Is There a CLEAR Role for Bempedoic Acid in Cardiovascular Risk Reduction?

Authors:
Sarah B. Edwards, PharmD
Briana Williams, PharmD, BCPS, BCACP

Reviewers:
Abby Frye, PharmD, BCACP
Joseph Saseen, PharmD, BCPS, BCACP

Citation:
Nissen SE, Lincoff AM, Brennan D, et al. Bempedoic Acid and Cardiovascular Outcomes in Statin-Intolerant Patients. N Engl J Med 2023;388:1353-64.

The Problem

Statins are recommended as first-line treatment for the primary and secondary prevention of atherosclerotic cardiovascular disease (ASCVD) due to consistent and compelling data demonstrating reduced cardiovascular events and unparalleled cost-effectiveness.¹ Despite their clear benefit, many patients are unable or unwilling to take statins at recommended doses due to adverse events, a nocebo effect, or negative perceptions of statins.  A significant proportion of patients (an estimated 40-75%) discontinue statin therapy within 1 year after initiation.² There are a variety of non-statin lipid-lowering medications with proven cardiovascular benefit that should be considered in statin-intolerant patients; however, most of the evidence has focused on their use as adjuncts with statins.³ Bempedoic acid offers a novel mechanism of action to treat hypercholesterolemia. But is there a CLEAR role for bempedoic acid in the treatment and prevention of ASCVD for statin-intolerant patients?