{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T18:19:16Z","timestamp":1790965156176,"version":"4.1.0"},"reference-count":21,"publisher":"Springer Science and Business Media LLC","issue":"6","license":[{"start":{"date-parts":[[2023,6,1]],"date-time":"2023-06-01T00:00:00Z","timestamp":1685577600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2023,6,1]],"date-time":"2023-06-01T00:00:00Z","timestamp":1685577600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100002352","name":"Ain Shams University","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100002352","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Cardiovasc Drugs Ther"],"published-print":{"date-parts":[[2024,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Purpose<\/jats:title>\n                <jats:p>Statins are first-line agents to reduce low-density lipoprotein cholesterol (LDL-C) and cardiovascular risk, however, they are insufficient and\/or intolerable in many patients. To that end, we conducted a meta-analysis of Bempedoic Acid (BA), a novel LDL-C lowering agent.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>We retrieved randomized clinical trials (RCTs) of BA by searching Pubmed, the Cochrane Central Register of Controlled Trials, and Clinicaltrials.gov. We used the Mantel-Haenszel method to pool estimates. The I<jats:sup>2<\/jats:sup> measure was used to quantify heterogeneity. Treatment effects are provided as relative risks (RR), absolute risk differences (ARD), and number needed to treat\/harm (NNTB\/H). Analyses were conducted using R, version 4.1.2.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>11 trials enrolling 18,496 patients were included. Compared to placebo, BA reduced the risk of major adverse cardiovascular events (RR: 0.87; 95% CI: 0.80 to 0.95; ARD: -1.63%; NNT: 62), myocardial infarction (RR: 0.76; 95% CI: 0.66 to 0.89; ARD: -1.03%; NNT: 98), unstable angina hospitalization (RR: 0.70; 95%: CI: 0.55 to 0.89; ARD: -0.57%; NNT: 177), revascularization (RR: 0.81; 95% CI: 0.72 to 0.91; ARD: -1.31%; NNT: 77), and myalgia (RR: 0.85; 95% CI: 0.75 to 0.95; ARD: -0.99%; NNT: 102). BA significantly increased the risk of gout (RR: 1.56; 95% CI: 1.27 to 1.91; ARD: 0.99%; NNH: 101), renal impairment (RR: 1.35; 95% CI: 1.22 to 1.49; ARD: 2.54%; NNH: 40), and cholelithiasis (RR: 1.87; 95% CI: 1.43 to 2.44; ARD: 1.01%; NNH: 100).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>BA effectively reduces the risk of cardiovascular events and myalgia but increases the risk of gout, cholelithiasis, and renal impairment.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s10557-023-07474-9","type":"journal-article","created":{"date-parts":[[2023,6,1]],"date-time":"2023-06-01T10:02:27Z","timestamp":1685613747000},"page":"1415-1420","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":18,"title":["The Clinical Efficacy and Safety of Bempedoic Acid in Patients at Elevated Risk of Cardiovascular Disease: A Meta-Analysis of Randomized Clinical Trials"],"prefix":"10.1007","volume":"38","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0150-8917","authenticated-orcid":false,"given":"Ahmed","family":"Sayed","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Omar","family":"Shazly","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leandro","family":"Slipczuk","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chayakrit","family":"Krittanawong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Farhala","family":"Baloch","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Salim S.","family":"Virani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2023,6,1]]},"reference":[{"key":"7474_CR1","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000000625","author":"SM Grundy","year":"2019","unstructured":"Grundy SM, Stone NJ, Bailey AL et al. 2018 AHA\/ACC\/AACVPR\/AAPA\/ABC\/ACPM\/ADA\/AGS\/APhA\/ASPC\/NLA\/PCNA Guideline on the Management of Blood Cholesterol. A Report of the American College of Cardiology\/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2019;139(25):e1082\u2013e143. https:\/\/doi.org\/10.1161\/CIR.0000000000000625"},{"issue":"25","key":"7474_CR2","doi-asserted-by":"publisher","first-page":"2982","DOI":"10.1016\/j.jacc.2020.11.010","volume":"76","author":"GA Roth","year":"2020","unstructured":"Roth GA, Mensah GA, Johnson CO, et al. Global Burden of Cardiovascular Diseases and Risk factors, 1990\u20132019: Update from the GBD 2019 study. J Am Coll Cardiol. 