A. Michael Lincoff, MD

@kcferdmd Of course, that CTT regression line was generated primarily by statins which also reduce CRP. And PCSK9i's fell below the line ... and don't reduce CRP. #CardsJC

HS CRP -22.2% at 6 mos is provocative, but probably not a major cause of decrease in MACE since LDL-C benefit lies directly on expected CTTC regression line LDL-C per 3 pt MACE. #CardsJC

@AlliBigeh Can also actually discuss nocebo effect with patients. "N of 1" trial (N Engl J Med 2020; 383:2182-2184) very illustrative - "90% of the symptom burden elicited by a statin challenge was also elicited by placebo." #CardsJC

Educating patients about this mechanism (i.e. how its different from statins) may help with the “nocebo effect” #CardsJC

@kcferdmd Apparent heterogeneity by primary/secondary prevention may well have been by chance. But re-emphasizes importance of treating high risk primary prevention patients, who are typically undertreated with LLT.

Primary prevention appeared to do even better, this might be by chance, but is an important finding because it gives some confidence in high risk patients that bempedoic acid might be useful in reducing MACE. #CardsJC

@goodmra1 @DrEugeneYang #CardsJC. Whether or not statin intolerance is real or nocibo effect in some patients, the bottom line is that they are not receiving the LDL-C reduction that would benefit them. No reason to believe CV benefit from BA is different in those with and without true intolerance.

@DrEugeneYang Am curious if you think that the ambiguity of "statin intolerance" impacts things here? #CardsJC

This is a major strength of the trial. Patients and researchers had to sign statements verifying their statin intolerance or unwillingness to take one despite the known benefit. #CardsJC