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Comprehensive review of statin-intolerance and the practical application of Bempedoic Acid
Journal article   Peer reviewed

Comprehensive review of statin-intolerance and the practical application of Bempedoic Acid

Siva Naga S Yarrarapu, Amandeep Goyal, Vikramaditya Samala Venkata, Viraj Panchal, Barath Prashanth Sivasubramanian, Doantrang T Du, Roopesh Sai Jakulla, Hema Pamulapati, Mazhar A Afaq, Steven Owens, …
Journal of cardiology, v 84(1), pp 22-29
Jul 2024
DOI: https://doi.org/10.1016/j.jjcc.2024.03.006
PMID: 38521120
url
https://doi.org/10.1016/j.jjcc.2024.03.006View
Published, Version of Record (VoR) Open

Abstract

Anticholesteremic Agents - adverse effects Anticholesteremic Agents - therapeutic use Cholesterol, LDL - blood Dicarboxylic Acids - adverse effects Dicarboxylic Acids - therapeutic use Ezetimibe - therapeutic use Fatty Acids Humans Hydroxymethylglutaryl-CoA Reductase Inhibitors - adverse effects Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use Hypercholesterolemia - drug therapy Randomized Controlled Trials as Topic
Statin-intolerance (SI) has prevalence between 8.0 % and 10 %, and muscular complaints are the most common reason for discontinuation. Bempedoic acid (BA), an ATP citrate lyase inhibitor, decreases hepatic generation of cholesterol, upregulates low-density lipoprotein (LDL) receptor expression in the liver, and eventually clears circulating LDL-cholesterol from the blood. Multiple randomized clinical trials studying BA demonstrate a reduction in LDL levels by 17-28 % in SI. The CLEAR OUTCOME trial established significant cardiovascular benefits with BA. A dose of 180 mg/day of BA showed promising results. BA alone or in combination with ezetimibe is US Food and Drug Administration-approved for use in adults with heterozygous familial hypercholesterolemia and/or established atherosclerotic cardiovascular disease. BA reduced HbA1c by 0.12 % (p < 0.0001) in patients with diabetes. Adverse events of BA include myalgia (4.7 %), anemia (3.4 %), and increased aminotransferases (0.3 %). BA can cause up to four times higher risk of gout in those with a previous gout diagnosis or high serum uric acid levels. Reports of increased blood urea nitrogen and serum creatinine were noted. Current evidence does not demonstrate a reduction in deaths from cardiovascular causes. More studies that include a diverse population and patients with both high and low LDL levels should be conducted. We recommend that providers consider BA as an adjunct to statin therapy in patients with a maximally tolerated dosage to specifically target LDL levels.

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