美国国家公共电台 NPR--Got muscle pain from statins? A cholesterol-lowering alternative might be for you

Got muscle pain from statins? A cholesterol¹-lowering alternative might be for you

Transcript²

When the FDA approved bempedoic acid, marketed under the brand name Nexletol, back in 2020, it was clear that the drug helped lower LDL — "bad" cholesterol. The drug was intended for people who can't tolerate statin medications due to muscle pain, which is a side effect reported by up to 29% of people who take statins.

What was unknown until now, is whether bempedoic acid also reduced the risk of cardiovascular events. Now, the results of a randomized, controlled trial published in The New England Journal of Medicine point to significant benefit. The study included about 14,000 people, all of whom were statin intolerant.

"The big effect was on heart attacks," says study author Dr. Steven Nissen of Cleveland Clinic.

People who took daily doses of bempedoic acid for more than three years had about a 23% lower risk of having a heart attack, in that period, compared to those taking a placebo³. There was also a 19% reduction in coronary revascularizations, which are procedures that restore blood flow to the heart, such as a bypass operation or stenting to open arteries⁴.

With these findings, the benefits of the medication are now clearer, says Dr. John Alexander, a cardiologist and professor at Duke University. "Bempedoic acid has now entered the list of evidence-based alternatives to statins," Alexander wrote in an editorial, published alongside the study.

Jennifer Kluczynski, 55, of Lambertville, Mich., had tried multiple statins but experienced lots of muscle aches and pains. "I felt like I had the flu" without the fever, she explains. Some days she just wanted to go back to bed. Her doctor prescribed Nexletol about two years ago, and she says she feels much better and hasn't "been achy."

And her cholesterol levels remain well controlled by the medicine.

"This is working for me wonderfully and I'm not having any side effects," Kluczynski says.

Bempedoic acid is a prodrug, which means it is activated⁵ by an enzyme⁶ after the medication enters the body. And, unlike statin drugs, bempedoic acid is mostly metabolized in the liver, not in peripheral⁷ tissues, like muscle, so Alexander says it "has few, if any, muscle-related side effects." In the clinical trial, myalgias, which are muscle aches or pains, were reported more among people taking the placebo (6.8%), compared to those taking bempedoic acid (5.6%).

Researchers say bempedoic acid was generally well-tolerated by people in the trial but there were some reported risks, including an increased incidence of gout, which was reported in 3% of the bemepedoic acid group, compared to 2% of the placebo group. And the study also found a small increase in the number of people who developed gallstones (2% in the bempedoic group, 1% in the placebo group). But the benefits of taking the drug " far outweigh⁸ the small risks that we observed in the trial," study author Nissen told NPR.

The study was funded in part by the maker⁹ of the drug, Esperion Therapeutics, but Nissen explains his team works independently. "My statisticians generated all the numbers in the manuscript," he says. "We do our own analyses and we report the adverse¹⁰ events very carefully because every drug has benefits and risks."

It's important to point out that statins are very well-tolerated by millions of people, Nissen says, and there's "enormous amounts of evidence that they reduce the risk of heart attack, stroke and death from cardiovascular causes."

Statins are also relatively¹¹ inexpensive with many patients paying less than $10 a month, given the many options, including generics¹³. Kluczynski's insurance plan covers the cost of Nexletol, but it can cost about $400 per month for people who are not covered by insurance. There is currently no generic¹² for Nexletol.

Nissen says statins will "continue to be the cornerstone of therapy to prevent cardiovascular events." But for people who simply cannot tolerate a statin, he says, "we have an alternative for them."

1 cholesterol   

n.（U）胆固醇

参考例句：

• There is cholesterol in the cell of body.人体细胞里有胆固醇。
• They are determining the serum-protein and cholesterol levels.他们正在测定血清蛋白和胆固醇的浓度。

2 transcript   

n.抄本，誊本，副本，肄业证书

参考例句：

• A transcript of the tapes was presented as evidence in court.一份录音带的文字本作为证据被呈交法庭。
• They wouldn't let me have a transcript of the interview.他们拒绝给我一份采访的文字整理稿。

3 placebo   

n.安慰剂；宽慰话

参考例句：

• The placebo has been found to work with a lot of different cases.人们已发现安慰剂能在很多不同的病例中发挥作用。
• The placebo effect refers to all the observable behaviors caused by placebo.安慰剂效应是指由安慰剂所引起的可观察的行为。

4 arteries   

n.动脉( artery的名词复数 )；干线，要道

参考例句：

• Even grafting new blood vessels in place of the diseased coronary arteries has been tried. 甚至移植新血管代替不健康的冠状动脉的方法都已经试过。 来自《简明英汉词典》
• This is the place where the three main arteries of West London traffic met. 这就是伦敦西部三条主要交通干线的交汇处。 来自《简明英汉词典》

5 activated   

adj. 激活的 动词activate的过去式和过去分词

参考例句：

• The canister is filled with activated charcoal.蒸气回收罐中充满了活性炭。

6 enzyme   

n.酵素，酶

参考例句：

• Above a certain temperature,the enzyme molecule will become unfolded.超过一定温度，酶分子将会展开。
• An enzyme that dissolves the fibrin of blood clots.能溶解血凝块中的纤维的酶。

7 peripheral   

adj.周边的，外围的

参考例句：

• We dealt with the peripheral aspects of a cost reduction program.我们谈到了降低成本计划的一些外围问题。
• The hotel provides the clerk the service and the peripheral traveling consultation.旅舍提供票务服务和周边旅游咨询。

8 outweigh   

vt.比...更重，...更重要

参考例句：

• The merits of your plan outweigh the defects.你制定的计划其优点胜过缺点。
• One's merits outweigh one's short-comings.功大于过。

9 maker   

n.制造者，制造商

参考例句：

• He is a trouble maker，You must be distant with him.他是个捣蛋鬼，你不要跟他在一起。
• A cabinet maker must be a master craftsman.家具木工必须是技艺高超的手艺人。

10 adverse   

adj.不利的；有害的；敌对的，不友好的

参考例句：

• He is adverse to going abroad.他反对出国。
• The improper use of medicine could lead to severe adverse reactions.用药不当会产生严重的不良反应。

11 relatively   

adv.比较...地，相对地

参考例句：

• The rabbit is a relatively recent introduction in Australia.兔子是相对较新引入澳大利亚的物种。
• The operation was relatively painless.手术相对来说不痛。

12 generic   

adj.一般的，普通的，共有的

参考例句：

• I usually buy generic clothes instead of name brands.我通常买普通的衣服，不买名牌。
• The generic woman appears to have an extraordinary faculty for swallowing the individual.一般妇女在婚后似乎有特别突出的抑制个性的能力。

13 generics   

n.（产品，尤指药物 ）无厂家商标的，无商标的( generic的名词复数 )

参考例句：

• Pfizer has set up an in-house division to handle such generics. Pfizer已经建立了一个内部机构来处理这些学名药。 来自互联网
• Payers are being more pushy about getting patients to take generics. 药物费用的支付者更倾向于让病人使用非专利药。 来自互联网