in recent years. They do not replace traditional treatment, but they provide new options for patients who previously struggled to reach safe cholesterol levels. For people with a high cardiovascular risk, these treatments are much more than just “another injection.” They offer a real opportunity to significantly reduce the likelihood of heart attack, stroke, and other serious complications. And importantly, we already have substantial real-world experience with these therapies.

• About Professor Westermann
• Department of Cardiology