Statins have long been the cornerstone in managing high cholesterol levels, particularly low-density lipoprotein (LDL) cholesterol, often referred to as “bad” cholesterol. They work by inhibiting the enzyme HMG-CoA reductase, which plays a central role in the production of cholesterol in the liver. This reduction in cholesterol levels helps prevent cardiovascular diseases, including heart attacks and strokes.
The Rise of Non-Statin Alternatives
However, a significant number of patients experience side effects from statins, such as muscle pain and weakness, leading to discontinuation of therapy. This has spurred the development of alternative medications that can effectively lower LDL cholesterol without the adverse effects associated with statins.
Bempedoic Acid: A Statin-Free Option
One such alternative is bempedoic acid, marketed under the brand name Nexletol. Approved by the U.S. Food and Drug Administration (FDA) in 2020, bempedoic acid works by inhibiting the enzyme ATP citrate lyase, which is involved in cholesterol synthesis in the liver. Unlike statins, bempedoic acid is activated only in the liver, thereby reducing the risk of muscle-related side effects.
Clinical trials have demonstrated that bempedoic acid effectively lowers LDL cholesterol levels and reduces the risk of heart-related events, such as heart attacks and strokes, in patients who are statin-intolerant or unwilling to take statins. In a study published in the New England Journal of Medicine, nearly 14,000 participants who were either intolerant or unwilling to take statins experienced a 21% greater reduction in cholesterol levels compared to those taking a placebo, along with a lower risk of heart-related events .
Other Emerging Therapies
In addition to bempedoic acid, other non-statin therapies are being explored. Inclisiran, for instance, is a small interfering RNA (siRNA) therapy that targets the PCSK9 gene, leading to reduced LDL cholesterol levels. Administered via subcutaneous injection every six months, inclisiran has shown promising results in clinical trials .
Conclusion
For patients who cannot tolerate statins, bempedoic acid offers a viable alternative to lower LDL cholesterol levels and reduce the risk of cardiovascular events. As research continues, other non-statin therapies may provide additional options for managing high cholesterol, ensuring that more patients can achieve optimal heart health.
