INCLISIRAN INJECTION FOR CHOLESTEROL LOWERING IN SINGAPORE
Aquila Longevity · Preventive Cardiology · Singapore CBD
Inclisiran in Singapore: a twice-yearly injection to lower LDL cholesterol
Inclisiran is a small interfering RNA (siRNA) therapy that lowers LDL cholesterol by silencing PCSK9 production in the liver. After two starting doses, it is given as a single subcutaneous injection every six months — an option for adults whose LDL stays above target on statins, or who cannot tolerate them. Assessed and administered by a doctor at our Robinson Road clinic.
per year
vs placebo, ORION trials
including review
very-high-risk adults
Start here
Find out what your numbers actually mean
Send your details and we will arrange a physician-led cardiovascular risk review. If you already have recent lipid results, bring them — it makes the first consultation considerably more useful.
- Full lipid panel interpretation against a target set for your risk category
- An honest view on whether escalating beyond your current therapy is warranted
- Written quotation and documentation you can submit to your insurer
Request an assessment
The problem
LDL cholesterol does not hurt. That is precisely the problem.
Low-density lipoprotein — LDL — is the particle that carries cholesterol through your bloodstream. When there is more of it circulating than your arteries can handle, LDL particles pass into the artery wall and stay there. Immune cells arrive to clear them, become inflamed, and the result is an atherosclerotic plaque: a slow-growing deposit that narrows the vessel and can rupture without warning.
This process is measured in decades, not weeks. It produces no symptom you can feel, no change you can see in the mirror, and often no abnormality on a resting ECG. Many people first learn about their arteries on the day something goes wrong with them.
The relationship between LDL and cardiovascular events is one of the most consistently reproduced findings in medicine, and it behaves cumulatively — it is the total LDL your arteries are exposed to over your lifetime that matters, not the reading on a single morning. Lowering LDL earlier, and keeping it low, does more than lowering it late.
What sustained high LDL contributes to
- Coronary artery disease, angina and myocardial infarction
- Ischaemic stroke and transient ischaemic attack
- Peripheral arterial disease affecting the legs
- Chronic inflammation and stiffening of the arterial wall
Mechanism
How inclisiran works: switching off the instruction, not blocking the protein
Your liver removes LDL from the blood using LDL receptors on its surface. A protein called PCSK9 destroys those receptors. Fewer receptors means less clearance, which means more LDL circulating. Every modern LDL-lowering strategy is a different way of interfering with that loop.
Three steps
- It reaches the liver by design. Inclisiran is chemically attached to a sugar molecule (GalNAc) that binds a receptor found almost exclusively on liver cells — so the drug concentrates where PCSK9 is made rather than dispersing through the body.
- It silences the message. Inside the cell, the siRNA is loaded into the cell's own RNA-interference machinery and directs the destruction of PCSK9 messenger RNA. The gene is untouched; only the instruction to build the protein is intercepted.
- Receptors survive, LDL falls. With less PCSK9, more LDL receptors remain on the liver surface, and more LDL is pulled out of circulation and broken down.
Because the siRNA stays active inside liver cells for months, the effect long outlasts the injection itself. This is why the maintenance schedule is twice a year rather than daily — and it is a genuinely different mechanism from a statin, which reduces how much cholesterol the liver makes in the first place.
In context
How it compares with the other options
Inclisiran is not a replacement for statins and is not a first-line treatment. It is generally used in addition to the maximum statin dose you can tolerate, or as an alternative pathway when statins genuinely cannot be used. Here is where each option sits.
| Approach | How it works | Dosing | Typical LDL reduction |
|---|---|---|---|
| Statins | Reduce cholesterol production in the liver | Oral, daily | 30–55%, dose-dependent |
| Ezetimibe | Reduces cholesterol absorption from the gut | Oral, daily | ~15–20% added to a statin |
| PCSK9 antibodies | Bind and neutralise circulating PCSK9 protein | Injection, every 2–4 weeks | ~50–60% |
| Inclisiran (siRNA) | Stops PCSK9 being made inside liver cells | Injection, day 0, month 3, then 6-monthly | ~50% vs placebo in ORION trials |
An honest limitation worth knowing before you decide
Inclisiran has strong, reproducible evidence for lowering LDL cholesterol. Large trials designed to confirm that this translates into fewer heart attacks and strokes — the ORION-4 and VICTORION-2P outcome studies — are still running. Statins, by contrast, already have decades of outcome data. That is a real difference, and any doctor recommending inclisiran to you should raise it unprompted.
