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Call to action: Reduce cholesterol in high-risk individuals to prevent heart attacks and strokes.

Call to action: Reduce cholesterol in high-risk individuals to prevent heart attacks and strokes

A recent study reaffirms the significance of lowering cholesterol in people who are at risk for heart disease but have not yet experienced one.

Bempedoic acid, a statin alternative, was the subject of the study. It was found to lower the risk of heart attack, stroke, and death in addition to lowering LDL cholesterol levels.

Bempedoic acid, according to the researchers, should not be used in place of statins.

It is significantly more expensive and does not have the same decades-long safety and effectiveness record. The new study, on the other hand, suggests that it is essential to find alternatives and that bempedoic acid can at least be a part of the solution for individuals who are unable to tolerate statins or a dose that is high enough to adequately lower their cholesterol levels.

People who have diabetes, obesity, high blood pressure, or high cholesterol are also more likely to have a heart attack or stroke. However, according to Cleveland Clinic cardiologist Dr. Steven Nissen, who led the new research that will be presented on Saturday at the annual conference of the American Diabetes Association in San Diego, less than half of those who are at high risk are taking the appropriate medication.

Nissen stated, "I believe this is a wake-up call to the medical community and to patients that people with high cholesterol and risk factors need to be treated."

The study is "good news," according to Dr. Christie Ballantyne, director of the center for cardiometabolic disease prevention at Baylor College of Medicine in Houston.

Ballantyne, who was not involved in the research, stated, "You can get your LDL down if you cannot get a statin." I believe that is a significant public message."

Don't take the findings too seriously

Nissen published a large study on bempedoic acid earlier this year, which served as the basis for the current study. Bempedoic acid was found to be a viable alternative to statins in 14,000 patients who were unable to take the more well-known, less expensive medications.

A subset of 4,200 of these people, who had not yet experienced a major cardiac event like a heart attack or stroke, were the focus of the study. Nissen called this "simply stunning": the half who took bempedoic acid had a 39% lower risk of dying from a cardiac event over the next three and a half years than the half who took a placebo.

Dr. Salim Virani, a preventive cardiologist who was not a part of the study, concurred with Nissen's message but was more cautious regarding the current findings.

Because it relied on a subset of trial participants, which may not be representative, Virani, who is vice provost for research at Aga Khan University in Pakistan and is affiliated with the Texas Heart Institute, places less weight on the specifics of the results.

More people dropped out of the trial in the group without a heart attack or stroke if they received a placebo than if they received bempedoic acid.

According to Virani, these individuals may also be more likely to have a heart attack or stroke because they are less likely to adhere to recommendations for a healthy lifestyle. This, in turn, may explain why those who took the drug appeared to have a better outcome.

He stated, "These groups are inherently different."

Dr. Rita Redberg, a cardiologist at the University of California, San Francisco, and editor-in-chief of the journal "JAMA Internal Medicine," agreed that it can be misleading to draw conclusions from a subgroup. She cited a well-known study from 2011 that found that aspirin reduced the risk of heart attacks in all participants but not in those born under the astrological signs of Gemini or Libra—a distinction that was clearly meaningless.

Redberg stated that the study was not representative of the typical American because the majority of participants were from Eastern Europe, where they likely consumed unhealthier diets and engaged in less physical activity, among other factors.

In an email, Redberg stated, "I will continue to recommend a healthy diet, regular physical activity, and nonsmoking as the best way to prevent heart disease and live longer."

Acid bempedoic

Esperion Therapeutics of Ann Arbor, Michigan, sells bempedoic acid, which was approved by the Food and Drug Administration in 2020. It is sold under the brand name Nexletol and is frequently used in conjunction with another cholesterol-lowering medication known as Nexlizet. Monthly, each drug costs about $400.

A subset of people who take statins have been shown to experience muscle aches, which can typically be reduced by decreasing the dosage. Gout, muscle pain, and gallstones are all possible side effects of bempedoic acid.

Virani stated that the study should not be interpreted as authorizing the use of bempedoic acid in place of statins. When a drug is meant to be taken for the rest of a person's life, it's important that statins have a safety record of 40 to 45 years. I hope it does not discourage patients from taking statin medication. That concerns me," he stated.

Nissen acknowledged that his findings do not specifically support the use of bempedoic acid. For those who are able to tolerate them, statins continue to be superior drugs. He has "taken on the pharmaceutical industry over drugs I thought did not provide a benefit over its risk" in the past, but in this instance, he believes that the benefits significantly outweigh the risks.

How important is prevention?

17 years ago, the most recent study examined the potential health benefits of lowering cholesterol in people who had not suffered a heart attack or stroke. It was stopped early because it showed that people with lower cholesterol lived longer, but some of its findings remained controversial because it was never finished.

Other studies had not found any benefit in this group, and it is cheaper and easier to study people who have already had a heart attack or stroke to see if treatment can stop them from having another one. As far as they might be concerned, obviously, bringing down cholesterol can be useful.

Ballantyne stated, "If you have a fire in your house and someone puts it out, that's great." He stated, "But it would be better to prevent the fire or, in this instance, a heart attack or stroke." The treatment of damage is always more difficult."

Ballantyne's brother and aunt never got another chance in his own family. Their first heart attacks led to their deaths. He is pleased that the new study demonstrates that LDL-lowering benefits high-risk individuals who have not experienced a heart attack or stroke.

Ballantyne claimed that he had witnessed a great deal of progress against heart disease throughout his career; however, in recent years, that progress has begun to become more revered.

He stated, "We have tremendous tools for prevention, but we're not using them well." Sadly, when it comes to our health, we choose to be reactive rather than proactive."

Nissen stated, "The benefits are large, the risks are small, and the number of people out there (who could benefit) is enormous" when it comes to cholesterol reduction. Tens of millions of people are involved."

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