How to Talk to Your Doctor About Statin Intolerance

(Family Features) If your doctor has concerns about your cholesterol levels, you may be familiar with statins. This is a class of medications that can help reduce your body's cholesterol production, lowering your risk of heart attack or stroke.

However, up to 30% of adults in the United States have some degree of statin intolerance, according to research published in the "Journal of Clinical Lipidology." Possible signs or symptoms of statin intolerance are muscle aches and cramps, fatigue, weakness, elevated liver enzymes and the onset of diabetes or impaired glucose tolerance.

As a result, nearly one-third of patients (29%) discontinue their statin within the first year, according to findings published in the "American Journal of Cardiology." Unfortunately, patients with statin intolerance are at an increased risk of cardiovascular disease, including higher rates of coronary heart disease and recurrent heart attack.

Lowering Bad Cholesterol
A diagnosis of high cholesterol involves measuring low-density lipoprotein (LDL) cholesterol, which is commonly referred to as "bad" cholesterol because it leads to the accumulation of plaque in your arteries. Plaque reduces your blood flow, which can cause damage to your cardiovascular system.

Bloodwork is the best indicator of your cholesterol levels, since you may not experience any symptoms of high cholesterol until you already have damage and buildup in your arteries.

To help create your treatment plan, talk to your doctor about your medical history, including whether you've had a heart attack or any heart procedures, such as a stent placement or bypass surgery. You'll also review current medications, recent lab results and notes on any symptoms you may be experiencing.

Your doctor is likely to recommend a series of steps to reduce your cholesterol. Some common recommendations include a healthy diet low in saturated and trans fats and high in fiber, especially fruits, vegetables and whole grains.

If you're not already getting regular physical activity, your doctor will likely encourage you to get at least 30 minutes of exercise daily, find ways to include more movement in your everyday lifestyle and, if necessary, work toward shedding extra weight.

Lifestyle changes can help but may not make a big enough impact to reduce cholesterol to a recommended level. In those cases, doctors rely on cholesterol-lowering medications such as statins. Statins can be highly effective at reducing bad cholesterol, making them a powerful tool to reduce the risks associated with heart disease.

When Statins Are Intolerable or Aren't Enough
For a variety of reasons, including intolerance to the medication, other health conditions or interactions with other medications, statins may not be the right choice for everyone.

"While statins remain the gold standard for cholesterol lowering, I often see patients who either can't or won't take a statin, as well as patients who require further LDL cholesterol reduction," said Guy L. Mintz, Director of Cardiovascular Health & Lipidolology at Northwell Health System. "For those patients, I prescribe non-statin medications, such as NEXLETOL (an oral prescription medication with the cholesterol lowering agent bempedoic acid) and NEXLIZET (a combination of cholesterol-lowering medicines bempedoic acid and ezetimibe). I am comfortable using NEXLETOL and NEXLIZET, along with a healthy diet and exercise, to reduce LDL cholesterol in adults with high blood cholesterol levels and to reduce risk of heart events. Non-statins are another important therapeutic tool in our lipid lowering toolbox."

To learn more visit Nexlizet.com.

Photo courtesy of Shutterstock

IMPORTANT SAFETY INFORMATION
What are NEXLIZET tablets and NEXLETOL tablets?

• Along with a diet:
• NEXLETOL is used, with other cholesterol-lowering medicines, or alone when use with other cholesterol-lowering medicines is not possible, to reduce low-density lipoprotein (LDL, or bad cholesterol) in adults with high blood cholesterol levels called primary hyperlipidemia, including a type of high blood cholesterol called heterozygous familial hypercholesterolemia (HeFH).
• NEXLIZET is used, with or without other cholesterol-lowering medicines, to reduce low- density lipoprotein (LDL, or bad cholesterol) in adults with high blood cholesterol levels called primary hyperlipidemia, including a type of high cholesterol called heterozygous familial hypercholesterolemia (HeFH).
• The bempedoic acid portion of NEXLIZET and NEXLETOL is used to lower the risk of heart attack and heart procedures like stent placement or bypass surgery, in adults who are unable to take recommended statin treatment (a cholesterol-lowering medicine), or are not taking a statin, who:
• have known heart disease, or
• are at high risk for heart disease but without known heart disease.

Do not take NEXLIZET if you are allergic to ezetimibe or bempedoic acid, or any ingredients in NEXLIZET or NEXLETOL. If you have any of the following signs and symptoms of a serious allergic reaction, call your healthcare provider or go to the nearest hospital emergency room:

• swelling of your face, lips, mouth, or tongue
• wheezing
• severe itching
• fast heartbeat or pounding in your chest
• trouble breathing
• skin rashes, redness, or swelling
• dizziness or fainting

What should I tell my healthcare provider before taking NEXLIZET or NEXLETOL? Tell your healthcare provider if you:

• have, or had, gout
• have or had tendon problems
• are pregnant or breastfeeding or may become pregnant or plan to breastfeed. It is not known if NEXLIZET or NEXLETOL passes into your breastmilk
• have severe kidney or severe liver problems

Tell your healthcare provider about all the medicines you take, including prescription and over-the- counter medicines, vitamins and herbal supplements.
Especially tell your healthcare provider if you take or plan to take simvastatin or pravastatin, as taking either with bempedoic acid may increase your risk of developing muscle pain or weakness. If you take NEXLIZET, tell your doctor if you take cyclosporine, fibrates, or cholestyramine.

What is the most important safety information I should know about NEXLIZET and NEXLETOL? NEXLIZET and NEXLETOL can cause serious side effects, including:

• increased levels of uric acid in the blood, which can lead to gout, a painful joint condition. Call your doctor if you have any of the following symptoms: severe foot pain especially in the toe joint, warm joints, swelling, tender joints or joint redness.
• tendon rupture or injury. Tendon problems can happen in people who take bempedoic acid, one of the medicines in NEXLIZET or NEXLETOL. The risk of getting tendon problems while you take NEXLIZET or NEXLETOL is higher if you: are over 60 years of age, are taking steroids, are taking antibiotics called fluoroquinolones, have renal failure, or have had tendon problems in the past. Stop taking NEXLIZET or NEXLETOL immediately and get medical help if you experience signs of tendon rupture such as snap or pop in tendon area, bruising after an injury in a tendon area, or unable to move or put weight on the affected area.

The most common side effects in people with primary hyperlipidemia:

• NEXLETOL includes symptoms of the common cold or flu-like symptoms, muscle spasms, back pain, stomach pain, bronchitis, pain in shoulder, legs, or arms, anemia and increased liver enzymes.
• NEXLIZET includes symptoms of the common cold or flu-like symptoms, muscle spasms, back pain, stomach pain, bronchitis, pain in shoulder, legs, or arms, anemia, increased liver enzymes, diarrhea, joint pain, swelling of sinuses and fatigue.

The most common side effects of bempedoic acid, a component of NEXLIZET and NEXLETOL, in people with heart problems include kidney problems, anemia, increased liver enzymes, muscle spasms, and gallstones.

These are not all the possible side effects of NEXLIZET and NEXLETOL. For more information, ask your healthcare provider or pharmacist for more information.

Call your healthcare provider for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.