Physician-administered, not self-injected
Inclisiran is given by a doctor or nurse as a subcutaneous injection into the abdomen, upper arm or thigh. There is nothing for you to store at home, nothing to refrigerate, and no technique to learn. The appointment itself typically takes ten to fifteen minutes including the review.
Because the maintenance interval is six months, the treatment fits around two appointments a year — a practical consideration if you travel frequently or find daily dosing difficult to sustain.
The schedule
Two doses to start, then twice a year
The dosing sequence is fixed and it genuinely is a sequence — the second dose comes earlier than the maintenance interval in order to reach steady LDL suppression, after which the six-month rhythm begins.
Fewer decision points
A daily tablet asks you to make the right decision 365 times a year. Two appointments ask you twice. For patients whose LDL drifts because of missed doses rather than biology, that structural difference matters.
Steady, not peaked
LDL lowering is sustained across the whole dosing interval rather than fluctuating between doses, which is what makes the six-monthly interval clinically workable.
Nothing to carry
No cold chain, no home storage, no travelling with medication. Relevant if you are frequently out of Singapore for extended periods.
Suitability
Who this is for — and who it is not for
Being interested in longevity is not on its own a clinical indication. Inclisiran is considered when there is a measurable LDL problem that existing treatment has not resolved. The list below is a guide to the conversation, not a substitute for it.
- Adults whose LDL remains above target despite the maximum statin dose they can tolerate
- Documented statin intolerance, including recurrent muscle symptoms on multiple statins
- Established atherosclerotic cardiovascular disease — prior heart attack, stroke, stenting or bypass
- Heterozygous familial hypercholesterolaemia, or a strong family history of premature heart disease
- Type 2 diabetes or metabolic syndrome with persistently elevated LDL
- Patients for whom adherence to daily oral therapy has repeatedly broken down
- Pregnancy, planned pregnancy, or breastfeeding
- Anyone under 18, outside specialist paediatric lipid care
- Known hypersensitivity to inclisiran or any excipient
- Severe liver or kidney impairment — safety data are limited and specialist input is needed
- People whose LDL has never been properly measured, or who have not yet tried first-line therapy
- Anyone seeking it as a substitute for diet, exercise or smoking cessation rather than in addition to them
Inclisiran is a prescription-only medicine in Singapore
It cannot be dispensed or administered without a doctor's assessment, and suitability depends on your lipid results, medical history, current medications and overall cardiovascular risk. This page is general medical information about a treatment we offer — it is not a recommendation for you personally, and no outcome is guaranteed.
Your numbers
There is no single "normal" LDL — there is a target for your risk level
Singapore laboratories report LDL cholesterol in millimoles per litre (mmol/L). If you have seen a figure in mg/dL from an overseas report, divide by 38.67 to convert. The target you should be aiming for is not a population average; it is set by how much cardiovascular risk you already carry.
Someone who has already had a heart attack needs a far lower LDL than someone with no risk factors at all — which is why two people can receive the same lab result and be given completely different advice. Establishing your risk category is the first thing a lipid consultation does, and it is what determines whether escalation beyond a statin is warranted.
Alongside LDL, a thorough review looks at non-HDL cholesterol, triglycerides, and where indicated lipoprotein(a) — an inherited particle that standard panels miss and that conventional therapy does not lower.
| If your risk is… | …your LDL-C target is | Same target in mg/dL |
|---|---|---|
| Very high risk | < 1.4 mmol/L | < 55 |
| High risk | < 1.8 mmol/L | < 70 |
| Moderate risk | < 2.6 mmol/L | < 100 |
| Low risk | < 3.0 mmol/L | < 116 |
Read the table downwards: these are targets to aim for, not your current reading. The more cardiovascular risk you already carry, the further below the population average you are asked to go — someone who has had a heart attack is given the strictest target of all.
What happens
Your cardiovascular risk review, step by step
No one is given an injection at a first visit. The sequence below is designed so that by the time treatment is discussed, both you and your doctor are working from the same evidence.
Baseline bloods and history
A fasting or non-fasting lipid panel, plus liver and kidney function, HbA1c and thyroid function where relevant. We take a full medication history — including which statins you have tried, at what dose, and what happened.
Risk stratification
Your results are interpreted alongside blood pressure, smoking status, diabetes, weight, family history and any prior cardiac events, to place you in a risk category and set a specific LDL target rather than a vague one.
Options discussion
We go through what optimising your current therapy could achieve first, then whether adding ezetimibe, a PCSK9 antibody or inclisiran is appropriate — including cost, evidence strength and what each would require of you.
Initiation, if suitable
If inclisiran is the agreed option, the first dose is given as a subcutaneous injection in clinic. You are observed briefly afterwards. Most people return to normal activity immediately, including driving.
