CONGRESS ABSTRACT

Background: Low-density lipoprotein cholesterol (LDL-C) variability could be related to increased cardiovascular risk in patients already treated with statins. Bempedoic acid (BA) is approved for the reduction of LDL-C in addition to or instead of statin therapy and ezetimibe.  Aim: to assess impact of BA addition to statin therapy at the maximum tolerated dose and ezetimibe 10 mg on the achievement of therapeutic targets and variability of LDL-C values in patient with previous acute coronary syndrome (ACS) and in follow up (FU) post-discharge. Methods: The routine data of 116 patients (89 M/27 F) mean aged 63 ± 7 years, in FU after ACS, treated with usual lipid lowering therapy (LLT) (high efficacy statins at maximum tolerated dose and ezetimibe 10 mg) who did not reach the lipid target and BA was added at dose of 180 mg once daily, were analysed. All patients underwent lipid profile and creatine phosphokinase (CPK) dosage at baseline and at 6 months after the start of therapy. Renal and hepatic function was also assessed. The efficacy of the drug was assessed by the reduction in LDL-C at 6 months and compared to baseline. Three indices of variability were used: coefficient of variation (CV), standard deviation (SD), and variability independent of the mean (VIM). The results were compared to those observed before the addition of BA (on at least 3 measurements before and after BA). At baseline, patients were divided into 3 groups: Low (<10%), moderate (10-20%), and high variability (>20%). Statistical Analysis: Normally distributed variables are presented as mean ± standard deviation (SD) and were compared by Student’s t-test for paired data. A p≤0.05 value was considered statistically significant. Results: the observation period lasted 9,38± 1,36 months. At 6 months, the LDL-C values ​​were 48,8±8,0 vs 60,9±4,6 mg/dL (p <0.0001).  With regard to variability, it was observed that after the addition of BA, the number of patients with high variability decreased (11 pts [12%] vs 33 pts [38%]), while the number of patients with low variability increased (55 pts [63%] vs 25 pts [29%]). Slightly reduced was the group of moderate variability (50 pts [58%] vs 58 pts [67%]). No statistically significant changes were observed in glomerular filtration rate, CPK and uric acid values (p=NS). Conclusions: BA added to standard LLT may be useful not only to reduce LDL values to the recommended target, but also to reduce the variability of these.