Opinion EDITORIAL Michael C. Honigberg, MD, MPP; Pradeep Natarajan, MD, MMSc Since the report of the first expert panel of the National Cho- with placebo), and there was similarly no significant excess lesterol Education Program in 1988, effectively the first con- of muscle symptoms compared with placebo within 12 temporary professional cholesterol guidelines in the United months. While not designed to evaluate cardiovascular out- States, lowering of low-density lipoprotein cholesterol comes, CLEAR Harmony showed nonsignificantly fewer (LDL-C) levels has been a major adverse cardiovascular events with bempedoic acid cornerstone of atheroscle- (4.6%) vs placebo (5.7%) during this time frame. Related article page 1780 rotic cardiovascular disease In this context, Goldberg et al report in this issue of (ASCVD) prevention. Consistent with classical and genetic JAMA findings on the LDL-C–lowering efficacy and adverse epidemiologic studies implying a causal relationship effects of bempedoic acid (180 mg daily) in the similarly between LDL-C and ASCVD, multiple randomized clinical designed CLEAR Wisdom trial that included 779 patients. trials have consistently observed proportional relationships Trial-eligible individuals had heterozygous familial hyper- between LDL-C lowering and ASCVD risk reduction from stat- cholesterolemia (5.5%) or ASCVD (94.5%), were taking ins. More recently, these findings have extended to
JAMA – American Medical Association
Published: Nov 12, 2019
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