Daily Dose: Bempedoic Acid Linked to 20% Reduction in Total CV Events

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Patient Care brings primary care clinicians a lot of medical news every day—it’s easy to miss an important study. The Daily Dose provides a concise summary of one of the website's leading stories you may not have seen.

Last week, we reported on findings from a study published in JAMA Cardiology that examined the impact of bempedoic acid on the total incidence of major adverse cardiovascular events (MACE).

The study

Researchers conducted a prespecified analysis of the Cholesterol Lowering via Bempedoic Acid, an ATP Citrate Lyase (ACL)–Inhibiting Regimen (CLEAR) Outcomes trial of 13 970 patients with high cardiovascular risk, intolerance of statin or high-intensity statin medication, and elevated low-density lipoprotein cholesterol (LDL-C) levels.

The findings

During a median follow-up of 3.4 years, investigators recorded 1746 positively adjudicated first 4-point MACE events and 915 additional MACE events among 612 patients. Of the 1746 adjudicated events, coronary revascularizations accounted for 32.8% of first events and 69.4% of additional events.

When they assessed the impact of bempedoic acid vs placebo on the total incidence of CV events, the team found use of the drug associated with relative risk reductions of:

• 20% for 4-point MACE (HR, 0.80; 95% CI, 0.72-0.89; P < .001)

• 17% for 3-point MACE (HR, 0.83; 95% CI, 0.73-0.93; P = .002),

• 31% for MI (HR, 0.69; 95% CI, 0.58-0.83; P < .001)

• 22% for coronary revascularization (HR, 0.78; 95% CI, 0.68-0.89; P <.001)

Importantly, additional analysis suggested that the magnitude of treatment benefit with bempedoic acid increased with an increasing number of patients’ MACE events. Relative risk reductions recorded were1:

• First event 13% (HR, 0.87; 95% CI, 0.79-0.96; P = .004)

• Second event 26% (HR, 0.74; 95% CI, 0.63-0.87; P <.001)

• Third event 31% (HR, 0.69; 95% CI, 0.51-0.93; P = .02),

• Fourth event 49% (HR, 0.51; 95% CI, 0.31-0.88; P = .02)

Authors' comment

"This finding highlights the importance of lipid lowering in patients at high cardiovascular risk. More effective clinical models are required to achieve more sustainable adherence to optimized lipid-lowering strategies in order to produce greater reductions in cardiovascular risk."

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