Evaluation of bempedoic acid in elderly patients: real-world evidence from the REALIST study

Statin intolerance and PCSK9 inhibitor reimbursement restrictions limit lipid-lowering options for elderly patients at high cardiovascular (CV) risk. Bempedoic acid (BA), an ATP-citrate lyase inhibitor, is a promising alternative. This study analyzed 54 patients over 81 years, selected from 2,564 individuals with medium to very high CV risk, who received BA for 52 weeks. Lipid profiles, renal and hepatic function, and adverse events were assessed. BA significantly reduced Low-Density Lipoprotein Cholesterol (LDL-C), triglycerides, and total cholesterol while maintaining stable HDL-C levels. Renal and hepatic function remained unchanged, with increased uric acid as the only notable adverse event. No treatment discontinuations occurred. During follow-up, five patients underwent coronary angiography, two developed atrial fibrillation, and two were hospitalized for heart failure. BA demonstrated efficacy and tolerability in this high-risk, elderly population. It represents a viable lipid-lowering option for statin-intolerant patients or those ineligible for PCSK9 inhibitors. Further studies are needed to confirm long-term cardiovascular benefits.