Empleo del ácido bempedoico en los pacientes con dislipemia. Una aproximación práctica

Abstract

The reduction in cholesterol levels obtained with lipid-lowering therapy is associated with a marked decrease in the risk of cardiovascular complications. However, a substantial proportion of patients with hypercholesterolemia do not achieve the recommended target level, irrespective of their cardiovascular risk. Although this is partly due to the intensity of lipid-lowering treatment being inadequate and although combination therapy could be prescribed more frequently, there is still a need for new drugs to help achieve therapeutic goals. Bempedoic acid is a new, first-in-class, oral, lipid-lowering drug that reduces cholesterol levels by inhibiting the enzyme adenosine triphosphate-citrate lyase, which plays a role in the cholesterol synthesis pathway upstream from where statins act. Importantly, bempedoic acid is not activated in skeletal muscle, which reduces the risk of muscle-related side effects. An extensive series of clinical trials has demonstrated the drug’s efficacy in reducing cholesterol levels when given as monotherapy or in combination with other lipid-lowering drugs. Moreover, its safety profile is good. In this document, a simple and easily applied algorithm is proposed for identifying those patients who potentially stand to benefit most from treatment with bempedoic acid. The algorithm takes into account cardiovascular risk, previous lipid-lowering therapy and the low-density lipoprotein cholesterol level. Its purpose is help the majority of patients achieve the treatment goals as soon as possible.