Defining the role of bempedoic acid in lowering low-density lipoprotein cholesterol

Abstract

There is an unmet medical need for patients who cannot achieve a sufficient reduction in low-density lipoprotein (LDL) cholesterol with the existing treatment options. Statin therapy remains the mainstay of treatment for both primary and secondary prevention. However, many patients cannot tolerate statin therapy because of statin-associated muscle symptoms. This underlines the importance of developing alternative cholesterol-lowering methods with good efficacy and tolerance in addition to statins. Bempedoic acid (ETC-1002) is one such novel cholesterol-lowering drug. It is an inhibitor of adenosine triphosphate citrate lyase, a cellular enzyme responsible for the production of precursors for the synthesis of fatty acids and cholesterol. Bempedoic acid reduces the synthesis of cholesterol in the liver cells and triggers the compensatory activation of the LDL receptor, as well as complementing other mechanisms targeted by current therapies, which leads to an additional decrease in LDL cholesterol. The current clinical trial's results suggest that bempedoic acid may represent a new therapeutic approach for lowering LDL cholesterol. The recent approval of bempedoic acid by the Food and Drug Administration (FDA) offers an additional option for lowering LDL cholesterol in patients with atherosclerotic cardiovascular disease or heterozygous familial hyperlipidemia. Additional data on the effects of bempedoic acid on long-term cardiovascular outcomes are currently being investigated in large cardiovascular outcome studies. In the present study, we discuss the history and development of bempedoic acid, the pharmacology, the relevant clinical trials, and the potential role of bempedoic acid as a lipid-lowering medication in the context of other currently available lipid-lowering therapies.