After just over a year and a half, 819, or 11.7 percent, of the patients in the bempedoic acid group had one of the heart-related complications.
In the placebo group, 927 patients, or 13.3 percent, had such an event.
The participants did not have muscle aches or increased risk of diabetes, the most common complaints with statins. With bempedoic acid, a small percentage in the trial experienced an increased risk of gout, joint inflammation that is treatable, and an increased risk of gallstones.
Now the question is, how important is this drug going to be?
Bempedoic acid is the sixth cholesterol-lowering drug, besides statins, shown to reduce heart attacks and strokes, noted Dr. Michael Davidson, director of the lipid clinic at the Pritzker School of Medicine. from the University of Chicago, who founded a company, New Amsterdam Pharma, that is developing a drug to lower LDL cholesterol. The others are bile acid resins, niacin, ezetimibe, PCSK9 inhibitors, and CETPi. They have varied effects on LDL and range from inexpensive to expensive. With this variety of drugs, Dr. Davidson said he hoped doctors could start to focus on getting high-risk patients’ LDL levels as low as possible, whatever the cost.
dr. Harlan Krumholz, a Yale cardiologist, said that given the modest effects of bempedoic acid and the fact that other drugs also lower LDL, “it’s unlikely to be a game changer.”
dr. Benjamin Ansell, a lipid expert at UCLA, said the drug was “better than nothing” but “not enough” for people who have high LDL levels and are at high risk.
Lipid experts say that many of those who say they can’t tolerate statins actually can. Some mistakenly attribute muscle pain from other causes to the drug. For others, a different dose of a statin or a different statin is tolerable.
But primary care physicians may not have the time or inclination to go through all this with patients, especially since they have to deal delicately with patients who insist they can’t or won’t take their medications.
“When you come in with guns blazing and say, ‘Take this medicine,’ a lot of patients walk away,” Dr. Ansell said. “There is a fear that the patient will not return.”