BREAKING NEWS: Bempedoic Acid Preferable To Statins? 😳

(Joey) #1

Yeah, I admit my heading is clickbait. A better question might be “Placebo Preferable To Statins?” … to which I’d say “yes.” Here’s why:

There’s a recent study this month in the New England Journal of Medicine (link below) getting favorable press over a potential statin replacement.

https://www.nejm.org/doi/full/10.1056/NEJMoa2215024

"We conducted a double-blind, randomized, placebo-controlled trial involving patients who were unable or unwilling to take statins owing to unacceptable adverse effects (“statin-intolerant” patients) and had, or were at high risk for, cardiovascular disease."

Okay, so the subjects were fairly sick folks who couldn’t stand the adverse effects of statins. This describes a vast population these days. Drum roll, please…

"Bempoedoic acid was found to lower LDL cholesterol by 29.2 mg/dL more than a placebo."

Hmmm. :thinking: And is this a desirable outcome? I guess it depends.

If LDL were ever shown to be the cause of illness, then yes, LDL would be a good thing to reduce.

But if it’s not, then why is it a good thing to curtail the body’s response to what else might be going on that’s affecting the health of these subjects (say, versus a placebo) that’s causing their serum LDL to rise in response?

Oh, but lowering LDL can saves lives, right?! Well, not so fast. Here’s a telling snippet right from the Abstract:

“Bempedoic acid had no significant effects on fatal or nonfatal stroke, death from cardiovascular causes, and death from any cause.”

Gee, well, then what’s the point of giving it to subjects with CVD who can’t tolerate statins?

Well statins have those pesky side effects, right? Okay, well then read on…

“The incidences of gout and cholelithiasis were higher with bempedoic acid than with placebo (3.1% vs. 2.1% and 2.2% vs. 1.2%, respectively), as were the incidences of small increases in serum creatinine, uric acid, and hepatic-enzyme levels.”

So, in the common parlance of most studies that report relative risk, the risk of gout rose by 41% (3.1% vs 2.2%) and the risk of cholelithiasis [gallstones] rose by 75% (2.1% vs 1.2%) with bempedoic acid. :wink:

So how about this news breaking headline:
"Bempedoic Acid Increases Gallstones by 75%!"

Sure, Doc, sign me up!

(Bacon is a many-splendoured thing) #2

You’ve obviously been learning from David Diamond, lol! Be careful, though, or Wikipedia will pull your page, because you are a “cholesterol denier”!

Given that a month’s worth of Nexletol can cost as much as $522 (retail), it’s a good thing that GoodRX.com is offering coupons for possibly as much as 80% off!!! Aren’t we lucky?

How much do you want to bet that the next end-of-year bonuses for the Esperion management team will be in the neighbourhood of $60,000,000 US?

(Joey) #3

:laughing: I’d bet well less than $60mm against that prospect.

(Bob M) #4

Another thing I did not like about that study was the use of composite endpoints. I never like those. Though, while they didn’t calculate actual risk, they did give you the explicit risks to make it easy to calculate, rather than having to figure it out yourself.