Comparative effectiveness of atorvastatin monotherapy vs. atorvastatin plus bempedoic acid combination in patients with coronary artery disease: a multicenter observational study.

OBJECTIVE: Aim: To evaluate the impact of adding bempedoic acid to atorvastatin therapy on cardiovascular outcomes, including major adverse cardiovascular events (MACE), cardiac arrest, all-cause hospitalization, and myopathy, in patients with established coronary artery disease. PATIENTS AND METHODS: Materials and methods: We conducted a retrospective cohort study using the TriNetX global health research network. Patients with established CAD were categorized based on their antilipemic therapy into two cohorts: atorvastatin monotherapy and atorvastatin plus bempedoic acid. Propensity score matching was employed to balance baseline characteristics between the cohorts. The primary outcome was the occurrence of MACE, while secondary outcomes included cardiac arrest events, all-cause hospitalization, and incidence of myopathy. RESULTS: Results: After matching, 6,549 patients were included in each cohort. MACE occurred more frequently in the atorvastatin group (5.7%) compared to the combination therapy group (3.2%), with a hazard ratio of 1.606 (95% CI: 1.302-1.980, P<0.001). Cardiac arrest and all-cause hospitalizations were also higher in the atorvastatin group, with hazard ratios of 1.628 (95% CI: 1.041-2.544, P<0.001) and 1.418 (95% CI: 1.177-1.710, P<0.001), respectively. No significant difference in myopathy was observed (HR 0.915, 95% CI: 0.741-1.129). CONCLUSION: Conclusions: Adding bempedoic acid to atorvastatin therapy appears to confer a protective effect in CAD patients by significantly reducing MACE, cardiac arrest, and hospitalizations without increasing myopathy risk. Prospective studies are warranted to confirm these findings.