Lipid clinic experience with bempedoic acid in three UK centres
Abstract
Objective Novel lipid-lowering therapies are being introduced. Few studies exist of the real-world effectiveness of adenosine-tri-phosphate citrate lyase inhibition with bempedoic acid. Methods This study audited bempedoic acid therapy in 216 consecutive patients from three hospital centres - a university hospital ( n = 77) and two district general hospitals ( n = 106 and 33). Cardiovascular disease (CVD) risk factors, prescription qualification criteria, efficacy and adverse effects were assessed. Results The population was aged 65.9 ± 11.0 years, 42% were male, 25% had type 2 diabetes, and 31% had familial hypercholesterolaemia. CVD was present in 19% and multibed vascular disease in 8%. Statin intolerance was reported in 92%. Bempedoic acid reduced total cholesterol by 1.58 ± 1.44 mmol/L (20%), LDL-C by 1.37 ± 1.31 mmol/L (27%), triglycerides by 0.22 mmol/L (2%) with an 0.06 mmol/L (1%) increase in HDL-C after 22 ± 9 months follow-up. An LDL- C 2 = .33) was predicted by baseline LDL-C ( β = .54; p 1c . Treatment was discontinued by 33% of patients and occurred due to myalgia (43%), lack of efficacy (16%) and gastrointestinal adverse effects (15%). No cases of gout were observed. In a logistic regression only the number of previous drug classes not tolerated ( β = 1.60; p = .009) was a contributing factor to discontinuation. Conclusion This audit suggests that bempedoic acid therapy is effective but that adverse effects and discontinuation are common. This suggests nocebo e…
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In that study, bempedoic acid achieved a 27% LDL-C reduction at 22-month follow-up.
“In this study, bempedoic acid achieved a 27% LDL-C reduction at 22-month follow-up (baseline LDL-C = 164 mg/dL) [41].”
From Systematic literature review on the real-world effectiveness and safety of bempedoic acid (2026) · cites this paper as [41]
In a mixed prevention cohort that included patients with monogenic familial hypercholesterolemia (31%), drug intolerance to at least two statins was reported in 89% of patients.
“In a mixed prevention cohort that included patients with monogenic familial hypercholesterolemia (31%), drug intolerance to at least two statins was reported in 89% of patients;”
From Systematic literature review on the real-world effectiveness and safety of bempedoic acid (2026) · cites this paper as [41]
In the same study, patients who discontinued bempedoic acid had a greater number of total lipid-lowering drug classes not tolerated (1.89 vs 1.46; p = 0.003) compared to those who remained on treatment.
“One study found that patients who discontinued bempedoic acid had a higher number of previously non-tolerated statins (2.86 vs 2.41; p = 0.02) and a greater number of total lipid-lowering drug classes not tolerated (1.89 vs 1.46; p = 0.003) compared to those who remained on treatment [41].”
From Systematic literature review on the real-world effectiveness and safety of bempedoic acid (2026) · cites this paper as [41]
In one study, patients who discontinued bempedoic acid had a higher number of previously non-tolerated statins (2.86 vs 2.41; p = 0.02) compared to those who remained on treatment.
“One study found that patients who discontinued bempedoic acid had a higher number of previously non-tolerated statins (2.86 vs 2.41; p = 0.02) and a greater number of total lipid-lowering drug classes not tolerated (1.89 vs 1.46; p = 0.003) compared to those who remained on treatment [41].”
From Systematic literature review on the real-world effectiveness and safety of bempedoic acid (2026) · cites this paper as [41]
In a mixed prevention cohort that included 31% patients with monogenic familial hypercholesterolemia, 40% of patients on bempedoic acid achieved an LDL-C target of <97 mg/dL (baseline LDL-C = 164 mg/dL).
“In one study in a mixed prevention cohort that included patients with monogenic familial hypercholesterolemia (31%), 40% of patients on bempedoic acid achieved a target of <97 mg/dL, and 20.0% achieved this when the target was set at <77 mg/dL (baseline LDL-C = 164 mg/dL) [41].”
From Systematic literature review on the real-world effectiveness and safety of bempedoic acid (2026) · cites this paper as [41]
In the same mixed prevention cohort, 20.0% of patients on bempedoic acid achieved an LDL-C target of <77 mg/dL.
“In one study in a mixed prevention cohort that included patients with monogenic familial hypercholesterolemia (31%), 40% of patients on bempedoic acid achieved a target of <97 mg/dL, and 20.0% achieved this when the target was set at <77 mg/dL (baseline LDL-C = 164 mg/dL) [41].”