2020;76(25):2982\u20133021. https:\/\/doi.org\/10.1016\/j.jacc.2020.11.010.","journal-title":"J Am Coll Cardiol"},{"issue":"25","key":"7474_CR3","doi-asserted-by":"publisher","first-page":"2387","DOI":"10.1056\/NEJMoa1410489","volume":"372","author":"CP Cannon","year":"2015","unstructured":"Cannon CP, Blazing MA, Giugliano RP, et al. Ezetimibe added to statin therapy after Acute Coronary Syndromes. N Engl J Med. 2015;372(25):2387\u201397. https:\/\/doi.org\/10.1056\/NEJMoa1410489.","journal-title":"N Engl J Med"},{"issue":"18","key":"7474_CR4","doi-asserted-by":"publisher","first-page":"1713","DOI":"10.1056\/NEJMoa1615664","volume":"376","author":"MS Sabatine","year":"2017","unstructured":"Sabatine MS, Giugliano RP, Keech AC, et al. Evolocumab and Clinical Outcomes in patients with Cardiovascular Disease. N Engl J Med. 2017;376(18):1713\u201322. https:\/\/doi.org\/10.1056\/NEJMoa1615664.","journal-title":"N Engl J Med"},{"issue":"22","key":"7474_CR5","doi-asserted-by":"publisher","first-page":"2097","DOI":"10.1056\/NEJMoa1801174","volume":"379","author":"GG Schwartz","year":"2018","unstructured":"Schwartz GG, Steg PG, Szarek M, et al. Alirocumab and Cardiovascular Outcomes after Acute Coronary Syndrome. N Engl J Med. 2018;379(22):2097\u2013107. https:\/\/doi.org\/10.1056\/NEJMoa1801174.","journal-title":"N Engl J Med"},{"issue":"48","key":"7474_CR6","doi-asserted-by":"publisher","first-page":"5047","DOI":"10.1093\/eurheartj\/ehac615","volume":"43","author":"KK Ray","year":"2022","unstructured":"Ray KK, Kallend D, Leiter LA, et al. Effect of inclisiran on lipids in primary prevention: the ORION-11 trial. Eur Heart J. 2022;43(48):5047\u201357. https:\/\/doi.org\/10.1093\/eurheartj\/ehac615.","journal-title":"Eur Heart J"},{"key":"7474_CR7","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2215024","author":"SE Nissen","year":"2023","unstructured":"Nissen SE, Lincoff AM, Brennan D, et al. Bempedoic Acid and Cardiovascular Outcomes in statin-intolerant patients. N Engl J Med. 2023. https:\/\/doi.org\/10.1056\/NEJMoa2215024.","journal-title":"N Engl J Med"},{"key":"7474_CR8","doi-asserted-by":"publisher","first-page":"100278","DOI":"10.1016\/j.ajpc.2021.100278","volume":"8","author":"HE Bays","year":"2021","unstructured":"Bays HE, Baum SJ, Brinton EA, et al. Effect of bempedoic acid plus ezetimibe fixed-dose combination vs ezetimibe or placebo on low-density lipoprotein cholesterol in patients with type 2 diabetes and hypercholesterolemia not treated with statins. Am J Prev Cardiol. 2021;8:100278. https:\/\/doi.org\/10.1016\/j.ajpc.2021.100278.","journal-title":"Am J Prev Cardiol"},{"issue":"18","key":"7474_CR9","doi-asserted-by":"publisher","first-page":"1780","DOI":"10.1001\/jama.2019.16585","volume":"322","author":"AC Goldberg","year":"2019","unstructured":"Goldberg AC, Leiter LA, Stroes ESG, et al. Effect of Bempedoic Acid vs Placebo added to maximally tolerated statins on low-density lipoprotein cholesterol in patients at High Risk for Cardiovascular Disease: the CLEAR Wisdom Randomized Clinical Trial. JAMA. 2019;322(18):1780\u20138. https:\/\/doi.org\/10.1001\/jama.2019.16585.","journal-title":"JAMA"},{"issue":"4","key":"7474_CR10","doi-asserted-by":"publisher","first-page":"568","DOI":"10.1016\/j.jacl.2019.05.003","volume":"13","author":"ND Lalwani","year":"2019","unstructured":"Lalwani ND, Hanselman JC, MacDougall DE, Sterling LR, Cramer CT. Complementary low-density lipoprotein-cholesterol lowering and pharmacokinetics of adding bempedoic acid (ETC-1002) to high-dose atorvastatin background therapy in hypercholesterolemic patients: a randomized placebo-controlled trial. J Clin Lipidol. 