LDL TARGET IN PATIENTS WITH HIV AT HIGH CARDIOVASCULAR RISK: THE ROLE OF BEMPEDOIC ACID

Abstract

Background: Previous observational studies have shown that 70% of HIV–infected patients have clinical conditions that classify them at high or very high cardiovascular risk. Among these patients, only 12% succeed in achieving a target LDL < 55 mg/dl in accordance with the latest ESC guidelines. Aim: To evaluate the impact of bempedoic acid therapy in achieving the LDL target for HIV–infected patients. Methods: From April 2023 to September 2023, all HIV–infected patients referred to our dedicated cardiology outpatient clinic were consecutively screened. Inclusion criteria were: acquisition of informed consent, high cardiovascular risk (defined in accordance with the latest ESC guidelines), need to optimize anti–dyslipidemic therapy to achieve LDL target < 55mg/dl. Planned follow–ups were at 3 and 6 months. Clinical and laboratory data were collected in spreadsheets and analyzed with GraphPad Prism 8. Results: Thirty–two patients were enrolled, 94% male with a mean age 61±4 years. At baseline the laboratory’s data (mean ± SD) were: total cholesterol 202±50 mg/dl, LDL 130±40 mg/dl, HDL 56±15 mg/dl, triglyceride 105±24 mg/dl. The 75% of patients was on statin+ezetimibe, but only 37% of them were taking high–intensity statins. No patients reached the target of LDL < 55 mg/dl and, therefore, all patients were prescribed bempedoic acid 180 mg/day. At three months of follow–up, all patients were compliant with bempedoic acid therapy, and none reported any side effects; the laboratory monitoring of the lipid profile showed a mean LDL 80±35 mg/dl, –39% from baseline and a mean total cholesterol of 156±44 mg/dl, –26% from baseline. The 12% of patients reached LDL target < 55 mg/dl with a reduction >50% from baseline. Conclusion: The use of bempedoic acid, in addition to statin+ezetimibe therapy, or ezetimibe alone in statin–intolerant patients, reduces baseline LDL by 39% and achieves the guideline–recommended LDL target in 12% of cases with an excellent safety and tolerability profile in HIV–infected patients.