Abstract Background and aims Patients with prior CVA are at high risk of recurrent vascular events. Intensive LDL-C lowering is central to secondary stroke prevention, yet statin intolerance, polypharmacy, and treatment burden frequently limit target attainment in patients. Bempedoic acid, alone or in combination with ezetimibe, provides a non-statin oral option and may be part of the solution for sustained LDL-C reduction. Methods A retrospective real-world analysis was conducted in primary care using anonymised electronic health records of adults with CVA who were treated with bempedoic acid–based therapy. Data included demographics, comorbid conditions, treatment regimen, and LDL-C values. Outcomes were assessed longitudinally over a mean 740 days, with reference to secondary prevention targets. The evaluation was conducted with local ethics approval. Results 105 patients were included (51 male, 54 female; mean age 72.5±11.0years). Most received fixed-dose bempedoic acid 180mg/ezetimibe 10mg (n=91), with smaller numbers receiving bempedoic acid with separate ezetimibe (n=7) or without ezetimibe (n=7). Mean baseline LDL-C was 2.40mmol/L. LDL-C fell progressively and remained low over time: 1.76mmol/L, 1.53 mmol/L, 1.47 mmol/L, and 1.21 mmol/L, with a low level at long-term follow-up (1.23 mmol/L at a mean of 740 days). These values are consistent with secondary prevention targets. Conclusions In real-world UK primary care, bempedoic acid–based therapy delivers durable LDL-C reduction in patients with prior stroke over extended follow-up. These findings support bempedoic acid as part of the solution for secondary stroke prevention, particularly for older patients unable to achieve lipid targets with sole agents alone. Conflict of interest Dr C Deaney has received honoraria/grants from Amarin, Amenarini, AZ, Chiesi, Daiichi Sankyo, Ferring, GSK, Idorsia, Novartis, and Novo Nordisk.
Deaney et al. (2026) studied this question.