Abstract Background The majority of patients at increased cardiovascular risk do not achieve the guideline-recommended low-density lipoprotein cholesterol (LDL-C) treatment targets. After statins and ezetimibe, bempedoic acid has emerged as a third orally available LDL-C-lowering drug with proven cardiovascular benefit. Real-world data on the effectiveness of bempedoic acid to lower LDL-C concentration are scarce. Purpose The purpose of this study was to evaluate the relative LDL-C reduction in patients before and after treatment with bempedoic acid in a real-world setting using electronic medical records. Methods Data from the IQVIA Disease Analyzer database, containing representative demographic, diagnostic, and prescription data collected in general (GP) and specialized practices in Germany were used. Patients were included if bempedoic acid was initiated between November 2020 and June 2023, and at least one recorded LDL-C measure 6 months before bempedoic acid initiation and between 15 days and 6 months after was available. LDL-C lowering was analysed in patients without concomitant lipid-lowering therapy (LLT) or with unchanged LLT at the two LDL-C measurement points. Patients were stratified for their lipid-lowering co-therapy. Results In total, 1,032 patients were included from 49 German cardiologist and 848 GP practices. The mean age was 66.3 (SD, 10.4) years and 42.4% were female. The average baseline LDL-C value was 127.5 mg/dl (SD, 51.5 mg/dl) and 82.9% of patients had very high cardiovascular risk according to the ESC 2021 CVD prevention guidelines (Table). In 425 patients, bempedoic acid was initiated while other LLTs remained unchanged or were absent (Figure). Patients without concomitant LLT (n=54) had a mean 29.2% LDL-C reduction after initiation of bempedoic acid, while those with unchanged LLT (n=371) had a 18.8% reduction in LDL-C. Of those on lipid-lowering co-therapy, mean LDL-C reductions were 16.7% and 23.4%, respectively, depending on co-medication with (n=255) or without a statin (n=116). Conclusion The findings from this retrospective analysis of electronic medical records are in line with previously published clinical trials and confirm the effectiveness of bempedoic acid as additional LLT in a real-world setting. The average LDL-C reduction was highest among patients without LLT, and lower if bempedoic acid was added on to a pre-existing LLT. Figure legend: Waterfall plot for change in LDL-C levels after initiation of bempedoic acid in patients where other lipid-lowering therapies remained unchanged or were absent. One patient whose change in LDL-C exceeded ± 5 standard deviations from the mean is not shown in the waterfall plot. LLT: lipid-lowering therapy.Figure Table
Katzmann et al. (Sat,) studied this question.