2019;13(4):568\u201379. https:\/\/doi.org\/10.1016\/j.jacl.2019.05.003.","journal-title":"J Clin Lipidol"},{"issue":"7","key":"7474_CR11","doi-asserted-by":"publisher","first-page":"e011662","DOI":"10.1161\/JAHA.118.011662","volume":"8","author":"U Laufs","year":"2019","unstructured":"Laufs U, Banach M, Mancini GBJ, et al. Efficacy and safety of Bempedoic Acid in patients with hypercholesterolemia and statin intolerance. J Am Heart Assoc. 2019;8(7):e011662. https:\/\/doi.org\/10.1161\/JAHA.118.011662.","journal-title":"J Am Heart Assoc"},{"issue":"11","key":"7474_CR12","doi-asserted-by":"publisher","first-page":"1022","DOI":"10.1056\/NEJMoa1803917","volume":"380","author":"KK Ray","year":"2019","unstructured":"Ray KK, Bays HE, Catapano AL, et al. Safety and Efficacy of Bempedoic Acid to reduce LDL cholesterol. N Engl J Med. 2019;380(11):1022\u201332. https:\/\/doi.org\/10.1056\/NEJMoa1803917.","journal-title":"N Engl J Med"},{"issue":"4","key":"7474_CR13","doi-asserted-by":"publisher","first-page":"593","DOI":"10.1016\/j.jacl.2021.05.002","volume":"15","author":"J Rubino","year":"2021","unstructured":"Rubino J, MacDougall DE, Sterling LR, et al. Lipid lowering with bempedoic acid added to a proprotein convertase subtilisin\/kexin type 9 inhibitor therapy: a randomized, controlled trial. J Clin Lipidol. 2021;15(4):593\u2013601. https:\/\/doi.org\/10.1016\/j.jacl.2021.05.002.","journal-title":"J Clin Lipidol"},{"issue":"13","key":"7474_CR14","doi-asserted-by":"publisher","first-page":"1154","DOI":"10.1016\/j.jacc.2013.05.050","volume":"62","author":"CM Ballantyne","year":"2013","unstructured":"Ballantyne CM, Davidson MH, Macdougall DE, et al. Efficacy and safety of a novel dual modulator of adenosine triphosphate-citrate lyase and adenosine monophosphate-activated protein kinase in patients with hypercholesterolemia: results of a multicenter, randomized, double-blind, placebo-controlled, parallel-group trial. J Am Coll Cardiol. 2013;62(13):1154\u201362. https:\/\/doi.org\/10.1016\/j.jacc.2013.05.050.","journal-title":"J Am Coll Cardiol"},{"key":"7474_CR15","doi-asserted-by":"publisher","first-page":"195","DOI":"10.1016\/j.atherosclerosis.2018.06.002","volume":"277","author":"CM Ballantyne","year":"2018","unstructured":"Ballantyne CM, Banach M, Mancini GBJ, et al. Efficacy and safety of bempedoic acid added to ezetimibe in statin-intolerant patients with hypercholesterolemia: a randomized, placebo-controlled study. Atherosclerosis. 2018;277:195\u2013203. https:\/\/doi.org\/10.1016\/j.atherosclerosis.2018.06.002.","journal-title":"Atherosclerosis"},{"issue":"6","key":"7474_CR16","doi-asserted-by":"publisher","first-page":"593","DOI":"10.1177\/2047487319864671","volume":"27","author":"CM Ballantyne","year":"2020","unstructured":"Ballantyne CM, Laufs U, Ray KK, et al. Bempedoic acid plus ezetimibe fixed-dose combination in patients with hypercholesterolemia and high CVD risk treated with maximally tolerated statin therapy. Eur J Prev Cardiol. 2020;27(6):593\u2013603. https:\/\/doi.org\/10.1177\/2047487319864671.","journal-title":"Eur J Prev Cardiol"},{"issue":"3","key":"7474_CR17","doi-asserted-by":"publisher","first-page":"556","DOI":"10.1016\/j.jacl.2015.12.025","volume":"10","author":"PD Thompson","year":"2016","unstructured":"Thompson PD, MacDougall DE, Newton RS, et al. Treatment with ETC-1002 alone and in combination with ezetimibe lowers LDL cholesterol in hypercholesterolemic patients with or without statin intolerance. J Clin Lipidol. 