Factors associated with enhanced low-density lipoprotein cholesterol lowering with bempedoic acid
Author(s)
Type
Journal Article
Abstract
Background
Bempedoic acid (BA) inhibits ATP‐citrate lyase in the cholesterol synthesis pathway and lowers low‐density lipoprotein cholesterol (LDL‐C). As with other lipid‐lowering therapies, interindividual variation in response to BA was observed in clinical trials. We characterized LDL‐C response to BA using guideline‐defined statin intensity categories and identified clinical factors associated with enhanced LDL‐C lowering with BA.
Methods and Results
This post hoc analysis used pooled data from 4 phase 3 studies. Patients were randomized 2:1 to once‐daily BA 180 mg (n=2321) or placebo (n=1167) for 12 to 52 weeks and grouped based on percent change in LDL‐C from baseline to week 12 according to guideline‐established statin intensity categories. Factors associated with ≥30% reduction in LDL‐C were identified using logistic regression analyses. From baseline to week 12, BA lowered LDL‐C levels comparable to a moderate‐ or high‐intensity statin (≥30%) in 28.9% of patients; this degree of LDL‐C lowering was observed in 50.9% of patients not receiving background statin therapy. In a multivariable analysis, the absence of statins, female sex, a history of diabetes, ezetimibe use, and higher high‐sensitivity C‐reactive protein level were associated with increased rates of achieving ≥30% LDL‐C reduction with BA (P<0.01 for each).
Conclusions
A large percentage of patients receiving BA achieved LDL‐C reductions comparable to a moderate‐ or high‐intensity statin. Factors including statin absence, female sex, diabetes history, ezetimibe use, and a higher high‐sensitivity C‐reactive protein level may be useful to identify patients who may have a greater LDL‐C reduction with BA.
Registration
URL: https://www.clinicaltrials.gov; Unique identifiers: NCT02666664, NCT02991118, NCT02988115, NCT03001076.
Bempedoic acid (BA) inhibits ATP‐citrate lyase in the cholesterol synthesis pathway and lowers low‐density lipoprotein cholesterol (LDL‐C). As with other lipid‐lowering therapies, interindividual variation in response to BA was observed in clinical trials. We characterized LDL‐C response to BA using guideline‐defined statin intensity categories and identified clinical factors associated with enhanced LDL‐C lowering with BA.
Methods and Results
This post hoc analysis used pooled data from 4 phase 3 studies. Patients were randomized 2:1 to once‐daily BA 180 mg (n=2321) or placebo (n=1167) for 12 to 52 weeks and grouped based on percent change in LDL‐C from baseline to week 12 according to guideline‐established statin intensity categories. Factors associated with ≥30% reduction in LDL‐C were identified using logistic regression analyses. From baseline to week 12, BA lowered LDL‐C levels comparable to a moderate‐ or high‐intensity statin (≥30%) in 28.9% of patients; this degree of LDL‐C lowering was observed in 50.9% of patients not receiving background statin therapy. In a multivariable analysis, the absence of statins, female sex, a history of diabetes, ezetimibe use, and higher high‐sensitivity C‐reactive protein level were associated with increased rates of achieving ≥30% LDL‐C reduction with BA (P<0.01 for each).
Conclusions
A large percentage of patients receiving BA achieved LDL‐C reductions comparable to a moderate‐ or high‐intensity statin. Factors including statin absence, female sex, diabetes history, ezetimibe use, and a higher high‐sensitivity C‐reactive protein level may be useful to identify patients who may have a greater LDL‐C reduction with BA.
Registration
URL: https://www.clinicaltrials.gov; Unique identifiers: NCT02666664, NCT02991118, NCT02988115, NCT03001076.
Date Issued
2022-08-02
Date Acceptance
2022-05-24
Citation
Journal of the American Heart Association, 2022, 11 (15)
ISSN
2047-9980
Publisher
Wiley
Journal / Book Title
Journal of the American Heart Association
Volume
11
Issue
15
Copyright Statement
© 2022 The Authors and Esperion Therapeutics, Inc . Published on behalf of the American Heart Association, Inc., by Wiley. This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
License URL
Identifier
https://www.webofscience.com/api/gateway?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=WOS:000835553100039&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=1ba7043ffcc86c417c072aa74d649202
Subjects
atherosclerotic cardiovascular disease
ATORVASTATIN
Cardiac & Cardiovascular Systems
Cardiovascular System & Cardiology
C-REACTIVE PROTEIN
DISEASE
DYSLIPIDEMIA
Life Sciences & Biomedicine
RISK
Science & Technology
statin intolerance
VARIABILITY
Publication Status
Published
Coverage Spatial
England
Article Number
e024531
Date Publish Online
2022-08-02