Effects of Bempedoic Acid on Arterial Structural and Functional Parameters

Background and Objectives Bempedoic Acid (BA) is one of the most recent therapeutic agents approved for the reduction of LDL–C. Its potential effects on arterial structural and functional parameters have never been evaluated. The aim of this study was to longitudinally evaluate these properties in patients initiating BA therapy and to compare them with those of a matched cohort receiving PCSK9–inhibitors (PCSK9i). Methods All patients who began BA therapy at the cardiology department of our hospital were enrolled. Carotid–femoral Pulse Wave Velocity (PWV), carotid Intima Media Thickness (IMT) and brachial Flow Mediated Dilation (FMD) were evaluated before the first administration (T0) and after 6 months (T1) and 1 year (T2). Data from 20 patients with a 1–year follow–up were analysed and compared with a matched (sex, age, and Body Mass Index – BMI) cohort of 20 PCSK9i patients. Results Mean age in the BA group was 65.3±7.9 years, with 55.0% male participants and a BMI of 25.7±2.9 kg/m2. Baseline LDL–C was lower in the BA group when compared to PCSK9i (101.5±36.9 vs 122.0±31.4 mg/dL) and the more frequent indication was primary prevention for BA (65.0%) and secondary prevention for PCSK9i (75.0%). Statins were used respectively by 45.0% and 40.0% in the bempedoic acid and PCSK9i groups, and ezetimibe by 80.0% in both groups. After the 1 year’s follow–up, a significant reduction in LDL–C was observed in both groups, the values were 77.6±37.3 mg/dL with Bempedoic Acid and 46.1±30.4 mg/dL with PCSK9i (p‹0.001). No statistically significant changes were observed in PWV (from 9.7±2.3 to 9.4±1.2 m/s, p=0.466), FMD (from 6.7±5.2 to 6.3±5.9 %, p=0.071), or IMT (from 715.2±153.4 to 678.6±180.9 μm, p=0.239) within the bempedoic acid group. Similarly, no significant changes were found in the PCSK9i group and in the between–group comparison. Conclusions Bempedoic acid was confirmed to be a highly effective LDL–C–lowering agent. However, no significant improvements were observed in arterial structural or functional parameters, either within the bempedoic acid group or in comparison with the PCSK9i group.