Review and maintenance
A repeat lipid panel around the second dose shows how far your LDL has moved against target. From there, maintenance settles into two appointments a year, with periodic reassessment of your wider risk profile.
Safety
Side effects and what to expect afterwards
Across the ORION clinical trial programme, inclisiran was generally well tolerated, with the most consistent finding being reactions at the injection site. Because the drug acts inside liver cells rather than circulating widely, systemic effects were uncommon.
Common and usually mild
- Injection-site redness, tenderness or a small firm area
- Mild pain or itching at the site, typically settling within days
Less common
- Joint aches
- Shortness of breath or chest discomfort reported in some trial participants
- Urinary tract infection reported in some trial data
Seek medical attention
- Rash, swelling of the face or lips, or difficulty breathing
- Severe or worsening pain at the injection site
- Any new chest pain, regardless of cause
Notably, inclisiran does not carry the muscle-related side effects associated with statins, which is part of why it is considered in documented statin intolerance. It also has no known significant interaction with the common statins, so it can be added to existing therapy rather than replacing it. Tell your doctor about every medication and supplement you take, including anything bought without a prescription.
The foundation
Medication sits on top of the basics, not instead of them
No injectable therapy removes the value of what you eat, how much you move, and whether you smoke. These remain the base layer of cardiovascular prevention, and they influence blood pressure, insulin resistance and inflammation in ways that no lipid drug addresses.
- Saturated fat. Reducing intake — coconut milk, palm oil, fatty cuts of meat, full-cream dairy — has a direct and measurable effect on LDL. This is worth naming plainly in a Singaporean diet, where several staples are coconut-based.
- Soluble fibre. Oats, barley, legumes, and vegetables bind cholesterol in the gut. Aim to build meals around them rather than adding them as an afterthought.
- Movement. Around 150 minutes of moderate activity a week improves HDL and triglycerides and supports weight control, even when LDL barely shifts.
- Smoking and vaping. Stopping is the single highest-yield cardiovascular intervention available to anyone who currently smokes.
- Blood pressure and glucose. Both compound arterial damage. Treating LDL while ignoring these leaves most of the risk in place.
A realistic plan is one you can hold for years. We would rather set changes you will actually sustain than a protocol you abandon in six weeks.
Questions
Frequently asked questions
The questions patients actually ask in consultation, answered directly.
How much does inclisiran lower LDL cholesterol?
In the ORION-9, ORION-10 and ORION-11 trials, inclisiran added to background therapy produced a placebo-corrected LDL cholesterol reduction of roughly 50% at day 510, sustained across the dosing interval. Individual response varies with your starting LDL, your genetics and what other therapy you are on, so the figure to watch is your own repeat lipid panel rather than the trial average.
Is inclisiran a statin?
No. Statins reduce how much cholesterol the liver produces. Inclisiran is a small interfering RNA that stops the liver making PCSK9, the protein that destroys LDL receptors. Different mechanism, different side-effect profile, and the two are usually used together rather than as alternatives.
Can I take it alongside my statin?
Yes — that is the most common way it is used. Inclisiran is generally added to the highest statin dose you tolerate, with or without ezetimibe. There is no known significant interaction with common statins. Do not stop your existing medication without speaking to your doctor first.
How often do I need the injection?
An initial dose, a second dose three months later, then one maintenance dose every six months. That works out to two injections a year once you are established on treatment.
Does the injection hurt?
Most patients describe it as a brief sting. It is a subcutaneous injection into the abdomen, upper arm or thigh, given with a fine needle. Some tenderness or redness at the site afterwards is the most commonly reported effect, and it usually settles within a few days.
How long is the appointment?
Around ten to fifteen minutes for a maintenance visit, including the injection and a brief review. Your first consultation is longer, because it covers history, risk assessment and results interpretation before any treatment decision is made.
Do I need a blood test first?
Yes. A baseline lipid panel is essential, along with liver and kidney function and, where relevant, HbA1c. Without a measured LDL and a defined target, there is no way to judge whether the treatment is appropriate or whether it is working.
How soon will my LDL come down?
LDL begins falling within weeks of the first dose and reaches a stable reduction that is maintained through the dosing interval. We usually recheck your lipid panel around the time of the second dose at month three to confirm the response against your target.
Is it a one-off cure? Can I stop after a few doses?
No. Inclisiran manages LDL for as long as you keep taking it. If you stop, PCSK9 production resumes and LDL returns toward its untreated level over the following months. It is long-acting, not permanent.
Has it been proven to prevent heart attacks and strokes?
