Role of bempedoic acid in patients with hypercholesterolemia and statin intolerance

introduction: Atherosclerotic cardiovascular disease is a leading cause of death and disability worlwide. The LDL-C causes atherosclerosis and therefore lowering the levels of these lipoproteins reduces the risk of acute myocardial infarction and other cardiovascular events. Statins are competitive inhibitors of 3-hydroxy-3-methylglutaryl coenzyme A reductase and are the most cost-effective medicines for lowering LDL-C. Up to 80% of patients treated with statins do not achieve optimal LDL-C levels, explained by high baseline LDL-C levels, aggressive LDL-C treatment goals, lack of sufficient statin efficacy or drug intolerance. Objective: This review discusses the characteristics of statin intolerance and the mechanism of action, efficacy, and safety of Bempedoic Acid as a lipid-lowering agent. Methods: We searched PubMed, ScienceDirect, the Virtual Health Library and Latin American and Caribbean Health Sciences Literature for articles published in the last five years using the following health descriptors: “bempedoic” OR “ATP-citrate lyase” AND hypercholesterolemia AND “coronary artery disease”. Results: Bempedoic acid is a prodrug that is converted to its active form (bempedoyl-CoA) by the acyl-CoA synthetase-1 enzyme. Acts two steps upstream from HMG-CoA reductase, the target of statins, in the same metabolic pathway, representing an additional lipid-lowering therapy. Conclusions:Bempedoic Acid’s active metabolite is an effective treatment option, alone or in combination with statin or ezetimibe, to lower LDL-C and reduce hsCRP, which is a marker of systemic inflammation associated with future risk of cardiovascular events, suggesting an anti-inflammatory response. Outcomes and cost-effectiveness are currently being investigated in the CLEAR Outcomes study, with results expected in 2023.