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Can't tolerate statins? New study supports Nexletol as an alternative cholesterol medication

Statins are the first-line choice for dealing with high cholesterol and preventing heart attacks and strokes. But they can cause problems for some patients.
Statins are the first-line choice for dealing with high cholesterol and preventing heart attacks and strokes. But they can cause problems for some patients.

Dr. Saima Zafar, a cardiologist with Texas Health Kaufman, tells KERA’s Sam Baker why statins don't work for some, and what makes Nexletol an acceptable alternative.

Why can’t some people tolerate statins?

The way the metabolic or medicalization of statins occurs in some patients, it can impact their muscle. So, we call that myopathy, which is weakness of the muscles.

Patients may complain of having difficulty getting up from a chair or just lifting things because of weakness in the proximal muscles, like the thighs and the upper arms.

And then other patients will have pain or cramping in the muscles, which is fairly difficult to tolerate and really hinders their lifestyle.

What is Nexletol and why would this particular drug warrant the lengthy study about it?

Nexletol is a medicine that is called bempedoic acid, and it helps in lowering the LDL cholesterol. The studies were done on about 14,000 patients, and it showed that it did help lower the LDL cholesterol, the bad cholesterol, by an average of about 21%.

Now, this is less than what the statins do, but it did not come with the side effects of the muscle aches and pains or the myopathy that the statins came with.

Is Nexletol as good as a statin?

It's not as important as a statin, but certainly is better than nothing.

Before, when patients could not tolerate statins, they had to stop the statins. And if they have a coronary disease or vascular disease, you know, you come to the point that there's really nothing they can do other than controlling their diet and exercising, which in some cases still doesn't get them to the target.

There's a couple of other medicines out there that are injectables that you would take once a month. But the pricing is prohibitive, and most insurance companies do not want to pay for it. And you have to go through lengthy processes to get them approved and even then, they get denied. So, in those instances, we had nothing left.

The results in the recent study definitely is very helpful because even a drop of 21% is a significant drop compared to zero.

Is it (Nexletol) enough to work on its own or do you have to do additional medication with it?

Then, I guess it can be used with a statin. So, for some patients we may not be able to get the target numbers and we can add it on to that.

Or if the patient cannot tolerate a statin and we're just using bempedoic acid, there's another agent that is given in combination with bempedoic acid and that medicine's actually called Nexlizet and it has an agent called Zetia that is combined with the bempedoic acid acid. It's given together so that it can enhance its effect.

Under what conditions, though, would you consider this for a patient?

I would consider this for a patient who has underlying vascular disease or previous heart attack or previous stent, previous bypass surgery or vascular disease like carotid artery blockages or blockages in the arteries in the legs, or previous history of stroke and high cholesterol. Those would be the patients that I would consider this for.

So, you would do this for relatively few patients. This isn't something for anybody, everybody.

No, it's not for everybody. But yet, if people have a family history of premature heart disease and they have a high cholesterol, those would also be good candidates. So they may not have had a vascular or a cardiovascular event, but for them to have prevention, this could be a good option.

Is medication the only way to deal with high cholesterol?

In somebody who's already had a cardiovascular event or a known coronary disease, we should use medication to lower cholesterol. But for prevention purposes, the first step, of course, is controlling diet and exercising.


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Nexletol Could Be Alternative Cholesterol Med for Folks Who Can't Take Statins

Got muscle pain from statins? A cholesterol-lowering alternative might be for you

Medical News Today: Nexletol (bempedoic acid)

WebMD: Nexletol

Sam Baker is KERA's senior editor and local host for Morning Edition. The native of Beaumont, Texas, also edits and produces radio commentaries and Vital Signs, a series that's part of the station's Breakthroughs initiative. He also was the longtime host of KERA 13’s Emmy Award-winning public affairs program On the Record. He also won an Emmy in 2008 for KERA’s Sharing the Power: A Voter’s Voice Special, and has earned honors from the Associated Press and the Public Radio News Directors Inc.