2016;10(3):556\u201367. https:\/\/doi.org\/10.1016\/j.jacl.2015.12.025.","journal-title":"J Clin Lipidol"},{"issue":"12","key":"7474_CR18","doi-asserted-by":"publisher","first-page":"1210","DOI":"10.1016\/j.jacc.2021.07.022","volume":"78","author":"JP Howard","year":"2021","unstructured":"Howard JP, Wood FA, Finegold JA, et al. Side effect patterns in a crossover trial of statin, Placebo, and no treatment. J Am Coll Cardiol. 2021;78(12):1210\u201322. https:\/\/doi.org\/10.1016\/j.jacc.2021.07.022.","journal-title":"J Am Coll Cardiol"},{"issue":"2","key":"7474_CR19","doi-asserted-by":"publisher","first-page":"e048893","DOI":"10.1136\/bmjopen-2021-048893","volume":"12","author":"Y Lin","year":"2022","unstructured":"Lin Y, Parco C, Karathanos A, et al. Clinical efficacy and safety outcomes of bempedoic acid for LDL-C lowering therapy in patients at high cardiovascular risk: a systematic review and meta-analysis. BMJ Open. 2022;12(2):e048893. https:\/\/doi.org\/10.1136\/bmjopen-2021-048893.","journal-title":"BMJ Open"},{"key":"7474_CR20","doi-asserted-by":"publisher","first-page":"130","DOI":"10.1016\/j.amjcard.2020.06.028","volume":"131","author":"MU Khan","year":"2020","unstructured":"Khan MU, Khan MZ, Munir MB, Balla S, Khan SU. Meta-analysis of the Safety and Efficacy of Bempedoic Acid. Am J Cardiol. 2020;131:130\u20132. https:\/\/doi.org\/10.1016\/j.amjcard.2020.06.028.","journal-title":"Am J Cardiol"},{"issue":"8","key":"7474_CR21","doi-asserted-by":"publisher","first-page":"825","DOI":"10.1177\/2047487320930585","volume":"28","author":"L Dai","year":"2021","unstructured":"Dai L, Zuo Y, You Q, Zeng H, Cao S. Efficacy and safety of bempedoic acid in patients with hypercholesterolemia: a systematic review and meta-analysis of randomized controlled trials. Eur J Prev Cardiol. 2021;28(8):825\u201333. https:\/\/doi.org\/10.1177\/2047487320930585.","journal-title":"Eur J Prev Cardiol"}],"container-title":["Cardiovascular Drugs and Therapy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s10557-023-07474-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s10557-023-07474-9\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s10557-023-07474-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,1,2]],"date-time":"2025-01-02T02:04:00Z","timestamp":1735783440000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s10557-023-07474-9"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,6,1]]},"references-count":21,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2024,12]]}},"alternative-id":["7474"],"URL":"https:\/\/doi.org\/10.1007\/s10557-023-07474-9","relation":{"references":[{"id-type":"uri","id":"","asserted-by":"subject"}]},"ISSN":["0920-3206","1573-7241"],"issn-type":[{"value":"0920-3206","type":"print"},{"value":"1573-7241","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,6,1]]},"assertion":[{"value":"22 May 2023","order":1,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"1 June 2023","order":2,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Dr. Virani is supported by grants from the Department of Veterans Affairs, the National Institute of Health, the Tahir and Jooma Family, and has received Honoraria from the American College of Cardiology (Associate Editor for Innovations, ACC.org). The opinions expressed reflect those of the authors and not necessarily those of the Department of Veterans Affairs or the US government. LS has received consulting honoraria from Philips and Amgen, participated in an advisory board meeting from BMS; and received Grant support from Amgen. He has also participated as site PI for the Victorian-INITIATE trial.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}},{"value":"This study was exempted from the institutional review board\u2019s approval because it used anonymized and de-identified data in a publicly available database.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical Approval"}},{"value":"As this work did not involve the participation of human subjects, no consent forms were required.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to Participate and Publish"}}]}}