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For patients who cannot tolerate statins or require additional lipid lowering despite maximum tolerated statin therapy, NICE guidance supports several alternative or adjunctive treatments: Ezetimibe : Reduces cholesterol absorption from the intestine and can be used alone or in combination with statins PCSK9 inhibitors (evolocumab, alirocumab): Injectable medications reserved for specific high-risk patients with familial hypercholesterolaemia or established cardiovascular disease who have not achieved targets with other therapies Bempedoic acid : A newer oral option for patients with statin intolerance Inclisiran : An injectable treatment given twice yearly for primary hypercholesterolaemia or mixed dyslipidaemia in line with NICE criteria Icosapent ethyl : For people with established cardiovascular disease and raised triglycerides despite statin therapy Fibrates : Primarily used for severe hypertriglyceridaemia Lifestyle modifications remain fundamental to cholesterol management and should be implemented alongside any pharmacological treatment
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