However, adverse musculoskeletal effects make them intolerable for some patients.

A recent trial examined the efficacy and safety of bempedoic acid, an ATP citrate lyase inhibitor, that reduces LDL cholesterol, for preventing cardiovascular events in patients with statin intolerance.

In this double-blind, randomized, placebo-controlled trial, 13,970 patients 18 to 85 years of age with increased cardiovascular risk, who were unable or unwilling to take guideline-recommended doses of statins, were assigned to receive 180 mg of oral bempedoic acid, or placebo, daily.

After a median follow-up of 40.6 months, the incidence of a primary endpoint event, a composite of death from cardiovascular causes, nonfatal myocardial infarction, nonfatal stroke, or coronary revascularization, was significantly lower in the bempedoic acid group, at 11.7%, than in the placebo group, at 13.3%.

A key secondary efficacy endpoint event, a composite of death from cardiovascular causes, nonfatal myocardial infarction, or nonfatal stroke, occurred significantly less often in the bempedoic acid group.

The overall rate of adverse events was similar in the two groups.

However, the bempedoic acid group had higher frequencies of elevated hepatic enzymes, renal impairment, hyperuricemia, gout, and cholelithiasis.

The authors conclude that in statin-intolerant patients requiring therapy for primary or secondary prevention of cardiovascular disease, treatment with bempedoic acid during a median follow-up of 40.6 months significantly reduced the risk of major adverse cardiovascular events.

Full trial results are available at NEJM.org.

For more information visit www.nejm.org