insurance companies will consider this drug a reasonable value and some experts already think that the price should come down given the size of the benefit on the positive side there was some indication that the benefit was increasing over time but that is highly speculative at this pointanother reason to hesitate the studys short time frame means that there wasnt much time in which to detect safety problems if you are cautious about the safety of medications you may want to wait and see what happens as more people start using itbesides there is a much less expensive alternative to evolocumab ezetimibe zetia is another medication that can be added to statins to further reduce cholesterol one study has indicated that it can reduce risk when added to statin therapy though not quite as much as evolocumab didfor people with a low risk of heart disease there is probably little to gain from taking a pcsk9 inhibitor many many of these kinds of patients would have to be treated for someone to benefit and there are no trials yet in this populationwhat about people who have trouble with statins first it turns out that some of the perceived problems with statins are not related to statins at all you may need help from your doctor to determine whats really causing your symptoms and some people tolerate one statin better than anotherif statins are really not for you ezetimibe is an option if you still want to further lower risk then you might add evolocumab despite its expense to ezetimibe this can be a particularly important option for people at high risk because of very high ldl levelsthere are not yet studies of outcomes in patients who use these medications because they cannot take statins but it is a reasonable guess that the benefit will be similar to that reported in the newly released study about a 15 percent reduction in heart attacks or strokesif there is a silver lining its that the triedandtrue remedies are highly effective at reducing the threat for those at great risk of heart attack and stroke despite the newest drugs a combination of hearthealthy behavior blood pressure control and statin therapy remains the gold standard