Esperion Welcomes Bempedoic Acid Inclusion in Cardiovascular Guidelines

Esperion welcomed the inclusion of bempedoic acid for LDL-C lowering and cardiovascular risk reduction in the 2026 Americal College of Cardiology/American Heart Association Multisociety Guideline on the Management of Dyslipidemia. "The reintroduction of guideline-directed LDL-C targets to reduce cumulative LDL-C exposure emphasizes the importance of earlier, aggressive combination therapy and the acknowledgement of statin intolerance as a significant clinical challenge to reducing cardiovascular risk addresses a critical unmet need," said Christie Ballantyne, MD, Professor of Medicine and Chief of Cardiology and Cardiovascular Research at Baylor College of Medicine. "These guidelines provide practical, evidence-based recommendations on how and when to escalate therapy beyond statins to more effectively reduce risk and improve long-term cardiovascular outcomes for patients." Summary of Key Bempedoic Acid Guideline Recommendations Class of Recommendation 1: In adults without a history of clinical atherosclerotic cardiovascular disease who experience statin-attributed muscle symptoms on the recommended intensity of statin therapy and are at high ASCVD risk based on a PREVENT-ASCVD equation of greater than or equal to10% or a coronary artery calcium core greater than or equal to300 AU, or women greater than65 years of age or men greater than60 years of age with diabetes, the addition of bempedoic acid and/or ezetimibe is/are indicated to lower LDL-C to less than70 mg/dL and non-HDL-C less than100 mg/dL and to reduce ASCVD risk. Class of Recommendation 1: In adults with clinical ASCVD who experience statin-attributed muscle symptoms on the recommended intensity of statin therapy and are unable to achieve recommended treatment goals, use of a reduced statin dose and the addition of bempedoic acid, ezetimibe, or a PCSK9 monoclonal antibody, alone or in combination, are recommended to lower LDL-C and reduce ASCVD risk. Class of Recommendation 1: In adults with diabetes who have statin-attributed side effects, initiation of ezetimibe and/or bempedoic acid or a PCSK9 mAb is recommended to lower LDL-C and reduce ASCVD risk. Class of Recommendation 1: In adults with severe hypercholesterolemia with or without clinical ASCVD who meet other guideline criteria and are on maximally tolerated statin therapy, the addition of ezetimibe, a PCSK9 mAb and/or bempedoic acid is recommended to achieve the desired LDL-C goal and to reduce ASCVD risk. Class of Recommendation 2a: In adults with clinical ASCVD who are not at very high risk and on maximally tolerated statin therapy, it is reasonable to add ezetimibe, a PCSK9 mAb, or bempedoic acid to achieve a goal LDL-C less than70 mg/dL and non-HDL-C less than100 mg/dL and to reduce the risk of ASCVD events. Class of Recommendation 2a: In adults with clinical ASCVD who are at very high risk on maximally tolerated statin therapy, it is reasonable to add bempedoic acid, with or without ezetimibe and/or PCSK9 mAb, to reach an LDL-C goal less than55 mg/dL and non-HDL-C less than85 mg/dL to reduce the risk of ASCVD events. Class of Recommendation 2a: In adults with subclinical atherosclerosis, it is reasonable to intensify therapy by increasing the intensity of statin therapy or, if needed, adding ezetimibe, a PCSK9 mAb or bempedoic acid to achieve a goal of LDL-C less than55 mg/dL and non-HDL-C less than85 mg/dL. Class of Recommendation 2b: In adults at high 10-year estimated risk for ASCVD on maximally tolerated statin with or without ezetimibe, it may be reasonable to add a PCSK9 mAb or bempedoic acid if a goal LDL-C less than70 mg/dL and non-HDL-C less than100 mg/dL is not achieved to lower LDL-C and reduce ASCVD risk.