• Julia Brandts and Kausik K Ray.
• Department of Medicine I, University Hospital RWTH Aachen , Aachen, Germany.
• Expert Opin Investig Drugs. 2020 Aug 1; 29 (8): 763-770.

IntroductionThe lowering of low-density lipoprotein cholesterol (LDL-C), regardless of the method used, results in a reduction of cardiovascular events. Bempedoic acid is a new and until now, the only approved adenosine triphosphate citrate lyase inhibitor that works through the cholesterol-synthesis pathway (similar to statins) that leads to a safe and effective reduction in LDL-C.Areas CoveredWe review clinical phase 2 and 3 studies on bempedoic acid's lipid-lowering effect and approved indications.Expert OpinionIn the United States, bempedoic acid is currently approved for use in secondary prevention. In primary prevention, its approval is limited to individuals with heterozygous familial hypercholesterolemia (FH). However, its tolerability and safety profile may warrant its use in primary prevention besides FH. Even though its efficacy appears weaker than high-intensity statins, it may be a useful adjunct in individuals who achieve less than desirable LDL-C reductions with statins or who cannot tolerate statins, where bempedoic acid alone or in combination with ezetimibe may be useful alternatives.

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