Bempedoic Acid

How it works

It is a prodrug activated in the liver that inhibits ATP-citrate lyase, an enzyme upstream of HMG-CoA reductase in the cholesterol synthesis pathway, reducing hepatic cholesterol production and increasing LDL clearance.

Prescribing in practice

• It can raise serum uric acid and may precipitate or worsen gout, so use caution in patients with a history of gout or hyperuricaemia.
• Cases of tendon rupture have been reported, and treatment should be discontinued if tendon rupture occurs.
• Because activation is largely confined to the liver rather than muscle, it is a useful option in statin intolerance, though lipid response should still be assessed.

Monitoring

Monitor the lipid profile for response and review uric acid and gout symptoms, stopping treatment if tendon injury is suspected.

Counselling the patient

• It is taken once daily, usually with another cholesterol-lowering medicine.
• Report painful or swollen joints suggesting gout, or tendon pain or swelling.
• Keep up dietary and lifestyle measures alongside it.

Evidence & guidelines

Bempedoic acid lowers LDL-cholesterol and has cardiovascular outcome evidence in statin-intolerant patients, and NICE supports its use in defined add-on scenarios.