Statin alternative lowers risk of cardiac events as well as cholesterol levels

A medication called bempedoic acid reduced the risk of cardiac events as well as statins and may offer an alternative to the popular cholesterol-reducing medications, according to industry-supported research being presented Thursday at ENDO 2023, the Endocrine Society's annual meeting, in Chicago, Ill.

Statins are widely prescribed to reduce levels of low-density lipoprotein (LDL) cholesterol. High levels of LDL cholesterol can raise an individual's risk of having a heart attack or stroke. While statins lower LDL cholesterol levels by slowing the liver's production of cholesterol, some patients taking statins have reported experiencing muscle and joint pain.

"Our findings indicate bempedoic acid may be a valuable therapy for patients who cannot tolerate adequate doses of statins or who need to further lower their LDL cholesterol levels," said A. Michael Lincoff, M.D., co-author of the study and Vice Chair for Research in the Department of Cardiovascular Medicine at the Cleveland Clinic in Cleveland, Ohio.

The study is a new analysis of the CLEAR Outcomes Trial, which enrolled 13,970 statin-intolerant patients. The main trial results released in March found that bempedoic acid lowered LDL cholesterol levels on average by 21% and reduced cardiovascular events, including heart attack, stroke, and procedures to open blocked blood vessels to the heart, by 13%. It was not clear, however, whether bempedoic acid's beneficial effect on cardiovascular risk was similar to the risk reduction that could have been achieved by lowering LDL cholesterol to the same extent with statins.

The new analysis found study participants taking bempedoic acid experienced a reduced risk of having a major cardiac event compared to those taking a placebo. The lowered risk level was comparable to that seen for the same extent of LDL reduction in individuals taking statins. This suggests that different classes of cholesterol drugs have similar benefits for cardiovascular health, unlike diabetes medications that can have varying effects on cardiovascular health even with a similar improvement in blood sugar levels.

"Cardiovascular disease remains the most prevalent cause of mortality and morbidity in the world," Lincoff said. "Medications to lower cholesterol offer an important tool to diminish this risk."

Esperion Therapeutics, which manufactures bempedoic acid, supported the study.

Cholesterol is a waxy, fat-like substance found in all cells in the body. The body only requires a small amount to function. When cholesterol levels are too high, fat is deposited in the artery walls. This can raise the risk of heart disease and stroke. Hormones—the body's chemical messengers and a key part of the endocrine system—control the pathways for fats and proteins to move around the body.