Cholesterol is a waxy substance found naturally in the body. We need it to build healthy cells, make hormones, and support other important functions, but too much of certain types can raise the risk of heart disease.
The main concern is LDL cholesterol, often called “bad” cholesterol. When LDL stays high for years, fatty material can collect inside the walls of arteries, making them narrower and increasing the chance of a heart attack or stroke.
Healthy food, regular physical activity, weight control, and not smoking can help improve cholesterol levels. But many people also need medicine, especially if they already have heart disease or have a high risk of developing it.
Statins are usually the first medicines doctors prescribe. They lower the amount of cholesterol made by the liver and have strong evidence showing that they can prevent heart attacks, strokes, and deaths from heart disease.
However, some people cannot tolerate statins because they develop unwanted symptoms, particularly muscle pain. Others can take only a small dose, which may not lower their LDL cholesterol enough.
A medicine called bempedoic acid offers another option. Like statins, it reduces cholesterol production in the liver, but it acts on a different step in the process and is activated mainly in the liver rather than in muscles.
Researchers wanted to find out whether lowering LDL with bempedoic acid could do more than improve a blood test. They wanted to know whether it could actually reduce serious heart and blood vessel problems in people who could not take statins.
The answer came from the large CLEAR Outcomes clinical trial, which included nearly 14,000 people who were unable or unwilling to take recommended statin doses because of side effects. Participants either received bempedoic acid or a placebo and were followed for several years.
The main results were published in The New England Journal of Medicine in 2023. The study found that bempedoic acid lowered LDL cholesterol by about 21% compared with placebo after six months and also reduced the overall risk of major heart-related events.
These events included heart attacks, strokes, procedures to restore blood flow to the heart, and death from heart-related causes. Overall, the combined risk of these major events was about 13% lower in the bempedoic acid group than in the placebo group.
Researchers later examined how these benefits compared with the well-known effects of statins. Their analysis suggested that for a similar reduction in LDL cholesterol, bempedoic acid produced a reduction in heart risk that was broadly similar to what has been seen with statin treatment.
This is important because it strengthens a key idea in heart medicine: lowering LDL cholesterol itself can protect the heart. The benefit does not appear to depend only on taking a statin, although statins remain the standard first treatment for most people who can use them safely.
Dr. A. Michael Lincoff of Cleveland Clinic, who led the CLEAR Outcomes trial, said the findings provide useful evidence for people who cannot tolerate statins. Having another medicine with evidence of reducing heart events gives doctors more choices when trying to control a patient’s cholesterol and long-term risk.
The findings also show why researchers look beyond changes in laboratory numbers. A medicine may lower cholesterol, blood sugar, or blood pressure, but doctors still need large studies to prove that it actually prevents illness and helps people live healthier lives.
Bempedoic acid is not suitable for everyone and can have side effects, so treatment decisions should be made with a healthcare professional. But for people who struggle with statins, the research provides reassuring evidence that another LDL-lowering option can also help protect the heart.
As heart disease remains one of the world’s biggest causes of death, having more proven ways to lower dangerous cholesterol could make a meaningful difference. For patients who once had few choices beyond statins, that is an important step forward.
If you care about heart health, please read studies that yogurt may help lower the death risks in heart disease, and coconut sugar could help reduce artery stiffness.
For more information about health, please see recent studies that Vitamin D deficiency can increase heart disease risk, and results showing vitamin B6 linked to lower death risk in heart disease.
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