IT is the biggest single killer worldwide, with a quarter of UK deaths attributable to cardiovascular disease in its various forms, including heart attack, stroke and peripheral vascular disease.

Hence it was no surprise when the announcement of a deal between pharmaceutical giant Novartis to supply the NHS with a new drug that lowers cholesterol, yet only needs an injection every six months, made the front page of most national newspapers.

The medicine in question, inclisiran, trade name Leqvio has shown excellent results in clinical trials, with a reduction in LDL or “bad” cholesterol in as little as two weeks. Administered as an injection, it is given at the start of treatment, after three months, then every six monthly from then on, hence the claim of it being only twice-yearly.

With plans to treat 300,000 patients in England and Wales over the next three years, it is estimated that 55,000 cardiovascular events and 30,000 deaths will be prevented as a result in the coming decade.

Inclisiran will initially be offered to those with established cardiovascular disease, meaning persons who have already had a heart attack, stroke or blood vessel bypass surgery, and in whom traditional medications have not lowered cholesterol levels sufficiently. However, it is hoped that in time treatment will be extended to those without cardiovascular disease, but whose cholesterol places them at increased risk. It may be offered instead of, or as an adjunct to statins, the most commonly prescribed medication for raised cholesterol.

Inclisiran is not the first injectable. Others, for example alirocumab and evolocumab, are well established, but require at least monthly injection, and remain the preserve of specialist doctors. Current plans are for nurses to give inclisiran in GP surgeries, reducing inconvenience and increasing accessibility for patients. Although both have the goal of reducing LDL cholesterol, inclisiran works slightly differently from statins, which have been in use since the late 1980s. Statins reduce production of the LDL-C molecule, whereas inclisiran turns off a gene PCKS9, the result being that the liver removes more LDL cholesterol from the bloodstream and then breaks it down. Cholesterol is moved around the body by two molecules. HDL or high-density lipoprotein, takes it from the circulation and stores it in the liver, LDL, or low-density lipoprotein, performs the opposite. High circulating levels of cholesterol increases deposition of fat in artery walls leading to narrowing and eventually blockage.

Although no longterm data exist as yet, inclisiran may become mainstream therapy in a very short time scale. But for the over 6.5 million persons in the UK on statins, I would advise against ditching these, at least in the short term.

Though blamed for a multiplicity of side effects, and with even some very senior doctors questioning their efficacy, statins have had a bad press, despite many high-quality studies showing they reduce cholesterol and cardiovascular risk. Indeed, the concept of the “nocebo effect” is well established, with data amply demonstrating some trial patients report untoward side effects, irrespective of whether they are taking the active drug or placebo pills. This is not to take away from the pain of those who do suffer side effects from statins. But many if not all medications have side effects, yet don’t receive the criticism bordering on hatred reserved for statins.

For those with established cardiovascular disease, or certain genetic conditions, namely familial hypercholesterolaemia, where both total and LDL cholesterol remain significantly elevated, diet and exercise alone will not be sufficient to lower levels of cholesterol to a safe level, or in a suitable time frame. Prevention is better than cure, and even if guidelines eventually decide we should all be offered a cholesterol lowering medication of some sort, the basic principles of a healthy diet, maintaining a sensible weight, regular but enjoyable cardiovascular exercise, alcohol consumption within recommended limits, and not smoking will always be the best “non- treatment” way of trying to reduce our cardiovascular risk.

Many pharmacies now offer walk-in blood pressure checks, so taking time to know your numbers and seek help if they’re persistently raised, will also reduce your chance of untreated high blood pressure, largely silent yet together with raised cholesterol, among the biggest risk factors for cardiovascular disease.

Lastly, stress is a risk factor for heart attack and stroke, so if you’re struggling in these difficult times, don’t ignore the symptoms and seek help as you would any physical concern.