Comparative efficacy of Statin Monotherapy, Statin–Ezetimibe Dual Therapy, and Statin–Ezetimibe–Bempedoic Acid Triple Therapy in patients with Acute Coronary Syndrome: A Prospective comparative study

Q: What are the key findings of this study?

Triple therapy with statin, ezetimibe, and bempedoic acid reduced LDL-C by 75.7% at 3 months vs 60.6% with dual therapy and 52.0% with statin monotherapy in ACS patients (p<0.001).

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Acute coronary syndrome (STEMI, NSTEMI, or unstable angina) (n=300). Intervention: Statin plus ezetimibe plus bempedoic acid triple therapy vs. Statin monotherapy or statin plus ezetimibe dual therapy. Primary outcome: Percentage reduction in LDL-C levels at 3 months (MD 16.47 mg/dL, p=<0.001).

Q: What does this research mean for the field?

Triple therapy with a statin, ezetimibe, and bempedoic acid achieves significantly greater LDL-C reduction (75.7% vs 60.6% and 52.0%) and superior target attainment (<55 mg/dL) compared to dual therapy or statin monotherapy in patients with acute coronary syndrome. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To compare the efficacy of statin monotherapy, statin plus ezetimibe dual therapy, and statin plus ezetimibe plus bempedoic acid triple therapy in reducing LDL-C levels and achieving target goals in patients with acute coronary syndrome.

doi:10.25258/ijddt.16.67s.125

October 14, 2026International Journal of Drug Delivery TechnologyOpen Access

Comparative efficacy of Statin Monotherapy, Statin–Ezetimibe Dual Therapy, and Statin–Ezetimibe–Bempedoic Acid Triple Therapy in patients with Acute Coronary Syndrome: A Prospective comparative study

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Key result

Triple therapy with statin, ezetimibe, and bempedoic acid is linked to ~76% LDL-C reduction in ACS.

MD +16.47 mg/dL
P<0.001
n=300

Why the study?

Many patients with ACS fail to achieve guideline-recommended LDL-C targets with statin monotherapy alone. Adding ezetimibe and bempedoic acid provides complementary LDL-C lowering that may improve target attainment in these very high-risk patients.

Does triple therapy with statin, ezetimibe, and bempedoic acid improve percentage LDL-C reduction and guideline target attainment (<55 mg/dL) compared to statin monotherapy or statin-ezetimibe dual therapy in lipid-lowering naive patients with acute coronary syndrome?

Key Points

To compare the efficacy of statin monotherapy, statin plus ezetimibe dual therapy, and statin plus ezetimibe plus bempedoic acid triple therapy in reducing LDL-C levels and achieving target goals in patients with acute coronary syndrome.
Prospective comparative study conducted between July 2024 and March 2026 including 300 patients with acute coronary syndrome and elevated LDL-C levels without prior lipid-lowering therapy.
Participants were allocated equally into three groups: statin monotherapy (n=100), statin plus ezetimibe (n=100), and statin plus ezetimibe plus bempedoic acid (n=100).
Lipid parameters were evaluated at baseline, 1 month, and 3 months to assess percentage LDL-C reduction and attainment of LDL-C <55 mg/dL.
At 3 months, mean LDL-C levels decreased to 53.0 ± 16.6 mg/dL with statin monotherapy, 44.8 ± 14.2 mg/dL with dual therapy, and 36.6 ± 16.1 mg/dL with triple therapy, representing percentage reductions of 52.0%, 60.6%, and 75.7%, respectively (ANOVA F=23.43, p<0.001).
Guideline-recommended LDL-C target attainment (<55 mg/dL) at 3 months was reached by 64.2% (52/81) of patients on statin monotherapy, 80.7% (67/83) on dual therapy, and 90.9% (80/88) on triple therapy.
Post-hoc Bonferroni analysis at 3 months confirmed triple therapy achieved significantly greater LDL-C lowering than statin monotherapy (mean difference 16.47 mg/dL, p<0.001) and dual therapy (mean difference 8.23 mg/dL, p=0.020).

Study Design

Type

Observational (n=300)

Blinding

Open-label

Randomization

Non-randomized (treatment selection according to physician discretion)

Multicenter

No

Structured PICO

Does triple therapy with statin, ezetimibe, and bempedoic acid improve percentage LDL-C reduction and guideline target attainment (<55 mg/dL) compared to statin monotherapy or statin-ezetimibe dual therapy in lipid-lowering naive patients with acute coronary syndrome?

P

Population

300 adults (29.3% female, mostly aged 45–74 years) in India presenting with acute coronary syndrome, elevated LDL-C, and no prior lipid-lowering therapy, followed for 3 months.

I

Intervention

Triple oral lipid-lowering therapy consisting of statin plus ezetimibe plus bempedoic acid (n=100) or dual therapy consisting of statin plus ezetimibe (n=100) for 3 months, with specific drug selection and dosage adjustments made according to prevailing clinical guidelines and treating physician discretion, alongside lifestyle and dietary counseling.

C

Comparator

Statin monotherapy (n=100) (or pairwise comparison between statin monotherapy, statin plus ezetimibe dual therapy, and statin plus ezetimibe plus bempedoic acid triple therapy), with dosage adjustments per clinical guidelines and physician discretion, plus lifestyle and dietary counseling.

