LDL-C lowering in patients treated with bempedoic acid in a real-world cohort

Elevated low-density lipoprotein cholesterol (LDL-C) is directly associated with cardiovascular disease, with the risk level determined by the magnitude and duration of exposure. In routine practice, there are limited data on the expected LDL-C lowering with bempedoic acid (BA) alone or in combination with ezetimibe (BA + EZE).

Patients initiating BA or BA + EZE were identified in the Veradigm Network EHR linked to claims (index). LDL-C levels were evaluated at baseline, 3, 6, and 12 months. To further examine BA and BA + EZE efficacy, patients were stratified by background statin use (12 months pre-index) and by continuous index therapy use (no therapy gap >45 days).

Of the 900 BA and 615 BA + EZE patients identified, median baseline LDL-C was 137 mg/dL and 127 mg/dL, respectively. By 3 months, BA (21%) and BA + EZE (33%, p < 0.0001 for both) were associated with significant reductions in median LDL-C levels. At baseline, only 6.3% of BA and 8.5% of BA + EZE patients had LDL-C <70 mg/dL; by 3 months, this increased to 16.8% and 33.3%. Over 12 months, 18.0% and 27.5% of patients had LDL-C <70 mg/dL. When stratified, the median reductions by 3 months highlighted use of BA and BA + EZE in patients without background statin use (BA: 24.2%; BA + EZE: 36.7%) and with continuous use (BA: 26.1%; BA + EZE: 40.2%).

Patients initiating BA and BA + EZE experienced early and sustained LDL-C improvements. The greatest reductions were in patients with continuous use and patients with no evidence of prior statin use, underscoring the importance of long-term adherence and treating patients not on statin therapy.