Alternativen zu Evolocumab (Repatha)

A vitamin B3 precursor that reliably raises cellular NAD+ levels and is well tolerated — but human trials have so far shown mostly null or mixed results on the functional outcomes (muscle, metabolism, blood pressure, cognition) that elevation is meant to drive.

A fully human monoclonal-antibody PCSK9 inhibitor (Praluent), injected under the skin every 2 weeks, that lowers LDL cholesterol by ~50–60%. In the ODYSSEY OUTCOMES trial of ~18,900 post-heart-attack patients it reduced major cardiovascular events and showed a possible all-cause mortality signal. Generally well tolerated; injection-site reactions and high cost/access are the main trade-offs. Prescription drug, not a supplement.

An SGLT2-inhibitor diabetes drug (Invokana) that lowers glucose by excreting it in urine. It extended lifespan in male mice in the NIA aging program, and the SGLT2 class has strong proven cardiovascular, kidney, and heart-failure benefits in humans. Longevity benefit itself is unproven; carries genital-infection and (rarely) ketoacidosis risks. Prescription drug, not a supplement.

An SGLT2-inhibitor diabetes drug (Jardiance) with the strongest human outcome evidence of its class — it cuts cardiovascular death, heart-failure hospitalization, and kidney-disease progression even in non-diabetics. The most widely used SGLT2 for off-label 'longevity,' though longevity itself is unproven (the lifespan data are for sibling canagliflozin in mice). A prescription drug, not a supplement.

A prescription oral statin (Crestor) that inhibits HMG-CoA reductase, the rate-limiting enzyme of cholesterol synthesis — one of the most potent statins, lowering LDL-C ~45–55%. In JUPITER (~17,800 people with elevated hsCRP), rosuvastatin cut major cardiovascular events and all-cause mortality; IVUS trials (ASTEROID, SATURN) show coronary plaque regression. Risks: myalgia, rare rhabdomyolysis, a small new-onset-diabetes signal, and transient liver-enzyme rise. Prescription drug, not a supplement.

An SGLT2-inhibitor diabetes drug (Farxiga/Forxiga) with broad, robust human outcome evidence — it cuts heart-failure hospitalization and cardiovascular death across the ejection-fraction spectrum and slows kidney-disease progression, including in non-diabetics. The sibling of empagliflozin, used off-label for 'longevity,' though longevity itself is unproven (the lifespan data are for sibling canagliflozin in mice). A prescription drug, not a supplement.

A prescription oral cholesterol-absorption inhibitor (Zetia) that blocks the intestinal NPC1L1 sterol transporter, lowering LDL-C ~15–20% on its own and more when added to a statin. In IMPROVE-IT (~18,000 post-ACS patients) ezetimibe added to simvastatin cut cardiovascular events — the first proof a non-statin LDL-lowering drug improves outcomes. Very well tolerated; rare myalgia and small liver-enzyme rise. Prescription drug, not a supplement.

An FDA-approved oral LDL-cholesterol-lowering drug (Nexletol) that inhibits ATP-citrate lyase (ACL) upstream of statins in the cholesterol-synthesis pathway. Because it is a prodrug activated in the liver — not muscle — it largely avoids statin-type muscle pain, making it a key option for statin-intolerant patients. The landmark CLEAR Outcomes RCT (~14,000 patients) showed reduced major cardiovascular events. Lowers LDL-C ~15-25% as monotherapy. Raises uric acid (gout), liver enzymes, and carries a small tendon-rupture signal. Prescription drug, not a supplement.