CONGRESS ABSTRACT

Dyslipidemia is a major risk factor for atherosclerotic cardiovascular disease (ASCVD), and  lipid-lowering therapies (LLT) are critical for reducing morbidity and mortality. Despite the widespread use of statins (ST) and other LLT agents, a significant proportion of patents (Pts) fails to achieve target lipid levels due to inadequate response, intolerance, or contraindications. Bempedoic acid (BA), the most recently LLT, is an ATP citrate lyase inhibitor that represents an alternative therapeutic option for Pts with hypercholesterolemia, particularly those who cannot tolerate high-dose ST. This study aims to investigate real-world data on BA use in an Italian cohort of  Pts to assess its clinical effectiveness and tolerability. This retrospective study analyzed Pts, referring to the our Dyslipidemia Center, who were prescribed BA between April 2023 and October 2024. Lipid profiles of Pts were assessed at baseline and at 3, 6, and 12 months following BA initiation. Data collection focused on treatment adherence, lipid level changes, and any reported adverse events. 159 patients (81 men, mean age 65.9 ±11.4 years) were prescribed BA, with 122 having at least one follow-up. The majority had hypertension (65.4%), and half were on secondary  prevention. Familial hypercholesterolemia was present in 38 Pts, and ST intolerance was observed in 96 (60.4%). Overall, 76 Pts were at high risk and 83 at very high risk. BA was prescribed  with ST for 84 Pts (52.8%), ezetimibe for 118 Pts (74.2%), and PCSK9 inhibitors for 38 Pts (23.9%), while it was used as monotherapy in 29 Pts (18.2%). LDL-C was reduced by 24.8%, 26.5%, and 25.8% at 3, 6, and 12 months, respectively. LDL-C reduction at the last follow-up was 25.1%. Differences in effectiveness were observed based on background therapy, with ST-treated patients showing a smaller LDL-C reduction (-21.3% vs -30.7% in non-ST-treated). Inter-individual variability in LDL-C response (from -86.1% to +89.4%) was noted. The drug discontinuation rate within one year was 5.7%, primarily due to adverse events (5.0%), most commonly musculoskeletal complaints. An increase in uric acid was reported in 5 Pts. In this real-world cohort, BA demonstrated LDL-C reductions across follow-up periods, with a manageable safety profile. The drug's effectiveness was influenced by background therapy, highlighting its role as an alternative or adjunctive option for high and very high-risk Pts, particularly those intolerant to high-dose ST.