IMR Press / RCM / Volume 23 / Issue 5 / DOI: 10.31083/j.rcm2305156
Open Access Review
Bempedoic Acid: A New Tool for LDL-Cholesterol Control in Patients with Coronary Artery Disease
Show Less
1 Division of Cardiology, West Vicenza General Hospitals, 36071 Arzignano-Vicenza, Italy
2 Department of Clinical and Molecular Medicine, University La Sapienza, 00185 Rome, Italy
3 Department of Health Promotion Sciences Maternal and Infantile Care, Internal Medicine and Medical Specialties, University of Palermo, 90127 Palermo, Italy
*Correspondence: (Claudio Bilato)
Academic Editors: Manuel Martínez-Sellés and John Elefteriades
Rev. Cardiovasc. Med. 2022, 23(5), 156;
Submitted: 24 January 2022 | Revised: 18 February 2022 | Accepted: 28 February 2022 | Published: 26 April 2022
(This article belongs to the Special Issue Coronary Artery Atherosclerosis: Translation from Basic to Clinic)
Copyright: © 2022 The Author(s). Published by IMR Press.
This is an open access article under the CC BY 4.0 license.

Nowdays a small proportion of patients with high/very high/extreme atherosclerotic cardiovascular disease risk achieves the optimal target of LDL-cholesterol, because of drug intolerance, poor adherence to the therapy, or inapplicability of the stepwise strategy in lipid lowering therapy, recommended by the current guidelines. The new oral agent bempedoic acid lowers plasma LDL-cholesterol by inhibiting adenosine triphosphate-citrate lyase, an enzyme involved in the synthesis of cholesterol, and, ultimately, by up-regulating the LDL receptors. Several clinical trials in patients with atherosclerotic cardiovascular disease or familial heterozygous hypercholesterolemia demonstrated that bempedoic acid alone or combined with statins and/or ezetimibe significantly reduced LDL-cholesterol and high-sensitivity C-reactive protein. Bempedoic acid is well tolerated with no significant increase in muscle-related symptoms, since it can be activated only in the liver but not in the skeletal muscles. Bempedoic acid provides an effective tool to further reduce LDL-cholesterol as add on therapy in patients unable to reach the target despite maximally tolerated lipid lowering therapy.

bempedoic acid
ATP citrate lyase
lipid-lowering treatment
novel LDL-C treatment
Fig. 1.
Back to top