A statin alternative joins drugs that may reduce heart attack risk

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After a little more than a year and a half, 819, or 11.7 percent, of patients in the bempedoic acid group had one of the heart-related complications.

In the placebo group, such an event occurred in 927 patients, or 13.3 percent.

Participants were not at risk of muscle pain or diabetes, the most common complaints with statins. With bempedoic acid, a small percentage in the trial experienced an increased risk of gout, an inflammation of the joints that is treatable, and an increased risk of gallstones.

Now the question is, how important is this drug going to be?

Bempedoic acid is the sixth cholesterol-lowering drug, besides statins, that has been demonstrated to reduce heart attacks and strokes, noted Dr. T. Michael Davidson, director of the Lipid Clinic at the University of Chicago Pritzker School of Medicine, who It was founded by a company, New Amsterdam Pharma, which is developing an LDL-lowering drug. Others are bile acid resins, niacin, ezetimibe, PCSK9 inhibitors, and CETPI. They have different effects on LDL and range from cheap to expensive. With this line of drugs, Dr. Davidson said he hopes doctors can begin to focus on getting high-risk patients’ LDL levels down as low as possible, no matter what.

Yale cardiologist Dr. Harlan Krumholz said that given the modest effects of bempedoic acid and the fact that other drugs also lower LDL, it is “unlikely to be a game changer.”

Dr. Benjamin Ansell, a lipid expert at UCLA, said the drug was “better than nothing,” but it’s “not enough” for people who have high LDL levels and are at high risk.

Lipid experts say that many people who say they can’t tolerate statins actually can. Some people mistakenly attribute muscle pain to medication for other reasons. For others, a statin or a different dose of a different statin is tolerable.

But primary care doctors may not have the time or inclination to go through all this with patients, especially because they have to deal delicately with patients who are adamant that they cannot take drugs or will not have.

“When you come into firearms and say, ‘Take this drug,’ it turns off a lot of patients,” Dr. Ansell said. “There’s a fear that the patient won’t come back.”

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