A doctor explains why they'd choose a PCSK9 inhibitor over a statin: statins may worsen insulin resistance, raise diabetes risk, damage mitochondria, and affect cognition, while PCSK9 inhibitors avoid these metabolic side effects and lower Lp cholesterol.
If I had to choose between a statin and a PCSK9 inhibitor drug for lowering cholesterol, I'd pick the PCSK9 inhibitor, and here's why. Statins can worsen insulin resistance and increase diabetes risk. They smash GLP-1 levels into the floor, and there's evidence that they can harm mitochondria. And all this is on top of common muscle aches and the potential for muscle injury in a small subset of people. Also, statins can cross into the brain, whereas PCSK9 inhibitors generally don't. And the cognitive impacts of these medications are still debated, but that difference does matter to me. Furthermore, PCSK9 inhibitors can lower Lp, a risk factor in some people, while statins can increase Lp. Now, of course, none of this is medical advice, nor do I have any relevant conflicts of interest, for what it's worth. This is just how I start to think about the tradeoffs. But if that piqued your interest and you want more than you can get in just a 1-minute short, check out my concise masterclass on how cholesterol-lowering medications actually work. Not just statins and PCSK9 inhibitors, but bempedoic acid and ezetimibe, and a few honorary non-prescription mentions like berberine, unsaturated fats, and certain fibers. Check it out.
