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What to Know About the New Cholesterol Drug

When our primary care doctors in Delray Beach prescribe statins to help lower cholesterol, we’re often disheartened by a number of our patients who cannot or will not take them.

Stroke is a leading cause of death in the U.S., and is a major cause of serious disability for adults, according to the Centers for Disease Control and Prevention (CDC).

Currently, more than 20 percent of Americans take cholesterol-lowering drugs known as statins to lower their risk of a first heart attack or stroke due to a blood clot. Statins are the first-line treatment for high cholesterol.

But often, the side effects—most commonly, muscle pain—lead patients to stop taking them. So we were especially pleased to learn the results of a new study showing a new drug called bempedoic acid that could replace statins for those people.

Easier to Tolerate

“I see heart patients that come in with terrible histories, multiple myocardial infarctions, sometimes bypass surgery, many stents and they say, ‘Doctor, I’ve tried multiple statins, but whenever I take a statin, my muscles hurt, or they’re weak. I can’t walk upstairs. I just can’t tolerate these drugs,’ ” Steven Nissen, a cardiologist and researcher at the Cleveland Clinic and co-author of the new study, told CNN.

His study, published this month in the New England Journal of Medicine (NEJM), found that in patients with increased cardiovascular risk, bempedoic acid was found to decrease the risk for heart attacks, as well as the need for procedures like a bypass operation or stents.

Doctors will still prescribe statins as the first solution to lowering cholesterol, but for the estimated 10-30 percent of patients who cannot tolerate them, bempedoic acid provides an alternative. Besides intense muscle pain, some other patients who tried statins also complained of fuzzy thinking or lapses in memory.

“Statins are the gold standard. They are the cornerstone,” Nissen told CNN.

“The purpose of this study was not to replace statins, but to allow an alternative therapy for people who simply cannot take them,” he explained.

The Study

Of course, just because a drug has fewer side effects doesn’t mean it’s effective. The U.S. Food and Drug Administration (FDA) approved bempedoic acid in 2020, but until now no study had shown that it could be as effective at preventing heart attacks and strokes as statins.

The researchers divided 14,000 patients into two groups. Half received bempedoic acid daily and half took a placebo. After six months, those who took bempedoic acid saw a 21 percent greater reduction in their LDL (“bad”) cholesterol than those who got the placebo. After three years, 9.5 percent of those in the placebo group had suffered a heart attack or stroke or died, compared with just eight percent of those who took bempedoic acid.

The drug also performed well in women and prevented first heart attacks and strokes.

When asked about side effects, Nissen told CBS News, “Let me first tell you what the drug didn’t do. It didn’t cause muscle pain. That was very important,” he said.

“It did increase the risk of gout by about an absolute of one percent. And it did increase the risk of gallstones by about one absolute percent. Neither of those do we consider to be particularly serious.”

In other words, he said the benefits outweigh the disadvantages.

“The number [of gout and gallstone attacks] was small,” Nissen told CNN, “and weighing that against a heart attack, I think most people would say, ‘Okay, I’d rather have a little gout attack.’ ”

Bempedoic acid also didn’t raise the chances of developing type 2 diabetes, another risk of traditional statins.

What this Means

Some may ask why they need statins, to begin with.

Cholesterol is a type of waxy, fat-like substance found in every cell in the body. Made by the liver and also present in some foods, it helps cells function properly, and helps synthesize Vitamin D as well as some hormones.

Despite the role cholesterol plays in keeping the body healthy, only a small amount is needed to maintain critical functions.

When the body has too much of the LDL-type of cholesterol, it can build up on the walls of blood vessels, causing them to become narrow. This in turn begins to block the free flow of blood to and from the heart and other organs in the body. When blood flow to the heart is blocked, it can cause chest pain (angina), a heart attack, or a stroke, among other cardiovascular problems. Thus, too much LDL is “bad” for the body.

Statins have been shown to lower the amount of LDL cholesterol in the blood, thereby reducing the risk of heart attack or stroke.

Many specialists welcomed the addition of bempedoic acid to the fight against heart disease.

“We continue to see that if we can lower your LDL significantly, we improve people’s cardiovascular health,” Manesh Patel, a cardiologist, and volunteer with the American Heart Association (AHA), who was not part of the new study, told CNN.

“And so we need as many different arrows in our quiver [as possible] to try to get that done,” he added.

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