INTRODUCTION: Cardiovascular (CV) diseases are the leading cause of death and 
disability in the developed countries. Lipid-lowering therapy is a cornerstone 
of the CV risk modification strategy. The first line treatment for 
hyperlipidemia is statins, which decrease low-density lipoprotein cholesterol 
(LDL-C) by 30-50% and proportionally reduce the CV events. However, they are not 
always enough to achieve LDL-C goals in many patients, and some patients are 
statin intolerant. For this reason, new powerful injectable lipid-lowering drugs 
have been developed.
AREAS COVERED: The aim of this narrative review was to summarize the more recent 
clinical data on safety and tolerability of injectable lipid-lowering drugs. 
After an attentive literature search, the authors resumed here information on 
proprotein convertase subtilisin/kexin 9 inhibitors (evolocumab and alirocumab), 
small interfering RNA molecule inclisiran, antisense oligonucleotides 
(mipomersen, volanesorsen, ISIS 681257), and drugs targeting angiopoietin-like 
protein 3 (evinacumab, IONIS-ANGPTL3Rx).
EXPERT OPINION: Injectable lipid-lowering therapy for patients at high risk for 
CV disease complications or with severe inherited hypercholesterolemias can be 
an important element of the available therapeutic armamentarium. Clinical data 
prove the favorable risk-benefit profile of evolocumab, alirocumab, and 
inclisiran. Mipomersen, volanesorsen, ISIS 681257, evinacumab, and 
IONIS-ANGPTL3Rx safety is currently less extensively studied, especially in 
patients with comorbidities and polypharmacotherapy.