Bempedoic acid alternative to statins may reduce risk of heart attack

• Statins are a popular cholesterol-lowering drug, but they come with the risk of muscle pain and other uncomfortable side effects.
• New research reveals that bempedoic acid may be an effective alternative for people who can’t or don’t want to take statins.
• Experts recommend talking to your doctor about your treatment options.

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For years, statins have been a mainstay of treatment to lower cholesterol and reduce the risk of heart disease complications. But, although they are effective, they can lead to intense side effects like muscle pain.

Now, a great new study published in the New England Journal of Medicine shows that another drug called bempedoic acid can be a good alternative for people who can’t take statins or don’t take them because of side effects.

The study looked at 13,970 patients from 32 countries who did not want to take statins, mostly because of musculoskeletal pain. Study participants were randomly divided into two groups: one was treated with bempedoic acid and the other was given a placebo. They were then followed for up to five years.

At the end of the trial, the researchers found that people tolerated bempedoic acid well and there was an almost 22% greater reduction in LDL (“bad”) cholesterol in the acid group. bempedoic compared to those taking a placebo. There was also a 13% lower risk of suffering cardiovascular events, including death, stroke and heart attack, in the group taking bempedoic acid compared to those taking the placebo.

It is important to note that the study did not directly compare bempedoic acid to statins. However, many people talk about bempedoic acid as an alternative to statins. Here’s what you need to know.

What is bempedoic acid?

Bempedoic acid (Nexletol) is a drug designed to help patients who cannot or do not want to take statins. It was approved by the Food and Drug Administration (FDA) in 2020 to treat these patients, its impact at the time on serious complications of heart disease had not been studied. In fact, the FDA required that the drug’s label state, “The effect of Nexletol on cardiovascular morbidity and mortality has not been determined.

Bempedoic acid works to help lower levels of LDL (“bad”) cholesterol in the blood. It specifically targets an enzyme called adenosine triphosphate-citrate lyase (ACL) and, “therefore, inhibits the production of cholesterol in the body,” says Jamie Alan, Ph.D., associate professor of pharmacology and toxicology at Michigan State. University.

It works a little differently than statins. “It targets the cholesterol biosynthetic pathway in the liver at an earlier stage than that targeted by statins,” says Emily Aboujaoude, Pharm.D., assistant clinical professor at Rutgers University, Ernest Mario School of Pharmacy.

Bempedoic Acid Side Effects

Like all medicines, bempedoic acid comes with its own risk of side effects. Here are the most common side effects of taking bempedoic acid, according to the Nexletol website:

• Cold or flu symptoms
• Muscle spasms
• Back ache
• Pain in the legs or arms
• stomach pain

Overall, however, bempedoic acid is activated in your liver, so it’s unlikely to cause muscle pain the way statins do, Alan says.

Bempedoic acid vs statins

Statins are drugs used to lower cholesterol and interfere with the production of cholesterol in the liver, according to Medline Plus. They work specifically to lower LDL cholesterol and raise HDL (“good”) cholesterol to help slow the build-up of plaque in your arteries that could build up and lead to heart attack or stroke.

“Statins are currently considered the gold standard” of cholesterol-lowering drugs, says Alan. They’re also an incredibly popular choice: 93% of adults using cholesterol-lowering medication use a statin, according to the Centers for Disease Control and Prevention (CDC).

But while statins are often effective, they have limitations. According to Penn Medicine, they can cause side effects such as muscle aches, increased blood sugar, brain fog, and even liver damage.

Statins and bempedoic acid “have a different mechanism of action,” says Alan. While statins and bempedoic acid work in your liver, “bempedoic acid’s target is primarily limited to the liver; The target of statins is also in the muscle as well as in the liver,” says Alan.

That’s why, she explains, muscle aches can be a side effect of statins.

So, do you have to Does bempedoic acid replace statins?

Not necessarily. This study did not directly compare bempedoic acid and statins, and statins are still considered the gold standard of care for lowering cholesterol. “However, many patients are intolerant to the drug class (statins) because of the muscle pain associated with it,” says Aboujaoude. “Having an alternative to statins would benefit these patients and allow them to reach their target cholesterol levels while avoiding unwanted muscle symptoms.”

The latest findings from the study have “impressive” results, says Jennifer Wong, MD, cardiologist and medical director of noninvasive cardiology at MemorialCare Heart and Vascular Institute at Orange Coast Medical Center in Fountain Valley, Calif. “There are many other cholesterol-lowering drugs out there that have really struggled to show a drop in adverse cardiovascular events when taken alone,” she says. “This study shows that, taken alone, there was a decrease with bempedoic acid. However, the degree of reduction is still not as impressive as with statins.

Dr. Wong says she would always recommend that her patients try statins first. “We still have a lot more evidence and experience with statins – they are still our first choice,” she says. “But, if someone absolutely cannot tolerate statins, that would be one of the other drugs we can turn to as an alternative. It may not have as many benefits, but it is a good alternative.

Rigved Tadwalkar, MD, a board-certified cardiologist at Providence Saint John’s Health Center in Santa Monica, Calif., agrees. “With statin therapy, we can see up to a 40-50% reduction in LDL cholesterol,” he says. “It’s actually still an alternative to statins, but it’s not as robust as statin therapy. We always try to keep patients on statins, even at low doses. »

Ultimately, says Alan, it’s a conversation to have with your prescribing doctor. “Statins aren’t the only game in town anymore,” says Alan. “There are several other options that can be used to lower cholesterol.”