Bempedoic acid: a simple guide to lowering LDL cholesterol

Bempedoic acid is a newer oral medicine that lowers LDL cholesterol. It works upstream of statins by blocking ATP citrate lyase, a liver enzyme used to make cholesterol. Because it activates only in the liver, muscle side effects are less common than with some statins. Doctors often offer it when statins alone do not reach LDL targets or when a patient cannot tolerate statins.

How much it helps: as a single pill bempedoic acid typically reduces LDL by around 15%. Add ezetimibe and the drop can get closer to 35% depending on your baseline and other meds. Patients with very high risk may still need stronger combinations, but bempedoic acid gives an extra, non-statin pathway to cut LDL.

Who should consider it

Good candidates include adults with primary hypercholesterolemia, people with heterozygous familial hypercholesterolemia, and patients who develop significant statin muscle pain. It is not a first-line drug for everyone; most people still start with lifestyle changes and statins. Also tell your doctor if you have gout, chronic kidney disease, or are pregnant, because bempedoic acid can raise uric acid levels and is not recommended during pregnancy.

How to take it and what to expect

The usual dose is one tablet taken once daily, with or without food. LDL response appears within 4 to 12 weeks, so expect a blood test after about six weeks. Many people do well on bempedoic acid with minimal side effects, but your clinician will monitor liver enzymes and uric acid. If LDL remains high, adding ezetimibe or other agents may be recommended.

Common side effects include increased uric acid and the occasional gout flare, mild muscle pain, gastrointestinal upset, and small rises in liver tests. Rare but serious issues like tendon rupture have been reported, especially in patients with certain risk factors. Stop the medicine and seek care if you have sudden tendon pain, severe muscle weakness, or trouble moving a joint.

Drug interactions are fewer than with many statins, but you should still list all drugs and supplements to your provider. Tell them about prescription and over-the-counter medicines, because adjustments may be needed. Don’t start or stop other cholesterol medicines without medical advice.

Practical tips that help: set a daily alarm to improve adherence, carry a medication list card for emergencies, and ask your pharmacy about savings programs. Combine the drug with heart-healthy habits — a Mediterranean-style diet, regular exercise, and smoking cessation boost results and lower overall heart risk.

Bottom line: bempedoic acid gives another option to lower LDL when statins fall short or cause side effects. Talk openly with your clinician about benefits, risks, costs, and follow-up testing so you get the best plan for your heart health.

If you have questions, write them down before your visit. Ask when to repeat lipid tests, what to do for side effects, and whether financial assistance is available. Track your symptoms and results so you and your doctor can make clear choices about treatment.