Bempedoic acid in the current era of lipid management

Bempedoic acid, a first-in-class adenosine triphosphate-citrate lyase inhibitor, significantly advances lipid management. This review examines the clinical evidence, efficacy, and safety profile of bempedoic acid based on major clinical trials and recent meta-analyses. The CLEAR trials program demonstrated significant low density lipoprotein cholesterol (LDL-C) reductions ranging from 17-28.5% across different patient populations, with the CLEAR outcomes trial showing a 13% reduction in major adverse cardiovascular events. Meta-analyses have confirmed these findings, showing consistent LDL-C reductions and cardiovascular benefits, particularly in statin-intolerant patients. The medication's unique liver-specific activation mechanism contributes to reduced muscle-related side effects compared to statins. Current guidelines from both the American College of Cardiology and the European Society of Cardiology position bempedoic acid as a valuable option for high-risk patients requiring additional LDL-C lowering, especially those who are statin-intolerant or unable to achieve goals with maximally tolerated statin therapy. Bempedoic acid demonstrates a generally favourable safety profile, monitoring is recommended for potential adverse effects including elevated uric acid levels and liver enzymes.