Impact of bempedoic acid alone and combined with ezetimibe on ldl-cholesterol reduction: graphical evidence and retrospective analysis of a real-world clinical cohort

Introduction Bempedoic acid, either as monotherapy or in combination with ezetimibe, has emerged as an effective therapeutic option for improving lipid control in patients at high cardiovascular risk. This retrospective study describes the reduction in low-density lipoprotein cholesterol (LDL-c) observed in a real-world cohort, using two paired graphical analyses that visually illustrate the magnitude and consistency of the change. Methods A consecutive retrospective cohort from January 2024 to July 2025 was included. Baseline characteristics (Table 1) reflected a high and very high cardiovascular risk profile, with a predominance of secondary prevention. Patients were on different lipid-lowering therapies: 70% received statins plus ezetimibe, 27% statin monotherapy, approximately 1% PCSK9 inhibitors, and about 1% ezetimibe monotherapy." Paired baseline and follow-up LDL-c measurements were collected. Patients received: 1.Bempedoic acid monotherapy (n = 49) 2.Bempedoic acid + ezetimibe (n = 92) Paired Student’s t-tests and Hedges’ g effect sizes were applied. An exploratory analysis assessed whether baseline variables influenced the magnitude of LDL-c reduction, with no clinically relevant subgroup differences identified. Individual changes and full value distributions were visualised using ggstatsplot, which served as the central analytical element. Results The graphical representations show that most patients experienced clear LDL-c reductions, with a marked shift toward lower values and reduced dispersion at follow-up (fig 1). Treatment was well tolerated, and no significant adverse events were reported. Conclusions In this retrospective real-world cohort, bempedoic acid—alone or in combination with ezetimibe—produced substantial and consistent reductions in LDL-c, even among patients previously treated with intensive lipid-lowering therapy, including PCSK9 inhibitors. The paired graphical evidence reinforces the robustness of the effect, with no relevant differences according to baseline characteristics, and supports its role as an effective and safe strategy to optimise lipid control in high-risk cardiovascular patients.For image description, please refer to the figure legend and surrounding text. For image description, please refer to the figure legend and surrounding text.