Statins have revolutionized heart disease by lowering cholesterol effectively—by up to 50% or more.
But anywhere from 7% to 29% of people who take them may be more susceptible to its side effects, which include weakening of muscles and pain, and decide they can’t tolerate them.
While alternative drugs, such as PCSK9 inhibitors, exist, they must be injected (unlike statins, which are pills), and can be far more costly than statins, many of which are available in generic form.
The new study provides that data, showing that the drug can not only lower LDL cholesterol but also contribute to reductions in adverse heart events—including heart attack, stroke, clogged heart vessels that need to be cleared, and death from heart disease.
The study included nearly 14,000 people with high cholesterol, and therefore at higher risk of heart disease. Most had already experienced a heart event, while about 30% of participants had not.
All were randomly assigned to take either bempedoic acid or a placebo.
While bempedoic acid does not appear to reduce cholesterol levels to the same extent as statins can, the study documented that it can be an effective alternative for lowering the risk of heart events and dying of a heart event.
“The bottom line is that for patients who cannot tolerate statins, we can offer them an alternative,” says Dr. Steven Nissen, a cardiologist at the Cleveland Clinic and lead author of the study.
Bempedoic acid avoids the muscle-weakening issues of statins because it doesn’t get activated in all cells—just the liver. The targeted location means less side effects in other tissues.
But as with any drug, bempedoic acid does come with side effects.
Still, says Nissen, gout can be treated with the proper medications, and “for somebody who is on a therapy to lower uric acid, it’s probably safe to give bempedoic acid. From my perspective, ...
...if I were a patient, I would take the slight increased risk of gout over a heart attack, but the risks are something that doctors and patients will have to discuss and balance.”
“It hasn’t been widely used,” says Nissen.
“The medical community has been waiting for more evidence, and now we’ve got good evidence [of its benefits].” That data could also help to convince more insurers to cover the drug for those who are statin intolerant.
That would make the drug applicable to a broader population.