Cardiovasc Diabetol. 2026 May 3. doi: 10.1186/s12933-026-03185-1. Online ahead of print.
ABSTRACT
Diabetes mellitus is a rapidly growing global health challenge and a major driver of atherosclerotic cardiovascular disease (ASCVD). Dyslipidaemia, highly prevalent in both type 1 and type 2 diabetes, plays a central role in this excess cardiovascular risk and often persists despite statin therapy. Although statins remain the cornerstone of lipid management, many patients with diabetes do not achieve recommended low-density lipoprotein cholesterol (LDL-C) goals. Therefore, there is a need for effective, safe, and practical adjunctive therapies. Bempedoic acid is a first-in-class oral ATP-citrate lyase inhibitor with liver-specific activation, resulting in significant LDL-C reduction without relevant muscle-related adverse effects. Across clinical trials, including the CLEAR programme, bempedoic acid has demonstrated consistent LDL-C lowering, as well as reductions in apolipoprotein B and non-HDL-C, and favourable effects on the inflammatory marker high-sensitivity C-reactive protein (hs-CRP), with similar efficacy in patients with and without diabetes. Importantly, the CLEAR Outcomes trial showed a significant reduction in major adverse cardiovascular events in statin-intolerant patients, almost half of whom had diabetes, without adverse effects on glycaemic control. This article summarises the evidence supporting the use of bempedoic acid in people with diabetes, proposes its therapeutic positioning within contemporary lipid-lowering algorithms, and highlights its role as an effective oral option, aiming to provide practical and nationally relevant guidance for lipid management in people with diabetes. By helping to reduce residual cardiovascular risk and bridge treatment gaps in patients who may not be eligible for or have access to PCSK9 inhibitors, bempedoic acid represents a valuable addition to personalised lipid management strategies aimed at lowering cardiovascular morbidity and mortality in this high-risk population.
PMID:42071223 | DOI:10.1186/s12933-026-03185-1