The statin alternative bempedoic acid can reduce the risk of heart attack

• Statins are a popular cholesterol-lowering medication, but they come with a risk of muscle aches and other uncomfortable side effects.
• New research finds that bempedoic acid can be an effective alternative for people who cannot take statins or do not 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, while they are effective, they can come with intense side effects such as muscle pain.

Now, a large new study published in the New England Journal of Medicine shows that another medication 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. The 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 that there was an almost 22% greater reduction in LDL (“bad”) cholesterol in the bempedoic acid group compared with those who took a placebo. There was also a 13% lower chance of experiencing cardiovascular events, including death, stroke and heart attack, in the group that took bempedoic acid than those that took the placebo.

It is important to note that the study did not directly compare bempedoic acid to statins. However, there are many people who 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 medication that is designed to help patients who cannot take statins or do not want to take them. It was approved by the Food and Drug Administration (FDA) in 2020 to treat these patients, its impact at the time on serious complications from heart disease had not been studied. In fact, the FDA necessary the drug label to read “the effect of Nexletol on cardiovascular morbidity and mortality has not been determined.”

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

It works a little differently than statins. “It pushes the pathway of cholesterol biosynthesis in the liver to a step before that targeted by statins,” says Emily Aboujaoude, Pharm.D., clinical assistant professor at Rutgers University, Ernest Mario School of Pharmacy.

Bempedoic acid side effects

Like all medications, bempedoic acid comes with its own risk of side effects. The following are the most common side effects of taking bempedoic acid, according to a The Nextletol website: :

• Symptoms of the common cold or flu
• Muscle spasms
• Back pain
• Pain in the legs or arms
• Stomach pain

In general, however, bempedoic acid is activated in your liver, so it is unlikely to cause muscle pain like statins, says Alan.

Bempedoic acid versus statins

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

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

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

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

This is why, she explains, this is why there can be muscle aches and pains as a side effect with statins.

Therefore, it must Does bempedoic acid replace statins?

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

The latest study results have “impressive” results, he says Jennifer Wong, MD, cardiologist and medical director of Non-Invasive Cardiology at MemorialCare Heart and Vascular Institute at Orange Coast Medical Center in Fountain Valley, California “There are many other medications out there that lower cholesterol that they really struggled to show that there was. a decrease in adverse cardiovascular events when taken alone,” he says. “This study shows that, when taken alone, there was a decrease with bempedoic acid. However, the degree of decrease is 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 statin drugs — they’re still our first choice,” he says. “But, if someone cannot tolerate statins. this would be one of the other medications that we can turn to as an alternative. It may not have so much benefit, but it is a good alternative.”

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

Ultimately, Alan says, this is a conversation to have with your prescribing physician. “Statins are no longer the only game in town,” says Alan. “There are many other options that can be used to reduce cholesterol.”