LDL Target in Patients With Hiv at High Cardiovascular Risk: The Role of Bempedoic Acid

Abstract Background Previous observational studies have shown that 70% of HIV–infected patients have clinical conditions that classify them at high or very high cardiovascular risk. Among these patients, only 12% succeed in achieving a target LDL 55 mg/dl in accordance with the latest ESC guidelines. Aim To evaluate the impact of bempedoic acid therapy in achieving the LDL target for HIV–infected patients. Methods From April 2023 to September 2023, all HIV–infected patients referred to our dedicated cardiology outpatient clinic were consecutively screened. Inclusion criteria were: acquisition of informed consent, high cardiovascular risk (defined in accordance with the latest ESC guidelines), need to optimize anti–dyslipidemic therapy to achieve LDL target 55mg/dl. Planned follow–ups were at 3 and 6 months. Clinical and laboratory data were collected in spreadsheets and analyzed with GraphPad Prism 8. Results Thirty–two patients were enrolled, 94% male with a mean age 61±4 years. At baseline the laboratory’s data (mean ± SD) were: total cholesterol 202±50 mg/dl, LDL 130±40 mg/dl, HDL 56±15 mg/dl, triglyceride 105±24 mg/dl. The 75% of patients was on statin+ezetimibe, but only 37% of them were taking high–intensity statins. No patients reached the target of LDL 55 mg/dl and, therefore, all patients were prescribed bempedoic acid 180 mg/day. At three months of follow–up, all patients were compliant with bempedoic acid therapy, and none reported any side effects; the laboratory monitoring of the lipid profile showed a mean LDL 80±35 mg/dl, –39% from baseline and a mean total cholesterol of 156±44 mg/dl, –26% from baseline. The 12% of patients reached LDL target 55 mg/dl with a reduction 50% from baseline. Conclusion The use of bempedoic acid, in addition to statin+ezetimibe therapy, or ezetimibe alone in statin–intolerant patients, reduces baseline LDL by 39% and achieves the guideline–recommended LDL target in 12% of cases with an excellent safety and tolerability profile in HIV–infected patients.