Last month, the Journal of the American Medical Association (JAMA) published a study that explored the use of bempedoic acid ― a fairly new medication that was approved by the FDA in 2020 ― as a cholesterol-lowering drug.
The results of the 4,000-person study were favorable; the medication lowered LDL cholesterol (which is the bad cholesterol that puts you at risk for heart attack and stroke) by roughly 21%.
The study ran for just under three years and was comprised of patients with no history of heart disease but were at high risk for cardiovascular events like heart attacks or strokes. Participants were also unable or unwilling to take statins. (Statins are a common high cholesterol treatment.)
In addition to successfully lowering cholesterol, bempedoic acid lowered the rate of heart attacks, stroke and death from heart disease, said Dr. Priya Freaney, a cardiologist at Northwestern University in Chicago who was not affiliated with the study.
These positive results were seen in the group of patients who were given 180 milligrams of bempedoic acid daily, but not in those with the placebo pill.
This isn’t the first time bempedoic acid has been looked at for its use in lowering cholesterol. Prior to this study, research published in the New England Journal of Medicine also looked into bempedoic acid’s impact on high cholesterol and negative cardiovascular events. This research, called the CLEAR Outcomes study, examined more than 13,000 people, according to Freaney.
Unlike the JAMA study, the CLEAR research “studied both those who had already had heart attacks and strokes and those who had not yet had a clinical event but were at risk for heart attack and stroke,” Freaney said.
As with most new medications, some adverse events were reported among people who participated in both studies. There were increases in gout, gallstones, and elevated kidney and liver enzymes, Freaney explained. “Those are things that need to be investigated in more detail but not to a degree enough that would be considered unsafe or unable to use the drug,” she added.
So, who should take bempedoic acid?
Many people don’t like taking statins — muscle soreness and muscle weakness are really common complaints, which causes many people to go off of the life-saving medication.
“There are a lot of people who won’t or can’t take statins who still need cholesterol lowering and that’s where these drugs like bempedoic acid come in,” said Dr. James O’Keefe, a preventive cardiologist at Saint Luke’s Mid America Heart Institute who was not affiliated with the study.
The study focused on people who had heart disease risk factors but could not take statins for one reason or another, which makes this group of people good candidates for the drug outside of the study, too.
Beyond those who are statin-intolerant, Freaney said this treatment may work for people who are on the highest dose of a statin medication but still need additional treatment to lower their cholesterol. But, she said, research is needed to determine if taking bempedoic acid on top of statins is an effective plan.
Dr. Kershaw Patel, a preventive cardiologist with Houston Methodist DeBakey Heart and Vascular Center who was not affiliated with the study, said roughly 1 out of 250 people have a genetic condition called familial hypercholesterolemia, which causes high cholesterol. People with this condition could also be good candidates for bempedoic acid, Patel said, and noted that for most people with high cholesterol, it’s related to diet and some family history. For most, it is not familial hypercholesterolemia.
Statins remain the best medication for lowering cholesterol.
Statins are still the most studied and most powerful way to lower your cholesterol, all three experts said.
“I would strongly emphasize still that the first-line medication to control cholesterol is still statins,” Patel said. “Because this trial also was in people who tried the first-line medicine, but they just couldn’t tolerate it.”
If a patient came to O’Keefe with a desire to start bempedoic acid treatment, he said he’d talk to them about treatment options, including statins, and, if they are intolerant to the drug he’d recommend bempedoic acid.
Why are statins the first choice? They’re more effective, O’Keefe stressed. They lower cholesterol anywhere from 40% to 50%, while bempedoic acid lowered cholesterol at 21% in the JAMA study. In other words, bempedoic acid’s “not going to be nearly as strong,” he said.
And, cholesterol-lowering medications are really common in the United States. “Upwards of 50% of people over age 45 or 50 in America are on a statin,” said O’Keefe.
A healthy lifestyle can help, too.
According to Patel, “the key to cholesterol control is predominantly related to diet. And the type of diet is essentially a reduction in the amounts of fats that are being ingested.”
He said you should aim for a low-fat diet and try to minimize the saturated fats that you consume. Saturated fats are typically found in red meats, butter, cheese, ice cream, fried foods and more, according to the American Heart Association.
Freaney added that a Mediterranean diet is a good option for folks with high cholesterol, too. “Folks should try to focus on home-cooked meals that are high in lean protein — chicken, fish without the skin — have lots of vegetables, whole grains,” noting that reducing sugar and alcohol intake is also key.
Maintaining a healthy weight and being physically active are important ways to keep your cholesterol low, too, Freaney said. Additionally, because heart disease remains the No. 1 cause of death in Americans and a huge issue for many, many people, it’s important that you talk with your doctor about the treatments that are best for you — some people require medication while others can maintain their cholesterol through lifestyle choices.