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Correspondence to Author: Amro Maarouf¹ , Manjit K Shergill¹ , Alan F Jones¹ , John Marriott² , Sudarshan Ramachandran¹. 

1. Department of Clinical Biochemistry, University Hospitals Birmingham NHS Foundation Trust, West Midlands, United Kingdom.
2. Institute of Clinical Sciences, University of Birmingham, Birmingham, United Kingdom.

DOI: 10.52338/jocd.2025.5198

Abstract:

Objectives: We describe decreases in total cholesterol (TC), non-high density lipoprotein-cholesterol (non-HDL-C) and low density lipoproteincholesterol (LDL-C) following bempedoic acid treatment in an out-patient setting and compare the results to those observed in phase 3 efficacy trials.
Design: We analysed a cohort of 113 patients not achieving LDL-C targets commenced on bempedoic acid after previous treatment with statins and ezetimibe using an intention-to-treat approach.
Methods: We compared pre and post bempedoic acid treatment lipids (3-months) in the total cohort using paired t-tests. Baseline patient characteristics associated with LDL-C decrease was established via linear/multiple regression analyses.
Results: Following bempedoic acid treatment absolute reduction (mean ± SD) in TC, non-HDL-C, and LDL-C values were 1.1 ± 1.0mmol/L, 1.0 ± 1.0mmol/L, and 1.0 ± 0.9mmol/L, respectively, whilst percentage reductions (mean ± SD) were 16.4 ± 14.1%, 18.8 ± 17.2%, and 23.2 ± 20.5%, respectively. Significant decreases in lipids were observed in every subgroup studied. The LDL-C decrease following bempedoic acid was independently greater in ex-smokers, individuals on ezetimibe at baseline, and those with higher baseline LDL-C values
Conclusions:Our results show that the LDL-C decrease seen with bempedoic acid was comparable to that observed in the phase 3 (CLEAR) efficacy trials. However, efficacy heterogeneity was observed in some of the subgroups studied such as patients on ezetimibe monotherapy or with higher LDL-C at baseline, the latter in accordance with the Wilder principle. The use of effect scores for identified patient subgroups might predict treatment response, enabling optimisation of lipid lowering efficacy.

Keywords: Bempedoic acid, cardiovascular disease, hypercholesterolaemia, low density lipoprotein cholesterol, Wilder principle.

Citation:

Dr. Amro Maarouf, Use of Bempedoic Acid in an Out-Patient Setting: an Assessment of Efficacy Heterogeneity. Journal of Cardiovascular Diseases 2025.