Real-world evaluation of bempedoic acid for LDL-C reduction

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Created On: 27/11/2025

Lipid-lowering therapy remains a key strategy in curtailing cardiovascular disease (CVD) risk and preventing adverse cardiac events.

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Key take away

Bempedoic acid effectively reduces LDL-C levels by up to 50% and is well-tolerated, making it a valuable option for patients with statin intolerance or suboptimal lipid control.

Background

Lipid-lowering therapy remains a key strategy in curtailing cardiovascular disease (CVD) risk and preventing adverse cardiac events. Although statins and ezetimibe are commonly prescribed, many patients fail to attain target low-density lipoprotein cholesterol (LDL-C) levels owing to limited potency or poor tolerability. This study aimed to determine the effectiveness and tolerability of bempedoic acid (BA) in helping patients reach LDL-C targets in real-world clinical practice.

Method

A total of 151 dyslipidemic patients (39% men, 61% women; mean age 70 ± 10 years; mean body mass index 28 ± 5 kg/m²; mean waist circumference 100 ± 11 cm) who initiated BA therapy were included. Among them, 89% were undergoing primary prevention. Cardiovascular risk levels were categorized as very high (26%), high (46%), moderate (20%), and low (8%).

Statin or lipid-lowering therapy intolerance was reported in 82% of volunteers. Approximately 25% were not receiving any lipid-lowering treatment at baseline, with most belonging to the high or very high cardiovascular risk groups (73%). Notably, 90% of patients exhibited LDL-C levels above recommended targets prior to starting BA.

Result

Of the total subjects, 122 underwent an initial follow-up after 1–3 months, and 32 were re-examined after 8–12 months. Treatment discontinuation occurred in 26 patients (21%), primarily due to administrative reasons rather than potency or safety concerns. Only 6 patients (5%) discontinued BA because of mild adverse effects such as headache, myalgia, or gastrointestinal discomfort.

At baseline, the mean LDL-C was 132 ± 42 mg/dL, with an average 40% gap from target values. Following 3 months of therapy, 74% of patients remained on treatment and attained a mean LDL-C of 88 ± 27 mg/dL, representing a 35% drop and a 28% average distance from target. Overall, 36% of patients met their LDL-C targets. Subgroup analysis illustrated that BA monotherapy lowered LDL-C by 34.5%, while combination therapy with ezetimibe boosted reductions up to 50%.

Conclusion

BA proved to be an effective, well-tolerated lipid-lowering option for those unable to tolerate statins. It achieved reductions in LDL-C levels and enabled a substantial proportion of patients to reach target goals—particularly those with moderate or low cardiovascular risk. Despite its favorable safety and efficacy profile, barriers such as limited prescriptibility and market access continue to challenge consistent use and optimal LDL-C control in clinical settings.