O

Outcome

Percentage reduction in LDL-C levels assessed at 1 month and 3 months follow-up.surrogate

Main Result

Mean Difference: 16.47

Absolute Event Rate: 75.7% vs 52%

p-value: p=<0.001

Early combination triple therapy with a statin, ezetimibe, and bempedoic acid achieved superior 3-month LDL-C reduction (75.7%) and guideline target attainment (<55 mg/dL in 90.9% of patients) compared with dual therapy or statin monotherapy in Indian patients with acute coronary syndrome.

Limitations

Single tertiary care center design, limiting generalizability to other populations and healthcare settings
Short follow-up period of 3 months, precluding assessment of long-term cardiovascular outcomes, recurrent ischemic events, or adherence
Loss to follow-up (48 of 300 patients by 3 months), which may have introduced attrition bias
Non-randomized treatment allocation based on treating physician discretion and notable baseline LDL-C differences between groups
Conducted at a single tertiary care center, limiting generalizability to other populations and healthcare settings
Follow-up period was limited to 3 months, preventing assessment of long-term cardiovascular outcomes, recurrent ischemic events, or long-term medication adherence
A proportion of patients were lost to follow-up (48 of 300 by 3 months), which may have introduced attrition bias
Non-randomized treatment allocation based on treating physician discretion

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Answers are grounded in this paper and cite their sources.

Implication

Triple therapy was associated with greater LDL-C reduction in ACS; hypothesis-generating and requires randomized confirmation before practice change.

Abstract

Background: Patients with acute coronary syndrome (ACS) remain at very high risk for recurrent cardiovascular events despite contemporary therapy.Current guidelines recommend aggressive low-density lipoprotein cholesterol (LDL-C) reduction following ACS.Although statins remain the cornerstone of lipid-lowering therapy, many patients fail to achieve recommended LDL-C targets with statin monotherapy.Ezetimibe and bempedoic acid provide additional LDL-C lowering through complementary mechanisms and may improve target attainment in high-risk patients.Objectives: To compare the efficacy of statin monotherapy, statin plus ezetimibe therapy, and statin plus ezetimibe plus bempedoic acid therapy in reducing LDL-C levels and achieving guideline-recommended LDL-C targets among patients with ACS.Methods: This prospective comparative study was conducted in 300 patients with ACS between July 2024 and March 2026.Eligible patients with elevated LDL-C levels and no prior lipid-lowering therapy were allocated into three treatment groups: statin monotherapy (n=100), statin plus ezetimibe (n=100), and statin plus ezetimibe plus bempedoic acid (n=100).LDL-C levels were assessed at baseline, 1 month, and 3 months.The primary outcome was percentage reduction in LDL-C levels.Secondary outcomes included absolute LDL-C reduction and achievement of LDL-C target <55 mg/dL.Results: All treatment groups demonstrated significant reductions in LDL-C levels during follow-up.At 3 months, mean LDL-C levels decreased to 53.0 ± 16.6 mg/dL in the statin monotherapy group, 44.8 ± 14.2 mg/dL in the statin plus ezetimibe group, and 36.6 ± 16.1 mg/dL in the triple therapy group.Percentage LDL-C reductions were 52.0%, 60.6%, and 75.7%, respectively.LDL-C target attainment (<55 mg/dL) at 3 months was achieved in 64.2% of patients receiving statin monotherapy, 80.7% receiving statin plus ezetimibe, and 90.9% receiving triple therapy.Intergroup differences were statistically significant (ANOVA F=23.43, p<0.001).Conclusion: Triple therapy consisting of a statin, ezetimibe, and bempedoic acid achieved significantly greater LDL-C reduction and superior LDL-C target attainment compared with statin monotherapy or statin-ezetimibe dual therapy in patients with ACS.Early intensive combination lipid-lowering therapy may represent an effective strategy for achieving guideline-recommended LDL-C goals in very high-risk patients.

Discussion

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Cite This Study

A 2026 study conducted an observational in Acute coronary syndrome (STEMI, NSTEMI, or unstable angina) (n=300). Statin plus ezetimibe plus bempedoic acid triple therapy vs. Statin monotherapy or statin plus ezetimibe dual therapy was evaluated on Percentage reduction in LDL-C levels at 3 months (MD 16.47 mg/dL, p=<0.001). Triple therapy with statin, ezetimibe, and bempedoic acid reduced LDL-C by 75.7% at 3 months vs 60.6% with dual therapy and 52.0% with statin monotherapy in ACS patients (p<0.001).

synapsesocial.com/papers/6aee6b6871a7594806220968 https://doi.org/10.25258/ijddt.16.67s.125

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Comparative efficacy of Statin Monotherapy, Statin–Ezetimibe Dual Therapy, and Statin–Ezetimibe–Bempedoic Acid Triple Therapy in patients with Acute Coronary Syndrome: A Prospective comparative study

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Comparative efficacy of Statin Monotherapy, Statin–Ezetimibe Dual Therapy, and Statin–Ezetimibe–Bempedoic Acid Triple Therapy in patients with Acute Coronary Syndrome: A Prospective comparative study

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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