Role of bempedoic acid in secondary prevention of atherosclerotic cardiovascular disease patients: A prospective observational study

Background and Objective: Atherosclerotic cardiovascular disease (ASCVD) is one of the leading causes of global mortality. Many patients with ASCVD fail to achieve the target lipid profile despite being on maximally tolerated statins. Bempedoic acid (BA) is a novel oral adenosine triphosphate-citrate lyase inhibitor, introduced as an effective therapy for managing hyperlipidaemia. This study evaluates its efficacy and safety as an add-on therapy in ASCVD patients. The objective of the study is to evaluate the efficacy and safety of BA as an add-on therapy to maximally tolerated statin therapy in patients with ASCVD for secondary prevention. Material and Methods: The study was a prospective, observational study conducted at King George’s Medical University, Lucknow. We included 113 patients with ASCVD between 18 and 70 years old. All patients were already on their maximum tolerated statin doses with low-density lipoprotein (LDL) levels >55 mg/dL. BA (180 mg once daily) was added to all ASCVD patients to achieve target LDL goals (as per European Society of Cardiology [ESC] guidelines 2019). The following biochemical parameters were evaluated: lipid profile, kidney and liver function tests; creatine kinase (CK); serum uric acid; estimated glomerular filtration rate (eGFR); haemoglobin A1c (HbA1c), at baseline and at 12 weeks. Results: All the enrolled patients completed the full 12-week follow-up. Comparing from baseline, after 12 weeks, the mean LDL cholesterol dropped significantly from 93.21 to 64.22 mg/dL (30% reduction), total cholesterol, triglycerides, non-high-density lipoprotein (HDL) cholesterol also decreased significantly from 187 to 147 mg/dL (20% reduction), 153 to 139 mg/dL (8% reduction), 138 to 92 mg/dL (32% reduction), respectively. HDL (good cholesterol) also increased by 11%, which is beneficial. There was a small but statistically significant drop in HbA1c levels (1.9% reduction) also in 65 ASCVD patients who were diabetic, indicating improvement in glycaemic control. Kidney and liver function remained mostly stable. There was a significant increase in creatinine levels by 7% and a drop in eGFR by 6%. Uric acid was increased by 9.2%. There were no significant changes in CK at the end of 12 weeks. Conclusion: Adding BA to maximally tolerated statin therapy in ASCVD patients led to better control of LDL cholesterol and other lipid parameters without major side effects. It was generally well-tolerated and showed potential as a helpful option for patients who have not reached their cholesterol goals with statins alone. These findings support the use of BA in real-world settings as part of secondary prevention strategies for heart disease.