Bempedoic Acid for Lipid Management in the Indian Population: An Expert Opinion

Abstract

Lipid-lowering is a central theme in the management of patients with atherosclerotic cardiovascular disease (ASCVD) and heterozygous familial hypercholesterolemia (HeFH), with statins being currently used as the first-line lipid-lowering agent (LLAs). Bempedoic acid (BA) has been recently approved for lipid management in ASCVD/HeFH patients. This expert opinion paper brings out the essential concept to assess the current place of BA in the Indian population. Here we highlight that the majority of the patients with clinical ASCVD may not be receiving the optimal dose of statin, thereby failing to achieve their lipid targets. The addition of BA to statin results in a significant reduction in low-density lipoprotein cholesterol (LDL-C) along with substantial reductions in non-high-density lipoprotein cholesterol (non-HDL-C), apolipoprotein B (ApoB), and high-sensitivity C-reactive protein (hsCRP) levels. For patients who do not achieve LDL-C targets, BA can be an effective add-on alternative to choose among non-statin LLAs. BA is a good choice for statin-intolerant cases, especially in combination with ezetimibe. Given the lack of effect of worsening hyperglycemia or any increase in the occurrence of new-onset diabetes, BA can be used without hesitation in patients with diabetes. The small risk of hyperuricemia could be mitigated with appropriate patient selection and monitoring of serum uric acid levels in patients at high risk of hyperuricemia. We believe BA is an excellent non-statin therapy that is efficacious, well-tolerated, and cost-effective for lipid management in ASCVD, HeFH, and statin-intolerant patients in India.

Efficacy and Safety of Bempedoic Acid to Prevent Cardiovascular Events in Individuals at Risk of Cardiovascular Diseases: A Meta-Analysis of Randomized-Control Trials

“…Moreover, unlike statins, it did not cause a rise in glycated hemoglobin levels or the incidence of new-onset diabetes [ 18 ]. Elevated levels of C-reactive protein have been established as a reliable and consistent risk marker for preventing cardiovascular disease, both in primary and secondary cases [ 19 ]. In order to target C-reactive protein, medical professionals have the option to utilize non-statin medications like ezetimibe and bempedoic acid in conjunction with statins.…”