Bempedoic Acid — EECC MCQ

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ModerateHypertension & Preventive CardiologyBempedoic AcidEECC

A 62-year-old woman with heterozygous familial hypercholesterolaemia is intolerant of all statins (myalgia confirmed by rechallenge). She is on ezetimibe 10 mg with an LDL-C of 4.8 mmol/L. Which add-on oral therapy has been specifically developed for statin-intolerant patients?

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Correct answer: D — Bempedoic acid

Bempedoic acid is an oral ACL (ATP citrate lyase) inhibitor that blocks cholesterol synthesis upstream of HMG-CoA reductase. Crucially, it is a prodrug activated only in the liver (not in skeletal muscle), making it free of statin-associated myalgia. The CLEAR Outcomes trial demonstrated a 13% reduction in MACE in statin-intolerant patients. The ESC/EAS Dyslipidaemia Guidelines recommend bempedoic acid as an option for statin-intolerant patients (Class IIa). Evolocumab and inclisiran are injectable (subcutaneous), not oral. Lomitapide is reserved for homozygous FH only due to hepatotoxicity. Ezetimibe doses above 10 mg are not standard.

Reference: ESC/EAS (2019/2025): Guidelines for the Management of Dyslipidaemias