The estimates are staggering: nearly 40 million American adults take a statin in order to lower their levels of LDL (bad) cholesterol, which can lead to blocked arteries and heart attacks if not kept under control. While a healthy lifestyle is also critical for keeping cardiac risk at bay, there’s no debate that statins play an important role for those at risk of a heart attack or stroke, or for those who have already suffered such an incident. While you need to discuss with your physician whether a statin makes sense for your age, medical history, and level of risk, it’s clear that millions of Americans now have less chance of experiencing a serious heart problem because they take a daily Lipitor, Crestor, or some other type of statin. For more on the role of statins, and measures to control cholesterol, take a look at previous agebuzz posts here.

Yet there remain a significant number of people who could benefit from a statin but are unable or unwilling to take this medication. In a new study published in JAMA Network Open, researchers found that despite the risks of untreated high levels of LDL cholesterol, nearly 20% of patients at risk do not take a daily statin, even when their physician recommends it. Of further concern is that women were 20% more likely to reject a statin recommendation than men. While some patients eventually come around after initial refusals, on average women were more likely to continue to refuse than men. Why this initial refusal and unwillingness to reconsider? Unfortunately, this study did not directly address this question so the answer is subject to speculation. It could be misinformation or misunderstanding of the risks and the benefits to be derived from taking a statin. Or it could be the experience of a negative side effect from a statin, including muscle aches or brain fog. It’s obviously a concern that a significant portion of people who could benefit refuse or are unable to take a proven drug that could drastically lower their risk of a heart attack or stroke. 

There is some good news on that front, however. The New England Journal of Medicine just published a new study involving the drug Bempedoic Acid, which is sold under the name brand Nexletol. While this medication was previously approved by the FDA in 2020, heart specialists were waiting for a clinical trial to prove a positive outcome with this drug for lowering levels of LDL cholesterol. It’s estimated that 7% – 29% of patients experience intolerable side effects from a statin, such as the aforementioned muscle aches. Rather than doing nothing to address their risky levels of LDL cholesterol, Bempedoic Acid may be an acceptable alternative to help such patients to lower their risks. This drug is not meant to replace a statin, which is still considered the “cornerstone” in treating high LDL levels, but there is now a clinically validated drug to substitute for a statin if needed. Bempedoic Acid does not cause the same sort of muscle aches produced by statins, as it targets an enzyme in the liver rather than in muscles. As an editorial accompanying the report in The New England Journal of Medicine makes clear, while not the equivalent of a statin, “Bempedoic acid has now entered the list of evidence-based alternatives to statins for primary and secondary prevention in patients at high cardiovascular risk. The benefits of bempedoic acid are now clearer, and it is now our responsibility to translate this information into better primary and secondary prevention for more at-risk patients, who will, as a result, benefit from fewer cardiovascular events.” And that’s an outcome to be celebrated.