A recent study confirms the significance of decreasing cholesterol in those who are at risk of a heart attack or stroke but have not yet experienced one.
The study examined bempedoic acid, a statin substitute, and discovered that lowering LDL cholesterol levels, also decreased the risk of heart attack, stroke, and death.
Bempedoic acid shouldn’t be used in place of statins, according to researchers.
It is far more expensive and lacks the long history of reliability and efficiency. However, the new study demonstrates that it’s critical to discover alternatives and that bempedoic acid can be at least a portion of the answer for patients who can’t tolerate statins or a high enough dose to get their cholesterol levels down sufficiently.
People are more likely to experience a heart attack or stroke if they also have high blood pressure, diabetes, obesity, a history of smoking, or high cholesterol. Dr. Steven Nissen, a cardiologist from the Cleveland Clinic, led the new study, which will be presented on Saturday at the American Diabetes Association’s annual meeting in San Diego. However, fewer than half of individuals at high risk are taking the recommended medicine, he added.
“I think this is a wake-up call to the medical community and to the patients that people with high cholesterol and risk factors need to be treated,” Nissen said.
The study, according to Dr Christie Ballantyne, director of the Baylor College of Medicine’s Centre for the prevention of cardiometabolic disease, is “good news.”
“You can get your LDL down if you can’t get a statin,” said Ballantyne, who was not involved in the study. “I believe that a message to the public is crucial.”
Take the findings with a grain of salt:-
The investigation was a continuation of a sizable study on bempedoic acid Nissen that was published earlier this year. Bempedoic acid was found to be a workable substitute for statins in 14,000 patients who could not take the more affordable, more widely used medications.
4,200 of those individuals who had not yet experienced a serious cardiac event, such as a heart attack or stroke, were the subject of the study. Over the next three and a half years, the group that received bempedoic acid was 39% less likely than the group that received a placebo to pass away from a cardiac incident. Nissen called the result “simply stunning.”
Dr. Salim Virani, a preventive cardiologist who was not engaged in the study, concurred with Nissen’s thesis but expressed more scepticism about the results.
Virani, a researcher at Aga Khan University in Pakistan and a member of the Texas Heart Institute places less faith in the specifics of the findings because they were based on a sample of trial participants that might not be representative.
More trial participants withdrew from the non-heart attack/stroke group if they were given a placebo than if they were given bempedoic acid.
According to Virani, those people may also be less inclined to adhere to healthy lifestyle advice, making them more likely to experience a heart attack or stroke.
These groupings are a little distinct by nature, he claimed.
Dr. Rita Redberg, a cardiologist at the University of California, San Francisco and the journal editor-in-chief of JAMA Internal Medicine, agreed that drawing conclusions from a subgroup can be deceptive. She referred to a well-known 2011 study in which it was shown that aspirin prevented heart attacks overall, but not among people who were born under the signs of Gemini or Libra—a distinction that was obviously irrelevant.
Redberg claimed that because the majority of participants were from Eastern Europe, where they probably had unhealthy diets and lower levels of physical activity, the study wasn’t reflective of the ordinary American.
The greatest strategy to prevent heart disease and live a longer life, according to Redberg, is to eat a nutritious diet, engage in regular physical activity, and abstain from smoking.
Bempedoic acid:-
Esprion Therapeutics in Ann Arbour, Michigan, sells bempedoic acid, which was given FDA approval in 2020, under the trade name Nexletol and frequently in conjunction with the cholesterol-lowering medication ezetimibe known as Nexlizet. Each medicine has a monthly cost of roughly $400.
A small percentage of people who take statins are known to experience muscle pain, which may typically be reduced by lowering the dose. Gallstones, gout, and muscle soreness are all risks that bempedoic acid can raise.
Bempedoic acid should not be used as a substitute for statins, according to Virani. The fact that statins have been safe for 40 to 45 years is significant for a medication intended to be used for the remainder of a person’s life. “I hope it doesn’t discourage people from taking statins. That worries me,” he remarked.
Nissen concurred that his findings don’t directly support the use of bempedoic acid. For those who can tolerate them, statins continue to be better medications. He has previously “taken on the pharmaceutical industry over drugs that I thought did not provide a benefit over its risk,” but he believes the advantages outweigh the disadvantages in this instance.
Importance of prevention :-
It has been 17 years since the last study examined the possible health advantages of decreasing cholesterol for persons who have not experienced a heart attack or stroke. It was halted early since it revealed persons with lower cholesterol lived longer, but some of its conclusions remained debatable because the study was never finished.
It is less expensive and simpler to investigate persons who have already experienced a heart attack or stroke to determine whether treatment can prevent a second incident. Other studies have failed to demonstrate a benefit to this group. It is obvious that decreasing cholesterol may be beneficial for them.
Ballantyne replied, “If you have a fire in your house and someone puts it out, that’s terrific. But he added that it would be preferable to avoid the fire altogether—or in this case, a heart attack or stroke. “Once you have damage, treating it is always more difficult.”
Ballantyne’s aunt and brother from his own family were never given the opportunity to host a second gathering. First heart attacks caused both of them to pass away. He is pleased that the latest research supports the idea that decreasing LDL has advantages for high-risk individuals who have not yet experienced a heart attack or stroke.
Ballantyne claimed that he has witnessed significant advancements in the fight against heart disease over the course of his career, but lately, this has begun to reverse.
“We have great preventative tools, but we’re not really using them,” he added. Sadly, we tend to be reactive rather than proactive when it comes to our health.
The benefits of decreasing cholesterol are significant, the hazards are minimal, and there are a lot of people who could benefit from it, according to Nissen. There are literally millions of people there.