Patients who need to lower their cholesterol will soon have a powerful new option.

On July 16, the Food and Drug Administration approved a new pill called enlicitide that can lower cholesterol levels substantially more than statins alone. The drug, which was developed by Merck and will be sold under the brand name Lipfendra, is expected to go on the market in the coming weeks.

Here is what to know.

Q: How does the new pill compare to other cholesterol treatments?

A: Lipfendra adds to the list of treatments that can lower low-density lipoprotein, or LDL, a form of cholesterol that, at high levels, increases the risk of heart disease. Studies over many decades have shown that drugs that safely lower LDL can protect people from heart disease.

The most commonly prescribed LDL-lowering drugs are statins, which inhibit the production of cholesterol in the liver. They have been used for decades and are safe and cheap, with list prices often around US$5 (S$6.50) to US$25 a month. Depending on the statin and the dose, they can lower LDL levels by around 30 per cent to 50 per cent.

Other drugs include ezetimibe, a pill that inhibits the absorption of cholesterol and can lower LDL levels by about 20 per cent. In its generic form, it is as cheap as statins. There also is bempedoic acid, which blocks production of cholesterol and also lowers LDL levels by about 20 per cent. The generic version carries a list price of about US$430 to US$517 a month. (Patients often pay less than the list price of a drug.)

The most powerful drugs available – including alirocumab, evolocumab, and inclisiran – work by blocking a protein called PCSK9, which slows the body’s ability to clear cholesterol. These drugs have been shown in clinical trials to lower LDL levels by 60 per cent to 70 per cent. They often are used alongside other drugs like statins to lower LDL even more aggressi...