These medicines block a liver enzyme and lower the main cholesterol-carrying particle further than any other drug. In people with arterial disease, fewer heart attacks and strokes follow over four to five years, and plaque shrinks. Total deaths have not clearly fallen, benefit is small where risk is low, and injection-site irritation is the main complaint. (Full Review)
| Marker | Target | Why |
|---|---|---|
| ApoB | Below 60 mg/dL; below 50 mg/dL with established arterial disease | Counts atherogenic particles directly; the quantity the drug acts on |
| LDL-C | Below 70 mg/dL; below 55 mg/dL with established arterial disease | The endpoint used in every outcome trial |
| Lipoprotein(a) | Below 75 nmol/L (roughly below 30 mg/dL) | Identifies inherited residual risk this class partially addresses |
| Non-HDL cholesterol | Below 100 mg/dL; below 85 mg/dL with established arterial disease | A no-cost cross-check on ApoB that needs no extra assay |
| Triglycerides | 70-90 mg/dL | Distorts calculated LDL-C and marks metabolic dysfunction the drug does not address |
| HbA1c | 4.8-5.4% | Tracks the glycaemic drift that the genetic data leave unresolved |
| hs-CRP | Below 1.0 mg/L | Separates residual inflammatory risk from residual cholesterol risk |
| ALT | Below 25 U/L in men, below 20 U/L in women | Baseline liver reference should symptoms or another liver-toxic drug arise later |
| Creatine kinase | Below 200 U/L in men, below 150 U/L in women | Distinguishes drug-attributed muscle symptoms from exercise-induced enzyme release |
| eGFR | Above 90 mL/min/1.73 m² | Background organ-function check; no dose adjustment depends on it |
Cadence: Baseline panel before the first dose; lipids rechecked at 4-8 weeks for the antibodies and at about 90 days for the twice-yearly injection; thereafter lipids twice yearly, with glucose and liver enzymes annually