Reshaping Dyslipidaemia Treatment with Bempedoic Acid-A Narrative Review

Abstract

Dyslipidaemia is one of the main causes of atherosclerotic cardiovascular disease (ASCVD) worldwide. Although statins remain the cornerstone of lipid-lowering therapy, many patients do not achieve optimal target levels of low-density lipoprotein cholesterol (LDL-C) due to intolerance or inadequate response. Bempedoic acid, an oral ATP citrate lyase inhibitor, provides a liver-specific mechanism that lowers LDL-C levels while minimising muscle-related side effects. Recent clinical trials, including the CLEAR Outcomes Study, have shown that bempedoic acid was able to reduce LDL-C by approximately 29 mg/dL and major adverse cardiovascular events (MACEs) by 13% in patients intolerant to statins. Combination therapy with ezetimibe further enhances this effect. However, adverse effects such as increased uric acid and gout have been reported, requiring careful patient selection and continuous monitoring. This review provides a comparative synthesis of the latest evidence on bempedoic acid, including its pharmacological profile, its efficacy in different patient groups, and its place within current treatment strategies for dyslipidaemia. It also identifies research gaps and directions for future studies.

Keywords: bempedoic acid; cardiovascular risk; dyslipidaemia; lipid-lowering therapy; statin intolerance.

Figure 1

Mechanism of action of bempedoic acid. The drug inhibits ATP citrate lyase (ACLY), reducing the availability of acetyl-CoA for cholesterol and fatty acid synthesis, and activates AMPK, downregulating lipogenic enzymes such as HMG-CoA reductase and acetyl-CoA carboxylase.