Bempedoic acid: Statin alternative helped reduce bad cholesterol by 21%

For the analysis, the researchers looked at 13,970 statin-intolerant patients.

The results showed that bempedoic acid reduced LDL cholesterol levels by an average of 21% and reduced the risk of heart attacks, strokes and procedures to unclog the heart’s blood vessels by 13%.

Compared with statins, the level of reduced risk was similar to patients taking bempedoic acid.

Many cardiologists and other health care professionals may be encouraged by these findings, that we now have a growing body of evidence for some non-statin cholesterol-lowering drugs that also offer a reduction in the risk of cardiovascular events, said Dr. Wesley Milks, a cardiologist at the Ohio Columbus State University Wexner Medical Center.

I was impressed that the mean LDL-C reduction was 21%, which was slightly higher than the published LDL-C reduction from the previous studies that led to the approval of bempedoic acid.

While these results are promising and bempedoic acid may be beneficial, statins will continue to be the primary method of treatment.

Bempedoic acid, while useful, remains far from a first-line choice for treating cholesterol and cardiovascular risk reduction, Milks said.

Statins will remain the mainstay of this therapy because of the immense body of data supporting statin treatment on reducing cardiovascular outcomes and the efficacy of lowering cholesterol, which can be less than a 50% reduction using the dose of higher-intensity statin choices.

PCSK9 inhibitors such as evolocumab and alirocumab can lower LDL-C by about 60%, although they require injection medication. Thus, a 20-25% reduction using bempedoic acid is beneficial but still modest compared with statins and PCSK9 inhibitors.

However, oral administration of bempedoic acid, like ezetimibe, may play a role for statin-intolerant patients who are averse to injection drugs, Milks added.

The drug [bempedoic acid] it’s safe and effective and now has a proven reduction in CVD (cardiovascular disease) risk, said Dr. Chip Lavie, medical director of cardiac rehabilitation and prevention at Ochsner Health.

Statins are significantly better as they can reduce LDL by 50-60% and have greater event reduction due to better LDL reduction. Typically, we use bempedoic acid in addition to statins and get an additional 17-18% reduction in LDL, and if we use bempedoic acid combined with exetimide, we can achieve an additional approximately 40% reduction in LDL, observed Lavie.

Heart-healthy lifestyle habits include the following:

• Follow a diet low in red meat and saturated fat.
• Switching to the Mediterranean diet can be beneficial to your overall health, including your heart health.
• Limiting foods and drinks high in processed carbohydrates and focusing on maximizing your intake of vegetables, fruits and whole grains can also be helpful, Milks explained.
• Regular physical activity, ideally at least 150 minutes of accumulated aerobic activity of moderate or higher intensity per week, can also help lower cholesterol, Milks noted.

Cholesterol is lowered by soluble fiber in the diet, as fiber can help trap and excrete cholesterol from the gastrointestinal tract.

Some other medications may also be effective in lowering cholesterol.

Estrogens reduce LDL by 10-15%. Ezetimide alone achieves additional 15 to 20 percent reductions in LDL, Lavie said. The older drugs, bile acid sequestrants, nicotinic acid, and fibrates all achieve modest LDL reductions, and the injectables (evolocomab, alirocomab, and inclisiran) achieve 45% to 65% reductions in LDL added to statins and also the first 2 have clinically demonstrated reductions in events (I have also been a consultant for these injectables).

Bempedoic acid has demonstrated efficacy in reducing the risk of cardiac events along with statins. The study authors reported that this drug could potentially act as an alternative to more commonly prescribed cholesterol medications.

While bempedoic acid may be helpful, experts have said statins will remain the leading method of treatment for cardiovascular problems.

To lower cholesterol, healthy lifestyle habits are beneficial. These include eating a diet low in red meat and saturated fat, avoiding processed foods that are high in carbohydrates, and exercising on a regular basis.