Star Cholesterol Drug: Why Diet Isn’t Enough, Doctor Says

A new class of cholesterol-lowering drugs has emerged as a “star treatment” for patients with high LDL (“bad cholesterol”) levels, according to Dr. Pablo Lapuente, a cardiologist at the Argentine Society of Cardiology, whose findings were published in La Nación on June 22, 2026. The medications—known as PCSK9 inhibitors—are now recommended alongside statins for patients who fail to reach target cholesterol levels through diet and lifestyle changes alone, marking a shift in clinical guidelines that experts say reflects growing evidence of their efficacy in reducing cardiovascular risk.

PCSK9 inhibitors, including drugs like alirocumab (brand name Praluent) and evolocumab (Repatha), work by blocking the PCSK9 protein, which normally breaks down LDL receptors in the liver. By inhibiting PCSK9, these drugs allow the liver to remove more LDL cholesterol from the bloodstream, often lowering levels by 50% or more in clinical trials. The U.S. Food and Drug Administration (FDA) approved evolocumab in 2015, and alirocumab in 2018, with both now widely used in high-risk patients across Latin America and Europe.

Dr. Lapuente’s analysis, based on a review of global clinical trials and Argentine health data, underscores that while diet—rich in fiber, healthy fats, and low in trans fats—remains foundational for cholesterol management, it is insufficient for many patients. “A healthy diet can reduce LDL by 5% to 10% in some cases,” he said. “But for patients with genetic conditions like familial hypercholesterolemia or those with multiple cardiovascular risk factors, that reduction is often not enough to prevent heart attacks or strokes.”

The shift toward PCSK9 inhibitors is supported by large-scale trials, including the FOURIER study (2017), which found that evolocumab reduced major cardiovascular events by 15% in high-risk patients with existing heart disease, even when combined with statins. A 2025 meta-analysis in The New England Journal of Medicine confirmed these benefits, though it also noted that the drugs carry a higher cost—typically $10,000 to $14,000 per year in the U.S.—and require subcutaneous injections every two to four weeks.

Argentina’s public health system has begun incorporating PCSK9 inhibitors into treatment protocols for select patients, though access remains limited due to budget constraints. In contrast, countries like Germany and the U.K. have expanded coverage under national health programs, citing long-term cost savings from reduced hospitalizations for cardiovascular events. Dr. Lapuente cited a 2024 cost-effectiveness study in JAMA Network Open that projected a 30% reduction in healthcare costs over five years for patients on PCSK9 inhibitors versus standard therapy alone.

Yet the drugs are not a panacea. A 2023 safety review in Circulation identified rare but serious side effects, including neurocognitive events and injection-site reactions, prompting the FDA to issue updated labeling warnings. “These medications are powerful tools, but they’re not for everyone,” said Dr. Lapuente. “Patients must still adhere to diet, exercise, and other lifestyle measures to maximize benefits and minimize risks.”

What remains uncertain is how long-term use of PCSK9 inhibitors affects other health markers, such as HDL (“good cholesterol”) or triglycerides, which some studies suggest may rise slightly. Ongoing trials, including the ORION-4 study, are investigating these effects in patients with diabetes, a population not fully represented in earlier research.

For readers managing cholesterol, the key takeaway is that treatment is now more personalized than ever. While diet and statins remain first-line therapies, newer medications offer a critical option for those who need deeper reductions in LDL. Experts emphasize that any treatment plan should be tailored by a healthcare provider, considering individual risk factors, genetic predispositions, and access to care.