Statins are among the most widely used medicines for lowering cholesterol and preventing heart attacks and strokes.
But some people cannot tolerate them, while others need additional treatment to bring their cholesterol down to a safer level.
A newer medicine called bempedoic acid could offer another option. Research discussed at an Endocrine Society meeting in Chicago found that the drug lowered harmful LDL cholesterol and reduced the risk of major heart problems in people who had difficulty taking statins.
Cholesterol is a waxy substance that the body needs to build cells and make certain hormones. The liver produces much of the cholesterol in the body, while some also comes from food.
Problems can develop when too much LDL cholesterol circulates in the blood. LDL is often called “bad” cholesterol because high levels can contribute to fatty deposits inside artery walls.
Over many years, these deposits can narrow or block arteries. They can also break open and trigger blood clots, increasing the risk of heart attack and stroke.
Statins lower LDL cholesterol mainly by reducing cholesterol production in the liver. They have been studied for decades and are highly effective at preventing cardiovascular disease, especially in people who already have heart disease or face a high risk of developing it.
However, statins are not ideal for everyone. Some patients report muscle pain or other symptoms while taking them, and a smaller group cannot tolerate the dose needed to control their cholesterol.
Bempedoic acid works differently. It blocks an enzyme involved in cholesterol production, but the drug becomes active mainly in the liver rather than in muscles, which may make it useful for some people who have experienced muscle symptoms with statins.
In research funded by Esperion Therapeutics, the company that developed bempedoic acid, investigators examined its effects in people who were unable or unwilling to take recommended statin treatment. The analysis was led in part by Dr. A. Michael Lincoff of the Cleveland Clinic.
The findings showed that bempedoic acid reduced LDL cholesterol by about 21% on average. Treatment was also associated with a 13% reduction in major cardiovascular events, including problems such as heart attacks and strokes.
Researchers were particularly interested in whether lowering LDL with bempedoic acid protected the heart in a way similar to lowering LDL with statins. Their analysis suggested that for a similar reduction in LDL cholesterol, the decrease in cardiovascular risk was comparable.
That finding supports a broader lesson from decades of cholesterol research: lowering LDL cholesterol can reduce cardiovascular risk. The medicine used to achieve that reduction may vary depending on a patient’s health, treatment goals, side effects, and other factors.
Bempedoic acid is not intended to replace statins for everyone. Statins remain a standard first treatment because they are effective, well studied, widely available, and tolerated by most patients.
Instead, the newer drug expands the choices available to doctors. It may be particularly useful for people who cannot take enough statin medication or whose LDL cholesterol remains too high despite other treatment.
Like all medicines, bempedoic acid can have side effects and is not appropriate for every patient. People concerned about statin symptoms should talk with their doctor rather than stopping treatment on their own, because untreated high cholesterol can quietly increase cardiovascular risk for years.
The research adds to a growing range of treatments that can help people manage high cholesterol. Having more options allows doctors to tailor treatment more closely to each patient while keeping the main goal the same: lowering dangerous cholesterol and preventing heart attacks and strokes.
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