Is this new drug another solution for high cholesterol?

Bempedoic acid lowered cholesterol by 21% in people at high risk for heart disease.

Last month, the Journal of the American Medical Association (JAMA) published a study exploring the use of bempedoic acid, a fairly new drug that was approved by the FDA in 2020 as a cholesterol-lowering drug.

The results of the 4,000-person study were favourable; the drug lowered LDL cholesterol (which is the bad cholesterol that puts you at risk for heart attack and stroke) by about 21 percent.

The study lasted just under three years and was made up of patients with no history of heart disease but at high risk of cardiovascular events such as heart attacks or strokes. Additionally, participants were unable or unwilling to take statins. (Statins are a common treatment for high cholesterol.)

In addition to successfully lowering cholesterol, bempedoic acid lowered the rate of heart attacks, strokes and death from heart disease, said Dr. Priya Freaney, a cardiologist at Northwestern University in Chicago who was not affiliated with the study.

These positive results were seen in the group of patients given 180 milligrams of bempedoic acid per day, but not in those on the placebo pill.

This isn’t the first time bempedoic acid has been scrutinized for its use in lowering cholesterol. Prior to this study, research published in the New England Journal of Medicine also looked at the impact of bempedoic acids on high cholesterol and adverse cardiovascular events. This research, called the CLEAR Outcomes study, looked at more than 13,000 people, according to Freaney.

Unlike the JAMA study, the CLEAR research studied both those who had previously had heart attacks and strokes and those who had not yet had a medical event but were at risk for heart attacks and strokes, Freaney said.

As with most new drugs, there were some adverse events reported among people who participated in both studies. There were increases in gout, gallstones, and elevations in kidney and liver enzymes, Freaney explained. These are things that need to be investigated in more detail but not to a level sufficient to be considered dangerous or unable to use the drug, he added.

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So who should take bempedoic acid?

Many people don’t like taking statins, muscle pain and muscle weakness are very common ailments, causing many people to stop their life saving medications.

There are many people who are unwilling or unable to take statins who still need to lower their cholesterol and that’s where these drugs like bempedoic acid come in, said Dr. James OKeefe, a preventive cardiologist at Saint Lukes Mid America Heart Institute which was not affiliated with the study.

The study focused on people who had heart disease risk factors but couldn’t take statins for one reason or another, making this group of people good candidates for the drug outside of the study as well.

In addition to those who are intolerant to statins, Freaney said this treatment could work for people who take the highest dose of statins but still need additional treatment to lower their cholesterol. But, she said, research is needed to determine whether taking bempedoic acid in addition to statins is an effective plan.

Dr. Kershaw Patel, a preventive cardiologist at the Houston Methodist DeBakey Heart and Vascular Center who was not affiliated with the study, said about 1 in 250 people have a genetic condition called familial hypercholesterolemia, which causes high cholesterol. People with the condition might also be good candidates for bempedoic acid, Patel said, and he noted that for most people with high cholesterol, it’s related to diet and a family history. For the most part, it is not familial hypercholesterolaemia.

A healthy lifestyle of exercise and a diet rich in vegetables and lean meats is one way to lower cholesterol.

Statins remain the best drug for lowering cholesterol.

Statins are still the most studied and most powerful way to lower cholesterol, all three experts said.

I would again strongly emphasize that the first-line drug for controlling cholesterol is still statins, Patel said. Because this trial also involved people who had tried first-line medicine, but could not tolerate it.

If a patient came to OKeefe with a desire to start treatment with bempedoic acid, he said he would talk to them about treatment options, including statins, and, if they were intolerant to the drug, he would recommend bempedoic acid.

Why are statins the first choice? They’re more effective, OKeefe pointed out. They lower cholesterol anywhere from 40% to 50%, while bempedoic acid lowered cholesterol by 21% in the JAMA study. In other words, the bempedoic acids won’t be as strong, she said.

And cholesterol-lowering drugs are very common in the United States. More than 50 percent of people over the age of 45 or 50 in America take a statin, OKeefe said.

A healthy lifestyle can help too.

According to Patel, the key to cholesterol control is primarily diet. And the type of diet is essentially a reduction in the amount of fat that is ingested.

She said you should aim for a low-fat diet and try to minimize the saturated fat you consume. Saturated fats are typically found in red meats, butter, cheese, ice cream, fried foods and more, according to the American Heart Association.

Freaney added that a Mediterranean diet is also a good option for people with high cholesterol. People should try to focus on home-cooked meals that are high in lean protein chicken, skinless fish with lots of vegetables, whole grains, noting that reducing sugar and alcohol intake is also key.

Maintaining a healthy weight and being physically active are also important ways to keep your cholesterol down, Freaney said. Also, since heart disease remains the leading cause of death in Americans and a big problem for many, many people, it’s important that you talk to your doctor about the treatments that are best for you, some people need medication while others can maintain their health. their cholesterol through lifestyle choices.

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