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A cholesterol-lowering alternative to statins reduces deaths from heart disease, a new study finds

A cholesterol-lowering alternative to statins reduces deaths from heart disease, a new study finds
Source: newsbreak.com

A new study finds that people with high levels of LDL, or "bad" cholesterol, may benefit from taking a statin alternative to lower their risk of heart disease death.


Researchers presented their findings on Saturday at the annual meeting of the American Diabetes Association. They found that when taken as a daily pill, bempedoic acid decreased LDL cholesterol and showed a significant 39% decrease in deaths from heart disease and heart attacks. JAMA published the findings simultaneously.


Lead author Dr. Steven Nissen, chief academic officer of the Heart, Vascular, and Thoracic Institute at the Cleveland Clinic, stated, "What we saw really surprised me." I trust this will be a reminder for patients and doctors."


According to Nissen, less than half of people who should be given a medication to lower cholesterol because they are at risk for heart disease are actually taking it right now. He said that needs to change.


"Treating individuals who have risk factors before their most memorable cardiovascular occasion would have huge advantages" in forestalling complexities as well as in forestalling deaths, he said.


What is a healthy cholesterol level?

Statins, which are regarded as the gold standard for treating high cholesterol, outperform bempedoic acid, which was approved by the Food and Drug Administration in 2020. However, due to the possibility of adverse effects like muscle pain, headaches, difficulty sleeping, and digestive issues, many people discontinue or refuse to take statins.


About 20% of people at high risk for heart disease, according to recent research, refuse to take statins when prescribed by their doctor. The study, which was published in JAMA Network Open, found that women in particular were less likely to accept a statin prescription.


Even though the new study only looked at how bempedoic acid affected people who had side effects from statins, it found that lowering cholesterol reduced the number of heart attacks and deaths caused by heart disease.


What's most significant is to get blood cholesterol to solid levels, whether by taking a statin, bempedoic acid, or other lipid-bringing drug, Nissen said in a meeting.


The type of cholesterol known as LDL—also known as low-density lipoprotein—increases the risk of cardiovascular events such as heart attacks and strokes by contributing to the formation of fatty deposits in the arteries. The 4,206 participants in the new study are part of a larger group that was discussed in a March New England Journal of Medicine article. The American Heart Association recommends that adults have a total cholesterol level of approximately 150 mg/dL and LDL levels of at least 100 mg/dL. Patients who only had risk factors were included in the NEJM study, as were those who had previously experienced a cardiovascular event like a stroke or heart attack.


Nissen and his colleagues only looked at participants in the new study who had high risk factors like high LDL, diabetes, and hypertension but had never been diagnosed with heart disease.


The new study's participants were 59% women, with an average age of 68. The majority had diabetes. At the beginning of the study, the average level of LDL in the participants' blood was 142.5 mg/dL. Six months later, participants who received a daily dose of bempedoic acid saw a 23.2 percent decrease in LDL cholesterol and a 22.7 percent decrease in inflammation caused by a protein in the blood that is linked to a higher risk of heart attack and stroke.


Other important findings of the study, which followed the majority of participants for just over three years, included the following:

  • The medication decreased patients' risk of heart attacks by 39%.
  • The risk of death from heart disease had decreased by 39%.
  • The consolidated risk of a patient passing on, having respiratory failure, or having a stroke had been cut by 36%.


When compared to those who received a placebo, those who received bempedoic acid had a slightly higher risk of developing complications such as gout and gallstones.


Statins as 'first-line treatment'

According to Dr. Druv S. Kazi, a cardiologist, in an editorial that was published alongside the JAMA study, bempedoic acid is more expensive than generic statins, despite the fact that it may not cause as many muscle-related symptoms.


Kazi wrote, "Patients are likely to face significantly higher out-of-pocket costs for bempedoic acid than for a generic statin."


According to Sheldon Koenig, CEO and president of Esperion, which manufactures Nexletol and funded the study, many insurance companies now cover the drug.


Koenig stated, "The company has preferred status for Medicare, and the copay is typically only $45 per month."


Dr. Marc Eisenberg, a cardiologist and associate professor of medicine at Columbia University's Vegelos College of Physicians and Surgeons, described the new findings as "exciting and very promising." However, statins should still be offered as a first-line treatment option. Eisenberg was not related to the new review.


Eisenberg stated that although the study is "well designed," "we still need more studies."


Dr. Robert Rosenson, a professor of medicine at the Icahn School of Medicine at Mount Sinai and director of metabolism and lipids for the Mount Sinai Health System, called these findings "very important."


Rosenson, who was not involved in the research, asserted that the benefits discovered in the new study are greater than one might anticipate based solely on the decreases in LDL levels.


According to Dr. Jeffrey Berger, director of the Center for the Prevention of Cardiovascular Disease at NYU Langone Health, the new study supports the notion that "targeting LDL cholesterol reduces cardiovascular risk."


Berger stated that the "largest group of patients we treat" are those who have risk factors for cardiovascular disease, such as diabetes and high LDL cholesterol, but have not yet been diagnosed with the condition. The new study did not include Berger.


Berger stated that bempedoic acid provides an alternative for individuals who are unable or unwilling to take statins.


However, I believe it is essential to acknowledge the drug's significant side effects. There are risks and benefits to everything in medicine, Berger stated.

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