Drugs known as statins are the first-choice treatment for high cholesterol but millions of people who can�t or won�t take those pills because of side effects may have another option.

In a major study, a different kind of cholesterol-lowering drug named Nexletol reduced the risk of heart attacks and some other cardiovascular problems in people who can�t tolerate statins, researchers reported Saturday.

Doctors already prescribe the drug, known chemically as bempedoic acid, to be used together with a statin to help certain high-risk patients further lower their cholesterol. The new study tested Nexletol without the statin combination — and offers the first evidence that it also reduces the risk of cholesterol-caused health problems.

Statins remain �the cornerstone of cholesterol-lowering therapies,� stressed Dr. Steven Nissen of the Cleveland Clinic, who led the study.

But people who can�t take those proven pills �are very needy patients, they�re extremely difficult to treat,� he said. This option �will have a huge impact on public health.�

Too much so-called LDL or �bad� cholesterol can clog arteries and lead to heart attacks and strokes. Statin pills like Lipitor and Crestor � or their cheap generic equivalents � are the mainstay for lowering LDL cholesterol and preventing heart disease or treating those who already have it. They work by blocking some of the liver�s cholesterol production.

But some people suffer serious muscle pain from statins. While it�s not clear exactly how often that occurs, by some estimates 10% of people who�d otherwise qualify for the pills can�t or won�t take them. They have limited options, including pricey cholesterol-lowering shots and another kind of pill sold as Zetia.

Nexletol also blocks cholesterol production in the liver but in a different way than statins and without that muscle side effect.

The new five-year study tracked nearly 14,000 people who were unable to tolerate more than a very low dose of a statin. Half got daily Nexletol and half a dummy pill.

The main finding: Nexletol-treated patients had a 13% lower risk of a group of major cardiac problems. Then researchers teased apart those different conditions and found a 23% reduced risk of a heart attack, the biggest impact. The drug also cut by 19% procedures to unclog arteries. There wasn�t a difference in deaths, which researchers couldn�t explain but said might require longer to detect.

The data was published in the New England Journal of Medicine and presented Saturday at a meeting of the American College of Cardiology. The study was funded by Nexletol maker Esperion Therapeutics.

The results are �compelling,� Dr. John H. Alexander of Duke University, who wasn�t involved with the study, wrote in the journal. They �will and should� spur use of the drug by patients unwilling or unable to take statins.

�It is premature, however, to consider bempedoic acid as an alternative to statins,� he cautioned. �Given the overwhelming evidence of the vascular benefits,� statins remain the top choice for most patients.

(AP)