Hearts & Minds Blog

Raison d’ etre

Tim Mayleben

President and Chief Executive Officer

“The most important reason or purpose for someone or something’s existence.”

Bonjour le tout,

I am writing to you following a trip to Paris, France with my wife, Dawn, late last month.  Visiting Paris had been on Dawn’s “bucket-list” for many years, and we took advantage of the little time we have together and did all of the things that first-time visitors to Paris do.  On our last night we climbed the stairs of the Arc de Triomphe for what we were told would be a spectacular night view of Paris. Indeed, it was spectacular, but getting there proved to be scary and exhausting for us both.

As I described in a previous post [Note from our CEO], Dawn recently learned she has elevated LDL-cholesterol and is unable tolerate the statins she was prescribed.

As we ascended the 284 steps of the Arc de Triomphe, Dawn became short of breath.  We stopped – twice – before we could finish the stair climb.  She became dizzy and had to sit down at the top of the stairs.  After she rested, we tried to enjoy the beautiful night scene laid out before us.  As we descended, Dawn confessed that she had been waking up the past few nights with pain in her left shoulder, upper-arm and chest.  She tried to pass it off as just being tired from traveling.  I thought I knew better.  This was ‘déjà vu’ for me – in the weeks before my Dad died of a heart attack thirty-five years ago, he complained of pain in his left shoulder and upper-arm.  We walked slowly back to our hotel, packed our bags and returned home the next morning.

Back home now, Dawn assured me that she was feeling fine.  The pain had gone away.  The next evening, we were scheduled to travel again and found ourselves literally running through the airport to catch our flight.  Once again her shoulder, upper-arm, and chest pain returned along with the dizziness.  She went to her doctor the following morning and was immediately sent to the hospital with an abnormal EKG.  In the emergency room, they performed a “triple-rule-out” Computed Tomographic Angiography (CTA), which is an imaging technique to evaluate the coronary arteries, aorta and pulmonary arteries simultaneously for patients with acute chest pain.  The CTA showed that Dawn had approximately 50% narrowing and calcification in her right coronary artery.  The doctors followed the CTA with nuclear stress tests.  Fortunately, these tests showed that the narrowing and calcification was not yet impeding blood flow to her heart.  What she experienced was an early warning signal and not a heart attack.  No acute intervention needed: no PCI (angioplasty); no stent – for now.  Her new cardiologist prescribed yet another statin – Pravachol 20 mg.  She took it for four days and then had to stop due to intense muscle pain, a side effect experienced by many statin-treated patients.

Dawn has now tried three different statins at or below the lowest approved starting dose in each case.  She has tried a less-than-approved dose by taking a statin every other day.  Unfortunately, she just can’t tolerate these drugs.  Dawn desperately wants to lower her LDL-cholesterol and reduce her risk of cardiovascular disease, but her cholesterol remains stubbornly high at 190 mg/dL.  There is no effective oral drug available to lower her LDL-cholesterol as much as she needs, and she certainly doesn’t want to face monthly or twice-monthly injections for the rest of her life.  Dawn eats a Mediterranean diet and started exercising regularly, but she and so many patients like her need new oral drugs to lower elevated levels of LDL-cholesterol and, hopefully, reduce cardiovascular disease risk.

Here are the things that I learned this past month, and that I hope will be helpful for you:

  • Don’t ignore or push-off early warning signals from your body. This is true especially for women.  Dawn, like many women, is always making sure everyone else is “OK”.  Dawn’s body was telling her she had problems that she needed to pay attention to (dizziness, shortness of breath, shoulder, upper-arm and chest pain).
  • Dawn was fortunate to be surrounded by experts in cardiovascular disease. Co-workers, friends, doctors and nurses helped to navigate the sometimes confusing signals that her body was sending.  If you or a loved one experiences any of these signals, don’t ignore them and don’t settle: go to see an expert cardiologist – and do it right away!
  • Time matters: when the signals come, don’t wait! My Dad ignored the signals because he was “tough” – and with disastrous consequences.  Dawn and I didn’t ignore the signals – and now we’re much more knowledgeable about the nature and extent of her disease.  She is also taking action to lower her LDL-cholesterol levels as much as she can.

After the recent scare with Dawn, the stakes for Esperion and bempedoic acid are even higher.  The need for us to rapidly develop and gain approval for bempedoic acid is even more pressing.

All patients, and my wife included, who suffer with elevated LDL-cholesterol levels and especially those that are statin intolerant, represent our own personal raison d’ etre.  The Esperion Team recognizes the need is urgent – and we are marshaling all of our experience, collective expertise, financial and human resources, and especially our passion, to bring bempedoic acid to patients and physicians who will benefit from a new, oral LDL-cholesterol lowering drug.  For my Team and for me, it’s personal.