Statins Aren't the Only Drugs That Can Lower Heart Attack Risk Anymore

In addition to lowering cholesterol, the researchers found that bempedoic acid also had a small but significant impact on reducing the risk of cardiovascular disease.

The millions of Americans at an increased risk for heart attacks owing to their frighteningly high LDL cholesterol levels have been advised by their doctors to take statins.. It has been shown that using these inexpensive generic drugs may considerably lower cholesterol levels and, as a result, lessen the chance of developing cardiovascular disease and dying from it. Statins have a side effect known as muscular discomfort, which is why many individuals choose not to take them or cannot take them.

Statins are the most effective treatment for lowering LDL, or "bad" cholesterol. Still, many people at risk for heart disease refuse to take them due to significant side effects, such as muscular discomfort and weakness.

Statins have efficiently reduced cholesterol levels by up to fifty percent or more, which has led to a revolution in the treatment of heart disease. Nevertheless, anywhere from 7% to 29% of individuals who take them may be more sensitive to the adverse effects of the drug, which include discomfort and a weakening of the muscles, and may decide that they are unable to handle the results of the drug.

According to a big clinical study presented Saturday at the annual conference of the American College of Cardiology, an alternative medicine, bempedoic acid, considerably reduces cholesterol and the risk of heart attacks, as well as the need for a treatment that unblocks blocked arteries. Saturday, the study was published in the New England Journal of Medicine.

The research included close to 14,000 participants who had high cholesterol and were, as a result, at an increased risk of developing heart disease. The majority of individuals had previously suffered from at least one heart-related incident, whereas around one-third had not. Every participant took either bempedoic acid or a placebo according to a predetermined schedule. (Some of the patients in the placebo group were already taking other cholesterol-lowering drugs, such as modest doses of statins, niacin, or PCSK-9 inhibitors; these treatments all decrease cholesterol, but they were unable to bring the patients' levels of cholesterol down to a low enough level.) During the course of an average of little more than three years, the researchers kept track of their patient's cardiac events as well as changes in their cholesterol levels. According to the study's findings, bempedoic acid may reduce the risk of cardiovascular disease and decrease cholesterol levels.

"Statins are the cornerstone of cardiovascular disease prevention, and they are advised to a huge number of individuals who have or are at risk for cardiovascular disease," said Dr. Steven E. Nissen, the chief academic officer at the Cleveland Clinic's Heart and Vascular Center. "Anywhere between 7% and 29% of patients develop intolerable side effects. Muscle aches are the key issue."

Nissen said these individuals would not do well if they could not reduce their cholesterol levels. He said bempedoic acid does not induce muscular adverse effects since it is inactive in muscle or other bodily tissues. The drug is not involved until it reaches the liver.

LDL cholesterol, also known as low-density lipoprotein cholesterol, is responsible for the buildup of fatty deposits in the arteries, which in turn raises the risk of cardiovascular events including heart attacks and strokes. The leading cause of death for both men and women in the United States is heart disease, and one of the most effective ways to prevent oneself from developing heart disease is to decrease one's LDL cholesterol levels. According to the American Heart Association, the ideal total cholesterol level for an adult is around 150 milligrams per deciliter (mg/dL), while the LDL level should be at or below 100 milligrams per deciliter.

When used with statins, bempedoic acid, which is already FDA-approved, has been found to reduce cholesterol levels.

In the current study, Nissen and his colleagues recruited 13,970 statin-intolerant individuals and randomly assigned them to receive bempedoic acid or a placebo daily. In the beginning, the average LDL cholesterol level of the patients was 139.0.

The LDL cholesterol levels decreased by 29.2 points after six months. By the conclusion of the follow-up period, which lasted a median of 40.6 months, the medicine reduced the risk of heart attacks by 23%. The chance of requiring cardiac revascularization (the surgery to remove blocked arteries) was reduced by 19%.

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Those who were given the actual drug had a higher risk of problems, such as gout and gallstones, than those who were given a placebo.

The study indicated that individuals who took bempedoic acid had a cumulative 13% decreased risk of mortality from cardiovascular disease, nonfatal strokes, and nonfatal heart attacks when compared with those in the placebo group.

Instead of concentrating just on cholesterol levels, the researchers looked at statistics that may be more important to patients, such as the chance of having a heart attack. Nissen expects that this will result in more people taking cholesterol-lowering medication.

Although bempedoic acid does not seem to decrease cholesterol levels to the same amount that statins do, research has shown that it can be an effective option for reducing the risk of having a cardiac event or passing away as a result of having a heart event.

Bempedoic acid does not be activated in all cells; rather, it only gets started in the liver. This means that it does not produce muscular weakness as statins do. Because of the location of the targeted area, there will be fewer adverse effects in adjacent tissues. But, just like any other medication, bempedoic acid might cause adverse reactions in certain people. According to the findings of the most recent research, it has the potential to raise blood levels of both uric acid and creatinine, making it potentially harmful for those who suffer from gout. Even so, according to Nissen, gout may be treated with the appropriate drugs, and "for someone who is on a treatment to decrease uric acid, it's probably okay to administer bempedoic acid." If I were a patient, from my point of view, I would choose to accept the slightly higher chance of gout rather than the danger of having a heart attack; nonetheless, the risks are something that both patients and their physicians will need to discuss and weigh.

Bempedoic acid, which is manufactured and marketed by Esperion, may be purchased on its own or in combination with ezetimibe, another prescription that reduces cholesterol levels. According to Dr. JoAnne Foody, a cardiologist who works for Esperion and serves as the company's chief medical officer, each version costs $395 per month.

Foody said that they do not want to compete with statin medications. They are considered to be the first treatment. Everyone who has access to statins should take them.

According to Dr. Howard Weintraub, clinical director of the Center for the Prevention of Cardiovascular Disease at the Leon H. Cheney Division of Cardiology at NYU Langone Health, bempedoic acid may not be as effective as statins. Still, it could be a life-saving medication for people at risk for cardiovascular disease who are unable or unwilling to take statins.

Dr. Robert Rosenson issued a warning to other medical professionals and people not to consider bempedoic to be the same as statins.

According to Rosenson, a professor of medicine at the Icahn School of Medicine at Mount Sinai in New York City, "Bempedoic acid is not an alternative for statin medication." The LDL-lowering effectiveness was limited, and the reductions in cardiovascular events were fewer than those seen with statins.

According to Dr. Benjamin Ansell, a specialist in lipids at the University of California, Los Angeles, the medicine is "better than nothing," but "it isn't enough" for those who have high LDL levels and are at an increased risk of developing cardiovascular disease.

However, primary care physicians might not have the time or the inclination to do this with their patients. This is especially true when considering the fact that they must proceed with caution when dealing with patients who are adamant that they cannot or will not take the medications.

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                       Study finds new treatment for high cholesterol