Real-world utilization of bempedoic acid in an academic preventive cardiology practice
Abstract
Background Lipid management for prevention and treatment of cardiovascular disease remains insufficient for many with currently available therapies. Objective Evaluate real-world use of bempedoic acid. Methods Retrospective study of patients in our Center for Preventive Cardiology who were prescribed bempedoic acid between February 2020 and July 2021. Patients were managed according to clinical standards of care, with lipid assessments at months ≤3, 6, and 12 post-bempedoic acid initiation. Results Seventy-three patients were prescribed bempedoic acid, with 64 initiating therapy. The majority had atherosclerosis (89%), familial hypercholesterolemia (64%), and statin intolerance (74%), with baseline low-density lipoprotein cholesterol (LDL-C) 120 mg/dL. Prior authorization requests and appeals of denials were required in 90% and 19% of cases, respectively. Cost-mitigating strategies reduced median monthly drug costs from $432 pre-insurance approval to $80 post-insurance approval, to $10 after financial assistance intervention. Bempedoic acid reduced LDL-C by -36.7%, -31%, and -20.3% at ≤3, 6, and 12, respectively, with >20% achieving LDL-C Conclusions Real-world use of bempedoic acid was limited by insurance and cost barriers requiring substantial post-prescription interventions. In patients at heightened risk for atherosclerotic events and statin intolerance, bempedoic acid was associated with clinically meaningful LDL-C lowering, but high rates of TEAEs and drug discontinuat…
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Among the few studies reporting treatment discontinuation (n = 4), rates ranged from 9% to 36% across heterogeneous populations with mixed prevention status, varying degrees of statin intolerance, and different background LLTs.
“Among the few studies reporting treatment discontinuation (n = 4) [23,28,30,40], rates ranged from 9% to 36% across heterogeneous populations with mixed prevention status, varying degrees of statin intolerance, and different background LLTs.”
From Systematic literature review on the real-world effectiveness and safety of bempedoic acid (2026) · cites this paper as [23]
Across two real-world studies involving patients with varied statin tolerability, the proportion achieving LDL-C targets on bempedoic acid ranged from 12.0% reaching <55 mg/dL after 3 months to 20.5% achieving <70 mg/dL after 12 months (baseline LDL-C = 120 mg/dL for the latter).
“Across two real-world studies involving patients with varied statin tolerability, the proportion achieving LDL-C targets on bempedoic acid, ranged from 12.0% reaching <55 mg/dL [33] to 20.5% achieving <70 mg/dL (baseline LDL-C = 120 mg/dL) [23] after 3 [33], and 12 months of treatment [23].”
From Systematic literature review on the real-world effectiveness and safety of bempedoic acid (2026) · cites this paper as [23]
Higher discontinuation rates observed (up to 36%) likely reflect the broader inclusion of patients with statin intolerance or LLT non-tolerance.
“An increased incidence of gout was observed with bempedoic acid [28,29]; higher discontinuation rates observed (up to 36%) [23,28,30,40] likely reflect the broader inclusion of patients with statin intolerance or LLT non-tolerance, although reasons for discontinuation were not consistently reported.”
From Systematic literature review on the real-world effectiveness and safety of bempedoic acid (2026) · cites this paper as [23]
In all-comer populations with mixed statin-intolerance and varied background LLTs, LDL-C reductions with bempedoic acid ranged from 18% to 42%.
“In all-comer populations with mixed statin-intolerance and varied background LLTs, LDL-C reductions also ranged from 18% to 42% [23,26,28,30,31,33,43].”
From Systematic literature review on the real-world effectiveness and safety of bempedoic acid (2026) · cites this paper as [23]
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References 33 · Cited by 39
- Authors
- Warden, B. A., Cardiology, B.-A., Purnell, J. Q., Duell, P. B., & Fazio, S.
- Affiliations
- Oregon Health & Science University (US)
- Corresponding author
- Warden, Bruce A.
- Venue
- Journal of Clinical Lipidology
- Publisher
- Elsevier BV
- Published
- 2022-01
- Volume
- 16
- Issue
- 1
- Pages
- 94-103
- ISSN
- 1876-4789 (ISSN-L)
- 1933-2874
- OpenAlex
- W4200475820
- Cited by
- 39
- References
- 33
- Citations by year
- 2026: 9 · 2025: 10 · 2024: 5 · 2023: 8 · 2022: 7
- FWCI
- 4.69
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of clinical lipidology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Lipoproteins and Cardiovascular Health
- Health Sciences › Medicine › Surgery › Cholesterol and Lipid Metabolism
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Lipid metabolism and disorders
- Keywords
- bempedoic acid, LDL cholesterol lowering, statin intolerance, familial hypercholesterolemia, atherosclerosis, prior authorization, insurance denials, financial aid, treatment-emergent adverse events, musculoskeletal symptoms, drug discontinuation, real-world applications, preventive cardiology
- MeSH terms
- Cardiology, Dicarboxylic Acids, Double-Blind Method, Fatty Acids, Humans, Hypercholesterolemia, Cholesterol, LDL, Retrospective Studies, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Atherosclerosis
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