Bempedoic Acid: Statin’s Younger Sibling for Hypercholesteremia
High cholesterol levels in blood vessels has been a hot topic in the media for several years now, ever since its link to heart attacks and strokes have been preached by physicians over the course of fifty-odd years. For nearly 30 years, statins have been the drug of choice to combat high cholesterol and low-density lipoproteins (LDL)—aka “bad cholesterol”—which increase the risk of atherosclerosis and coronary heart disease. The most severe side effect of statins is myotoxicity that can range from myopathy and myalgia (muscle pain and weakness) to myositis and rhabdomyolysis, which can lead to kidney failure, clotting/bleeding disorders (disseminated intravascular coagulation), and ultimately death. Though the latter rarely occurs, muscle pain and weakness that statins can invoke have drudged up reluctance to comply with the daily intake of the medication. Bempedoic acid is a potentially new cholesterol-lowering drug that’s almost as effective as statins but without the muscle achiness.
Cholesterol is synthesized by the liver, and despite its bad reputation, is vital to most cellular processes that keep humans alive. In excess, mostly contributed by high-fat and high-carb diets, along with genetic predisposition in some cases, LDL sticks to the walls of blood vessels, causing plaque buildup, and in turn obstruct blood flow. The fallout: heart disease, hardened blood vessels, heart attacks, and strokes.
Statins work by inhibiting an enzyme called HMG-CoA reductase, which is responsible for creating mevalonate which is then converted into cholesterol. Bempedoic acid, on the other hand, targets a different enzyme—adenosine triphosphate citrate lyase (ACL)—to decrease cholesterol production in the liver. This alternate pathway does not utilize any enzymes that are present in skeletal muscle, eliminating any potential muscle ache and soreness as a possible side effect.
A clinical trial led by Imperial College London tested the drug 2,200 participants over the course of a year as a once-daily oral medication. The trial results indicated bempedoic acid as a safe, well-tolerated medication without the muscle weakness. However, cholesterol and LDL-lowering efficacy fell behind statins at 18 percent versus 50 percent with statins.
If compliance to cholesterol-lowering medication is dictated by a single factor—muscle ache—then bempedoic acid may, in the long run, prove to be a better option to prevent fatal cardiac conditions.