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Bempedoic Acid in Patients with Chronic Coronary Syndrome Not Achieving LDL Targets Despite Intensive Therapy: A

José Javier Gómez-Barrado1,2, Paula Gómez-Turégano1, Miguel Turégano-Yedro1,3

  • 1Department of Cardiology, Hospital Universitario San Pedro de Alcántara, 10003 Cáceres, Spain.

Journal of Clinical Medicine
|August 13, 2026
PubMed

Insights

Bempedoic acid (BA) effectively lowers low-density lipoprotein cholesterol (LDL-C) in chronic coronary syndrome (CCS) patients on intensive therapy. Higher baseline LDL-C and diabetes predict greater reduction, with BA showing good tolerability and persistence.

Area of Science:

  • Cardiology
  • Pharmacology
  • Public Health

Background:

  • Achieving target low-density lipoprotein cholesterol (LDL-C) levels in chronic coronary syndrome (CCS) patients is difficult despite intensive therapy.
  • Bempedoic acid (BA) is an oral option, but real-world data on its effectiveness and patient-specific response factors in Spain are limited.

Purpose of the Study:

  • To evaluate the clinical performance and safety of bempedoic acid (BA) in a real-world Spanish cohort of chronic coronary syndrome (CCS) patients.
  • To identify patient-level factors associated with LDL-C reduction and target attainment when adding BA to intensive lipid-lowering therapy.

Main Methods:

  • Prospective, multicentre study in Cáceres province, Spain, involving 118 CCS patients with LDL-C ≥ 55 mg/dL on stable intensive lipid-lowering therapy.
  • Bempedoic acid (BA) 180 mg/day was added to background treatment; lipid parameters, metabolic profile, and safety were assessed over a median of 28 weeks.
  • Multivariable analyses were used to determine factors influencing LDL-C reduction and goal achievement.

Main Results:

  • Bempedoic acid (BA) reduced LDL-C by 22.8% (mean reduction of 16.36 mg/dL; p < 0.001), achieving target LDL-C < 55 mg/dL in 48.3% of patients.
  • Higher baseline LDL-C and the presence of diabetes mellitus were independently associated with greater LDL-C reduction (p=0.001 and p=0.024, respectively).
  • BA was well tolerated with high treatment persistence (94.4%), despite a modest increase in uric acid levels and no reported gout events. Over half the patients had elevated baseline lipoprotein(a) levels, indicating significant residual risk.

Conclusions:

  • In a real-world Spanish CCS population on intensive therapy, bempedoic acid (BA) provides significant LDL-C reduction and is well-tolerated.
  • Patients with higher baseline LDL-C and diabetes mellitus experience greater benefits, supporting personalized treatment approaches.
  • BA serves as a valuable intermediate-cost therapeutic option in Spain for patients needing further LDL-C lowering before escalating to more expensive treatments.

Keywords:
ATP citrate lyasebempedoic acidcardiovascular riskchronic coronary syndromelipid-lowering therapylipoprotein(a)low-density lipoprotein cholesterolreal-world study

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