Not yet definitively, and this is important to be clear about. Inclisiran has robust evidence for lowering LDL cholesterol, and lowering LDL is strongly associated with fewer cardiovascular events across decades of research on other drug classes. But the dedicated cardiovascular outcome trials for inclisiran itself — ORION-4 and VICTORION-2P — are still ongoing. Statins already have that outcome data; inclisiran does not yet. Any doctor discussing this treatment with you should say so.
What are the side effects?
The most consistent finding in trials was mild injection-site reaction — redness, tenderness or a small firm area. Joint aches, shortness of breath and urinary tract infection were reported in some participants. Unlike statins, inclisiran is not associated with muscle-related side effects. Seek medical attention for rash, facial or lip swelling, or breathing difficulty.
Can I have it if I am pregnant or trying to conceive?
No. Inclisiran is not used in pregnancy, in women planning pregnancy, or while breastfeeding. Because the effect persists for months after a dose, timing matters — tell your doctor if pregnancy is a possibility at any point, including in the year ahead.
Is it covered by insurance or MediSave in Singapore?
Coverage depends entirely on your individual policy, your rider, and whether the indication meets your insurer's criteria — it is not something we can confirm on your behalf. We can provide an itemised quotation and supporting clinical documentation for you to submit to your insurer before you commit to treatment. Check with your insurer directly first.
I feel completely healthy. Why would I treat anything?
Because atherosclerosis is asymptomatic for most of its course. Feeling well tells you about your symptoms, not about your arteries. If your LDL is measurably above target for your risk category, arterial exposure is continuing whether or not you can feel it — and the earlier that exposure is reduced, the more of it you avoid over a lifetime.
What if I have already tried statins and could not tolerate them?
Documented statin intolerance is one of the situations where inclisiran is most often considered. Bring the details: which statins, at what doses, what symptoms, and how they resolved. Genuine intolerance is a clinical finding, and establishing it properly changes what your options are.
Where is your clinic, and how do I book?
Aquila Medical Center is at 160 Robinson Road, #05-01 SBF Centre, in Singapore's CBD — a short walk from Tanjong Pagar and Telok Ayer MRT stations, and close to Shenton Way, Raffles Place and Marina Bay. Use the form below or message us on WhatsApp to arrange an assessment.
The clinic
Cholesterol management in the Singapore CBD
Aquila Medical Center sits at 160 Robinson Road, #05-01 SBF Centre — inside the financial district, which makes a lunchtime or before-work appointment realistic for people who otherwise defer these things indefinitely. We are a few minutes on foot from Tanjong Pagar and Telok Ayer MRT, and easily reached from Shenton Way, Cecil Street, Raffles Place, Marina Bay and Chinatown.
Cardiovascular disease remains one of the leading causes of death in Singapore, and raised blood cholesterol is among the most common — and most modifiable — contributors to it. Our preventive cardiology work sits within Aquila Longevity, alongside biological age and longevity assessment, health screening and chronic disease management, so lipid optimisation can be handled as part of a wider picture rather than in isolation.
Teleconsultation is available for follow-up and results review, though the injection itself must be given in person by a clinician.
Visit us
Aquila Medical Center
160 Robinson Road, #05-01 SBF Centre
Singapore 068914
Nearest MRT
Tanjong Pagar (EW15) · Telok Ayer (DT18)
WhatsApp
+65 8755 5696
Related services
Biological Age & Longevity Assessment ·
Health Screening ·
Chronic Disease Management
Next step
Your arteries age quietly. Your assessment does not have to wait.
If your LDL has stayed above target despite treatment, a proper cardiovascular risk review is the step that tells you whether escalation is warranted — and whether it is not.
Sources
References
- HealthHub, Singapore — Inclisiran medication information. healthhub.sg
- SingHealth — Inclisiran drug information. singhealth.com.sg
- MedlinePlus, U.S. National Library of Medicine — Inclisiran Injection. medlineplus.gov
- Ray KK et al. Two Phase 3 Trials of Inclisiran in Patients with Elevated LDL Cholesterol (ORION-10 and ORION-11). New England Journal of Medicine, 2020.
- Raal FJ et al. Inclisiran for the Treatment of Heterozygous Familial Hypercholesterolemia (ORION-9). New England Journal of Medicine, 2020.
- Mach F et al. 2019 ESC/EAS Guidelines for the management of dyslipidaemias. European Heart Journal, 2020.
- British Heart Foundation — Inclisiran: what you need to know. bhf.org.uk
- Australian Prescriber — Inclisiran for hypercholesterolaemia. australianprescriber.tg.org.au
- MIMS Singapore — Inclisiran prescribing information. mims.com
- Ministry of Health Singapore — National Population Health Survey (cardiovascular risk factor prevalence).