Statin alternative joins drugs that could reduce heart attack risk

A new study published in NEJM found that bempedoic acid (Nexletol—Esperion Therapeutics) modestly reduced the risk of heart attacks, strokes, and other complications from heart disease. However, it did not reduce the overall mortality rate. Bempedoic acid was approved by FDA 3 years ago to reduce low-density lipoprotein (LDL) levels.

The nearly 14,000 study participants included those at high risk for a heart attack or stroke who were randomly assigned to take bempedoic acid or a placebo. Their average LDL level was elevated at 139 mg/dL. At the end of the study period, the average LDL level in those taking the drug was 107 mg/dL compared with 136 mg/dL in the patients taking a placebo. After slightly more than 18 months, 819 patients (11.7%) in the bempedoic acid group had one of the heart-related complications. In the placebo group, 927 patients, or 13.3%, had such an event.

John Alexander, MD, a cardiologist at Duke Health, who wrote an accompanying editorial but was not involved in the study, said that the lack of outcome data for bempedoic acid has prompted insurers to generally not cover the drug’s cost of about $140 a month.

The trial was funded by Esperion Therapeutics and led by Steven E. Nissen, MD, of the Cleveland Clinic.