Bempedoic acid (Nexletol) blocks a different step in cholesterol production than statins do, making it weaker alone but more effective when combined with a statin. Genetic evidence shows reducing intestinal absorption works. Together, both drugs upregulate the liver's LDL receptors to clear more cholesterol from the blood.
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Reducing cholesterol absorption reduces heart disease, proven by Mendelian studies of the Neiman Pixi 1 like protein also now. Okay, I can now deplete cholesterol synthesis in the liver. I can reduce absorption of cholesterol from the gut, depleting the cholesterol pool. We do have a backup way to inhibit cholesterol synthesis nowadays. It's called Benpedoic acid Nexlitol. It inhibits a different step in the cholesterol synthesis chain. Not quite as potent as the statins which inhibit the rate limiting enzyme, but nonetheless, I can further reduce cholesterol synthesis. If I combine bempedoic acid in the statin, I can really shut off cholesterol synthesis. But even by itself, bempedoic acid shuts off enough cholesterol synthesis that the liver will have to get cholesterol elsewhere. Upregulate LDL receptors, pulling in your particles.