Strikic Dominik, Begic Zvonimir, Radman Ivana, Zlopasa Fran, Mateljic Jana, Zec Ivica, Titlic Marina, Sliskovic Ana Marija, Pecin Ivan, Reiner Zeljko, Mercep Iveta
Division of Clinical Pharmacology, University Hospital Centre Zagreb, 10 000 Zagreb, Croatia.
Division of Plastic and Reconstructive Surgery, University Hospital Centre Zagreb, 10 000 Zagreb, Croatia.
Biomedicines. 2025 Jun 13;13(6):1460. doi: 10.3390/biomedicines13061460.
Dyslipidaemia is one of the main causes of atherosclerotic cardiovascular disease (ASCVD) worldwide. Although statins remain the cornerstone of lipid-lowering therapy, many patients do not achieve optimal target levels of low-density lipoprotein cholesterol (LDL-C) due to intolerance or inadequate response. Bempedoic acid, an oral ATP citrate lyase inhibitor, provides a liver-specific mechanism that lowers LDL-C levels while minimising muscle-related side effects. Recent clinical trials, including the CLEAR Outcomes Study, have shown that bempedoic acid was able to reduce LDL-C by approximately 29 mg/dL and major adverse cardiovascular events (MACEs) by 13% in patients intolerant to statins. Combination therapy with ezetimibe further enhances this effect. However, adverse effects such as increased uric acid and gout have been reported, requiring careful patient selection and continuous monitoring. This review provides a comparative synthesis of the latest evidence on bempedoic acid, including its pharmacological profile, its efficacy in different patient groups, and its place within current treatment strategies for dyslipidaemia. It also identifies research gaps and directions for future studies.
血脂异常是全球动脉粥样硬化性心血管疾病（ASCVD）的主要病因之一。尽管他汀类药物仍然是降脂治疗的基石，但由于不耐受或反应不足，许多患者未能达到低密度脂蛋白胆固醇（LDL-C）的最佳目标水平。口服ATP柠檬酸裂解酶抑制剂贝派地酸提供了一种肝脏特异性机制，可降低LDL-C水平，同时将肌肉相关副作用降至最低。包括CLEAR Outcomes研究在内的近期临床试验表明，对于他汀类药物不耐受的患者，贝派地酸能够使LDL-C降低约29mg/dL，并使主要不良心血管事件（MACE）减少13%。与依折麦布联合治疗可进一步增强这种效果。然而，已有报道称会出现尿酸升高和痛风等不良反应，这需要谨慎选择患者并持续监测。本综述对贝派地酸的最新证据进行了比较综合，包括其药理学特征、在不同患者群体中的疗效以及在当前血脂异常治疗策略中的地位。它还确定了研究差距和未来研究方向。
