Controlling risk factors-such as blood lipid levels-is central to the secondary prevention of cardiovascular events in patients with a history of such events. In practice, this is often far from straightforward. On 1 September 2021, the National Institute for Health and Care Excellence (NICE) issued draft final guidance recommending inclisiran (Leqvio; Novartis) for people with primary hypercholesterolaemia or mixed dyslipidaemia, who have already had a cardiovascular event 1,2 . Specifically, inclisiran is now a recommended option in a group of secondary prevention patients that is often dicult to manage: those with persistently high low-density lipoprotein cholesterol (LDL-C) levels despite maximum tolerated therapy with other lipid-lowering agents, such as statins and ezetimibe, but with LDL-C below the NICE thresholds for eligibility for proprotein convertase subtilisin/kexin type 9 (PCSK9) monoclonal antibodies (PCSK9i) evolocumab and alirocumab (NICE technologies appraisal guidance TA393/4).
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