Key result
Bempedoic acid therapy achieves ~1.1 mmol/L LDL-C reduction with high adherence in secondary prevention.
Why the study?
Achievement of ESC LDL-C targets for ASCVD risk reduction remains suboptimal in Europe and the UK, particularly among older multimorbid primary care patients, and real-world data on bempedoic acid from rural primary care settings are limited.
Does bempedoic acid-containing therapy improve LDL-C reduction, adherence, and ESC target attainment in patients treated for primary or secondary ASCVD prevention in a rural UK primary care setting?
Observational (n=998)
Does bempedoic acid-containing therapy improve LDL-C reduction, adherence, and ESC target attainment in patients treated for primary or secondary ASCVD prevention in a rural UK primary care setting?
In a real-world rural UK primary care cohort of older, multimorbid patients, bempedoic acid-containing therapy demonstrated high adherence (90.99%), strong continuation (90.4%), a 1.05 mmol/L mean LDL-C reduction, and substantial ESC LDL-C target attainment.
Supports bempedoic acid integration into rural primary care lipid strategies; extends real-world evidence while leaving cardiovascular outcomes open.
Background Achievement of the European Society of Cardiology (ESC) low-density lipoprotein cholesterol (LDL-C) targets for atherosclerotic cardiovascular disease (ASCVD) risk reduction remains suboptimal across Europe and the United Kingdom (UK), particularly among older adults with multimorbidity managed in primary care.1 Bempedoic acid provides an oral adjunctive lipid-lowering therapy with a favourable tolerability profile; however, population-scale real-world data from rural primary care settings are limited.2 Purpose To evaluate patient characteristics, prescribing patterns, tolerability, adherence, LDL-C reduction, and ESC target attainment following implementation of bempedoic acid–containing therapy in a large rural UK primary care cohort. Methods We conducted a retrospective observational analysis of 998 consecutive patients prescribed bempedoic acid–containing therapy within a rural UK primary care network. Demographic characteristics, comorbidities, prescribing patterns, prescription collection–based adherence, treatment continuation, and lipid parameters were extracted from electronic health records and analysed descriptively. Results A total of 998 patients were included (487 male, 511 female; mean age 70.1 ± 10.1 years). Combination bempedoic acid/ezetimibe therapy was prescribed in 865 patients, while 133 patients received bempedoic acid monotherapy (93 also received ezetimibe separately). The overall treatment continuation rate was 90.4%, with discontinuation in 9.6%; mean adherence was 90.99%. Established ASCVD was present in 31% of patients (65% coronary disease, 36% cerebrovascular disease, 16% peripheral arterial disease), with 69% treated for primary prevention. Multimorbidity burden was substantial: hypertension (70%), chronic kidney disease (41%), diabetes (27%), pre-diabetes (23%), chronic obstructive pulmonary disease (15%), heart failure (15%), psoriasis (8%), and rheumatoid arthritis (2%). Bempedoic acid was co-prescribed with statins in 61% of patients and with inclisiran in 36% of those receiving secondary prevention therapy. Mean LDL-C reduction across the cohort was 1.05 mmol/L (SD 0.15) (Figure 1). Among secondary prevention patients receiving fixed-dose combination therapy within structured lipid-lowering pathways, ESC LDL-C target attainment was high: 85% achieved <1.8 mmol/L, 68% achieved <1.4 mmol/L, and 39% achieved <1.0 mmol/L (Figure 2). Conclusions In a large, older, multimorbid, rural UK primary care cohort, bempedoic acid was associated with high treatment continuation, strong adherence, and clinically meaningful LDL-C reduction. When incorporated into combination lipid-lowering strategies, substantial ESC target attainment was achieved. These findings suggest that bempedoic acid may be an effective oral therapeutic option to improve LDL-C goal attainment and address residual ASCVD risk in real-world primary care practice.1,2
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Donaldson et al. (2026) conducted an observational in Atherosclerotic cardiovascular disease (ASCVD) risk reduction (31% secondary prevention, 69% primary prevention) (n=998). Bempedoic acid–containing therapy (monotherapy or combined with ezetimibe) was evaluated on Treatment continuation, adherence, LDL-C reduction, and ESC LDL-C target attainment (Mean LDL-C reduction 1.05 mmol/L (SD 0.15)). Bempedoic acid–containing therapy achieved a 90.4% continuation rate, 90.99% adherence, a mean LDL-C reduction of 1.05 mmol/L, and 68% attainment of LDL-C <1.4 mmol/L in secondary prevention.
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