The downside [of ezetimibe and bemoedoic acid], I believe, is the cost of these compared to standard statins.
Not really, it’s the lack of clinical evidence for outcome benefit. We know these agents reduce cholesterol, and we know lower cholesterol is associated with fewer CV events. But we have only limited evidence that they might help reduce events. Statins on the other hand and extremely well researched and do reduce CV events. They also reduce cardiovascular events to a greater extent than would be expected by their cholesterol lowering effect – I.e. we think there are additional (anti-inflammatory?) effects.
To put that in context, it’s crystal clear that there are significant benefits post-stroke in people who have elevated HDL cholesterol or other factors pointing to artery disease
OP’s comments suggest to me blood cholesterol markers were/are normal, so it’s slightly less clear whether he would personally see those benefits.
NB If you’re looking at cardiac disease this would be almost completely backwards. Statins reduce events almost irrespective of starting cholesterol, and the benefit is much greater in patients who have had CV events (even with low cholesterol) than patients who are well with high cholesterol. That’s why your GP doesn’t prescribe statins based only on cholesterol levels, it takes into account your other cardiovascular risk factors.
The statin side effect thing is a big concern for the public health of the country. The vast majority of ‘statin side effects’ are not reproducible in placebo (or ‘nocebo’) studies. Take from that what you will – but this is where your GP’s skepticism of your side effects comes from.