From Systematic literature review on the real-world effectiveness and safety of bempedoic acid (2026) · cites this paper as [41]
LDL-C reductions with bempedoic acid in statin-intolerant patients ranged from 22% to 38%.
“Consistent effects were also seen when bempedoic acid was added to statins (15% to 39%) [25,30,32,38,39,44], and when used in statin intolerant patients (22% to 38%) [24,29,34,35,37,40,41], despite the latter group having higher baseline LDL-C.”
From Systematic literature review on the real-world effectiveness and safety of bempedoic acid (2026) · cites this paper as [41]
Cites
Virani, S. S., Newby, L. K., Arnold, S. V., Bittner, V., Brewer, L. C., Demeter, S. H., Dixon, D. L., Fearon, W. F., Hess, B., Johnson, H. M., et al. (2023) · Circulation · doi:10.1161/cir.0000000000001168 · Cited by 1,598 · see citing works
Bempedoic Acid and Cardiovascular Outcomes in Statin-Intolerant Patients
Nissen, S. E., Lincoff, A. M., Brennan, D., Ray, K. K., Mason, D., Kastelein, J. J. P., Thompson, P. D., Libby, P., Cho, L., Plutzky, J., et al. (2023) · New England Journal of Medicine · doi:10.1056/nejmoa2215024 · Cited by 988 · see citing works
Bempedoic acid safety analysis: Pooled data from four phase 3 clinical trials
Bays, H. E., Banach, M., Catapano, A. L., Duell, P. B., Gotto, A. M., Laufs, U., Leiter, L. A., Mancini, G. B. J., Ray, K. K., Bloedon, L. T., et al. (2020) · Journal of Clinical Lipidology · doi:10.1016/j.jacl.2020.08.009 · Cited by 103 · see citing works
De Filippo, O., D’Ascenzo, F., Iannaccone, M., Bertaina, M., Leone, A., Borzillo, I., Ravetti, E., Solano, A., Pagliassotto, I., Nebiolo, M., et al. (2023) · Cardiovascular Diabetology · doi:10.1186/s12933-023-02022-z · Cited by 43 · see citing works
Real-life experience of the first patients treated with Bempedoic acid in 2 lipid clinics of Belgium
Demeure, F., Sperone, A., Snel, M., & Descamps, O. (2023) · Atherosclerosis · doi:10.1016/j.atherosclerosis.2023.06.840 · Cited by 4 · see citing works
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Systematic literature review on the real-world effectiveness and safety of bempedoic acid
Cicero, A. F. G., Cannon, C. P., Gautam, R., Anwar, S., Ghatak, A., Sarnes, E., Powell, H. A., Chhabra, R., & Jawla, S. (2026) · Atherosclerosis Plus · doi:10.1016/j.athplu.2026.100562 · Cited by 1 · see citing works
“…to initiation of bempedoic acid, patients had LDL-C levels ranging from 90 mg/dL to 146 mg/dL. Diabetes was present in 11% to 66% of patients [23,25,29,30,32,38, 39,41,42]; hypertension in 33% to 83% [23,25,29,30,32,39,42,44]; and one study focusing on HIV reported HIV in 100% of patients [28].”
Influential
- Authors
- Jakubowska, A., Al Hasani, W., Williams, J., MacMahon, Z., Balbas, B., Crook, M. A., Viljoen, A., Reynolds, T. M., & Wierzbicki, A. S.
- Affiliations
- Lister Hospital (GB)
- Department of Metabolic Medicine/Chemical Pathology, Guy’s & St Thomas’ Hospitals, London, UK
- St Thomas' Hospital (GB)
- Department of Metabolic Medicine/Chemical Pathology, Queen’s Hospital, Burton-on-Trent, UK
- Corresponding author
- Wierzbicki, Anthony S.
- Venue
- Current Medical Research and Opinion
- Publisher
- Informa UK Limited
- Published
- 2024-04-25
- Volume
- 40
- Issue
- 6
- Pages
- 911-916
- ISSN
- 0300-7995 (ISSN-L)
- 1473-4877
- OpenAlex
- W4394818204
- Cited by
- 5
- References
- 5
- Citations by year
- 2026: 3 · 2025: 1 · 2024: 1
- FWCI
- 2.11
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Current Medical Research and Opinion (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Lipoproteins and Cardiovascular Health
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Lipid metabolism and disorders
- Health Sciences › Medicine › Surgery › Cholesterol and Lipid Metabolism
- Keywords
- bempedoic acid, ATP-citrate lyase inhibition, lipid-lowering therapy, statin intolerance, LDL cholesterol lowering, triglyceride lowering, adverse effects, treatment discontinuation, myalgia, nocebo effect, familial hypercholesterolemia, type 2 diabetes, real-world effectiveness
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