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Heart Patients, Keep Trying


New medications are expanding the toolbox for health care providers like me to treat patients with high cholesterol.  That gives more than 100 million at-risk Americans a better shot at effective, patient-centered care.

Just this month a new drug called bempedoic acid became available.  The drug lowers LDL cholesterol and joins the existing cadre of treatment options, which include:

  • Statins, first-line, time-tested drugs that have protected countless patients from heart attack and stroke
  • Ezetimibe, often used alongside statins and changes to diet
  • PCSK9 inhibitors, innovative injectable drugs that can lower LDL cholesterol for patients who don’t have an adequate response to statins.

When I treat my patients for high blood pressure, I have multiple options for therapy.  These include tablets that contain two medications, making it easier for patients to use combination therapy to reduce blood pressure to meet the lower treatment target in our guidelines.  Because many patients need combination therapies to adequately lower LDL cholesterol, having choices is important.  

Bempedoic acid marks a valuable addition to available treatments and is now available in a combination tablet with ezetimibe.  It’s designed especially for high-risk patients on maximally tolerated statins, people with heart disease or those with an inherited form of high cholesterol called familial hypercholesterolemia. It’s yet another option for patients who may not adequately respond to statins or perhaps can’t tolerate them.  

Let me be clear that, across the board, the biggest problem with statins is patients not taking them as prescribed.  Patients give up. Some decide not to take anything at all. This is dangerous.

Statin-associated side effects do occur from time to time.  Patients with side effects commonly complain of muscle cramps, pain or weakness.  I believe patients when they report these symptoms. But I do not view them as a rationale for giving up.  Yes, muscle cramps can be debilitating. But a heart attack or stroke is much, much worse.

Sometimes addressing side effects is a simple matter of switching statins.  Patients typically go through two to three different statins before finding the right statin.  They also may need to try reducing the dose to find both the statin and the dose they can tolerate.  In some cases, non-statin drugs may be needed in addition to maximally tolerated statin therapy to adequately lower LDL cholesterol, as clearly stated in the most recent guidelines.

The introduction of bempedoic acid serves as a hopeful reminder to patients that we continue to research and develop new options to help them lower their levels of LDL cholesterol.  Yes, finding the right treatment regimen can require some trial and error. But as therapies like bempedoic acid and PCSK9 inhibitors show us, the treatment choices continue to expand.

For each patient, a tailored treatment plan of diet, exercise and medications can be developed in consultation with a health care provider.  It is important not to give up until patients find the regimen of lifestyle and drug therapy that works for them. As non-statin medications add to our treatment options, I hope more patients will take control of their heart health and continue to work with their health care providers to optimally control LDL cholesterol, along with other risk factors.  This will help to prevent cardiovascular events, which remain a major cause of pain, suffering and death in our society.

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