Can’t take statins? New pill cuts cholesterol, heart attacks
Drugs known as statins are the first-choice treatment for high cholesterol, but millions of people who can’t or won’t take those pills because of side effects may have another option.
In a major study, a different kind of cholesterol-lowering drug named Nexletol reduced the risk of heart attacks and some other cardiovascular problems in people who can’t tolerate statins, researchers reported Saturday.
Doctors prescribe the drug, known chemically as bempedoic acid, to be used together with a statin to help certain high-risk patients further lower their cholesterol. The new study tested Nexletol without the statin combination — and offers the first evidence that it also reduces the risk of cholesterol-caused health problems.
Statins remain “the cornerstone of cholesterol-lowering therapies,” stressed Dr. Steven Nissen of the Cleveland Clinic, who led the study.
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But people who can’t take those proven pills are “extremely difficult to treat,” he said. This option “will have a huge impact on public health.”
Too much so-called LDL or “bad” cholesterol can clog arteries and lead to heart attacks and strokes. Statin pills such as Lipitor and Crestor, or their cheap generic equivalents, are the mainstay for lowering LDL cholesterol and preventing heart disease or treating those who already have it. They work by blocking some of the liver’s cholesterol production.
But some people suffer serious muscle pain from statins. While it’s not clear exactly how often that occurs, by some estimates 10% of people who’d otherwise qualify for the pills can’t or won’t take them. They have limited options, including pricey cholesterol-lowering shots and another kind of pill sold as Zetia.
Nexletol also blocks cholesterol production in the liver but in a different way than statins and without that muscle side effect.
The new five-year study tracked nearly 14,000 people who were unable to tolerate more than a very low dose of a statin. Half got daily Nexletol and half a dummy pill.
The main finding: Nexletol-treated patients had a 13% lower risk of a group of major cardiac problems. Then researchers teased apart those different conditions and found a 23% reduced risk of a heart attack, the biggest impact. The drug also cut by 19% procedures to unclog arteries. There wasn’t a difference in deaths, which researchers couldn’t explain but said might require longer to detect.
The data was published in the New England Journal of Medicine and presented Saturday at a meeting of the American College of Cardiology. The study was funded by Nexletol maker Esperion Therapeutics.
The results are “compelling,” Dr. John H. Alexander of Duke University, who wasn’t involved with the study, wrote in the journal. They “will and should” spur use of the drug by patients unwilling or unable to take statins.
“It is premature, however, to consider bempedoic acid as an alternative to statins,” he cautioned. “Given the overwhelming evidence of the vascular benefits,” statins remain the top choice for most patients.
Here are 15 foods that boost good cholesterol
Oatmeal
Oats are loaded with soluble fiber, which can help keep bad cholesterol from being absorbed into your bloodstream. Even better? Some of that soluble fiber comes in the form of beta glucan, a type of fiber tied to lower LDL cholesterol.
Getting 3 grams of beta glucan daily has been shown to improve heart health — and you can get about half that amount from 3/4 cup of dry oats.
Beans and legumes
Lentils and black beans and chickpeas — oh, my! Beans and legumes are another great source of cholesterol-friendly soluble fiber.
In fact, a review of 26 studies found that eating just 1/2 cup daily could help lower LDL cholesterol by an average of 6.6 mg/dL, improving your LDL-to-HDL ratio.
Olive oil
Consider using it as your go-to for cooking. Olive oil is packed with heart-healthy monounsaturated fats.
Research has shown that a Mediterranean-style diet rich in olive oil can boost important HDL cholesterol functions like sweeping excess cholesterol out of the heart’s blood vessels, keeping them open.
Apples
An apple a day… you know the rest. But hey, it just might be true! The crunchy fruit is a top source of pectin, which can lower LDL cholesterol to improve your LDL-to-HDL ratio.
Apples are also loaded with polyphenols. And according to a 2013 study, those polyphenols could help keep your arteries from becoming clogged or inflamed by stopping LDL cholesterol from oxidizing.
Fatty fish
Fish like salmon, tuna, mackerel and herring are brimming with omega-3 fatty acids. These fats don’t directly raise HDL, but they can help lower your triglycerides, a type of unhealthy fat in your blood.
They improve your heart health in other ways, too, like lowering blood pressure and reducing the risk for dangerous blood clots.
Avocado
The fruit serves up plenty of monounsaturated fats and fiber, both of which are keys for keeping your cholesterol levels healthy.
One study found that adults with higher body weights who ate an avocado each day lowered their LDL cholesterol levels more than those who skipped the creamy green fruit. More guac, anyone?
Berries
Strawberries, blueberries, raspberries, blackberries and cranberries are chock-full of antioxidant compounds like anthocyanins, phenolic acids, stilbenes, tannins and carotenoids, which are linked to lower inflammation and healthier cholesterol levels.
Walnuts
Nuts like walnuts are a good source of polyunsaturated fats — heart-healthy fats that play a key role in improving your total cholesterol ratio. And if you’re not a fan of fish, good news: Walnuts offer omega-3 fatty acids too.
Help yourself to two or three handfuls a day — according to a 2010 review of 25 studies, eating that amount could help lower your LDL cholesterol by as much as 10 points.
Almonds
Like avocado and olive oil, almonds (and other nuts) are a good source of heart-healthy monounsaturated fats that can improve your total cholesterol ratio.
They’re also high in phytosterols, plant compounds that are structurally similar to cholesterol and help block cholesterol from being absorbed in your gut.
You’ll reap the same benefits whether you nosh on whole almonds or almond butter.
Barley
The chewy whole grain is another great way to get your fill of beta glucan, the soluble fiber that can lower your LDL cholesterol.
Try it as an alternative to oats for a hearty breakfast porridge, throw it into a salad or use it to give extra body to bean and veggie soups.
Grapes
These juicy little fruits pack a one-two punch for heart health. They contain antioxidant compounds and the heart-healthy fiber pectin, which help bring HDL cholesterol up and LDL cholesterol down.
Cocoa and dark chocolate
Nope, your eyes aren’t tricking you. Both cocoa and dark chocolate contain compounds that can lower bad cholesterol and help you get to a healthier total cholesterol level overall.
How? It seems that both foods help prevent LDL cholesterol from oxidizing, which can up the risk for heart disease.
The key to reaping the benefits is enjoying cocoa and dark chocolate in a healthy context.
Instead of guzzling a sugary hot chocolate with whipped cream, stir cocoa powder into your morning oatmeal or yogurt. If opting for dark chocolate, make sure the cocoa content is at least 75% and stick to a 1-ounce portion.
Soy foods
According to a recent review of 46 studies, eating about 25 grams of soy protein per day can lower LDL cholesterol levels by 3 to 4%.
Just remember that not all soy foods are created equal. You’ll do the most good for your heart by choosing minimally processed soy products — choose tofu, tempeh or miso over packaged soy burgers or deli slices.
Love sipping soy milk? Steer clear of added sugar by choosing one that’s unsweetened.
Leafy greens
You already knew kale was a superfood, but here’s one more reason it’s worth adding to your shopping list: Dark leafies can bind to bile acids, which could help your body flush out more bad cholesterol (and get your HDL-to-LDL ratio in a healthier place).
This benefit might come from lutein, an antioxidant that’s been shown to prevent cholesterol from sticking to artery walls.
Green tea
It’s loaded with catechins, a family of antioxidants that have been shown to reduce LDL cholesterol and overall cholesterol concentration.
And the more you drink, the greater the benefits seem to be. A large, long-term study found that adults who sipped five cups of green tea daily were 26% less likely than non-tea drinkers to die of a heart attack or stroke.
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