Bempedoic Acid: From Guidelines to the Real World

Atherosclerotic cardiovascular disease remains the global leading cause of mortality. Hypercholesterolemia is a major, yet mostly insufficiently controlled, cardiovascular risk factor. Guideline-recommended lipid-lowering therapies (LLT) are underutilized, leading to low rates of low-density lipoprotein cholesterol (LDL-C) goal attainment. Poor adherence and intolerance to statins contributed to the need for developing non-statin lipid-lowering drugs. Their role increased following the concept of upfront combination LLT in patients unlikely to reach their LDL-C goal on statin monotherapy. Bempedoic acid emerged as a generally safe, efficient, and cost-effective strategy to lower LDL-C and cardiovascular risk in high- and very-high-risk individuals unable or unwilling to take statins. This updated review 1) outlines the basic pharmacology of bempedoic acid, 2) summarizes the results of clinical trials and real-world studies evaluating the efficacy and safety of bempedoic acid in the treatment of dyslipidemias, and 3) discusses the various current guidelines on the use of bempedoic acid in clinical practice.