Lipid clinic experience with bempedoic acid in 3 UK centres.

Objective: Novel lipid-lowering therapies are being introduced. Few studies exist of the real-world effectiveness of adenosine-tri-phosphate citrate lyase inhibition with bempedoic acid. Methods: This study audited bempedoic acid therapy in 216 consecutive patients from 3 hospital centres - a university hospital (n = 77) and 2 district general hospitals (n = 106 & 33). Cardiovascular disease (CVD) risk factors, prescription qualification criteria, efficacy and adverse effects were assessed. Results: The population was aged 65.9 ± 11.0 years, 42% male, 25% has type 2 diabetes, and 31% had familial hypercholesterolaemia. CVD was present in 19% and multibed vascular disease in 8%. Statin intolerance was reported in 92%. Bempedoic acid reduced total cholesterol by 1.58 ± 1.44mmol/L (20%), LDL-C by 1.37 ± 1.31mmol/L (27%), 0.22mmol/L (2%) in triglycerides and 0.06mmol/L (1%) increase in HDL-C after 22 ± 9 months follow-up. An LDL-C < 2.5mmol/L was achieved in 40% and <2mmol/L in 20%. Efficacy (r2 =0.33) was predicted by baseline LDL-C (β = 0.54; p < 0.001). No significant changes were seen in transaminases, creatinine, creatine kinase, urate or HbA1c . Treatment was discontinued by 33% of patients and occurred due to myalgia (43%), lack of efficacy (16%) and gastrointestinal adverse effects (15%). No cases of gout were observed. In a logistic regression only the number of previous drug classes not tolerated (β = 1.60; p = 0.009) was a contributing factor to discontinuation. Conclusion: This audit suggests that bempedoic acid therapy is effective but that adverse effects and discontinuation are common. This suggests nocebo effects might be generalisable to all lipid-lowering drug therapies in susceptible individuals.