{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T02:58:54Z","timestamp":1791428334299,"version":"4.3.3"},"reference-count":29,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circulation"],"published-print":{"date-parts":[[2026,1,20]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND:<\/jats:title>\n                    <jats:p>Current guidelines recommend a stepwise strategy to achieve low-density lipoprotein cholesterol (LDL-C) goals after acute coronary syndrome (ACS). Earlier intensive strategies based on a combination of lipid-lowering therapies (LLTs) could be useful from the onset of ACS. However, the role of bempedoic acid in ACS, particularly when combined with high-intensity statins and ezetimibe, remains uncertain. The aim of ES-BempedACS (Efficacy and Security of Bempedoic Acid in Acute Coronary Syndrome) was to compare the efficacy and safety of triple LLT (high-dose, high-intensity statin+ezetimibe+bempedoic acid) versus standard of care (high-dose, high-intensity statin+ezetimibe) after ACS.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS:<\/jats:title>\n                    <jats:p>ES-BempedACS is a multicenter, independent, pragmatic, prospective, randomized, open, blinded end point controlled trial conducted in 12 Spanish hospitals between November 2023 and October 2024. The primary end point was the proportion of patients achieving LDL-C &lt;55 mg\/dL (&lt;1.4 mmol\/L) at 8 weeks after ACS, comparing triple LLT with standard of care.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS:<\/jats:title>\n                    <jats:p>\n                      A total of 206 patients (59.5\u00b110.9 years of age [mean\u00b1SD]; 21.4% women) were randomized within the first 72 hours of ACS to triple LLT or standard therapy of high-intensity statin+ezetimibe (ie, dual LLT). The baseline LDL-C level was 133.6\u00b128.8 mg\/dL. After 8 weeks, the LDL-C level was reduced to &lt;55 mg\/dL in 59.4% of patients in the triple LLT group compared with 53.1% in the control group (dual LLT;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.376). The percentage change in LDL-C level was 57.5\u00b117.8% and 56.9\u00b118.5% in the triple and dual LLT groups, respectively (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.823). Triple versus dual LLT showed similar results in reduction of non\u2013high-density lipoprotein cholesterol levels (49.0\u00b125.4 in triple LLT versus 49.1\u00b131.2 in dual LLT;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.970) and triglyceride levels (14.9\u00b136.9 in triple LLT versus 16.8\u00b136.0 in dual LLT;)\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.718), without differences in adverse events.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS:<\/jats:title>\n                    <jats:p>Both dual and triple LLT after ACS allow for high rates (&gt;50%) of adequate LDL-C control (&lt;55 mg\/dL) at 8 weeks. Adding bempedoic acid to statin\u2013ezetimibe therapy in the setting of ACS is safe but failed to improve the percentage of patients achieving the LDL-C goal (&lt;55 mg\/dL) at 8 weeks. Larger, randomized studies are needed to confirm our findings.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>REGISTRATION:<\/jats:title>\n                    <jats:p>\n                      URL:\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/www.clinicaltrialsregister.eu\">https:\/\/www.clinicaltrialsregister.eu<\/jats:ext-link>\n                      ; Unique identifier: 2021-006550-31.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/circulationaha.125.075388","type":"journal-article","created":{"date-parts":[[2025,11,7]],"date-time":"2025-11-07T10:00:15Z","timestamp":1762509615000},"page":"140-149","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":12,"title":["Triple Versus Dual Lipid-Lowering Therapy in Acute Coronary Syndrome: The ES-BempedACS Randomized Clinical Trial"],"prefix":"10.1161","volume":"153","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6462-4715","authenticated-orcid":true,"given":"Sergio","family":"Raposeiras-Roub\u00edn","sequence":"first","affiliation":[{"name":"Cardiology Department, University Hospital \u00c1lvaro Cunqueiro and Instituto de Investigaci\u00f3n Sanitaria Galicia Sur, Vigo, Spain (S.R.R., P.D.E., A.A. Abej\u00f3n, A.I.R.)"},{"name":"University of Santiago de Compostela, Spain (S.R.R.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emad","family":"Abu Assi","sequence":"additional","affiliation":[{"name":"Povisa Hospital, Vigo, Spain (E.A.A.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C\u00e9sar","family":"Jim\u00e9nez M\u00e9ndez","sequence":"additional","affiliation":[{"name":"Cardiology Department, University Hospital Puerta del Mar, C\u00e1diz, Spain (C.J.M., A.V.R., M.T.G.G., J.A.P.d.l.M.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-8323-6589","authenticated-orcid":true,"given":"Ester","family":"M\u00ednguez de la Gu\u00eda","sequence":"additional","affiliation":[{"name":"Cardiology Department, University Hospital of Albacete, Spain (E.M.d.l.G., M.L.V., F.S.M., M.C.-P.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1451-1445","authenticated-orcid":true,"given":"Jos\u00e9 \u00c1ngel","family":"P\u00e9rez Rivera","sequence":"additional","affiliation":[{"name":"Cardiology Department, University Hospital of Burgos, Spain (J.\u00c1.P.R., L.A.I., A.M.M., E.S.C., I.S.S.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2074-5726","authenticated-orcid":true,"given":"Marta","family":"Marcos Mangas","sequence":"additional","affiliation":[{"name":"Cardiology Department, Bellvitge University Hospital, L\u2019Hospitalet de Llobregat, Barcelona, Spain (M.M.M., \u00c1.V.H.-M., A.A.-S.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana","family":"Ayesta","sequence":"additional","affiliation":[{"name":"Cardiology Department, University Hospital Central de Asturias, Oviedo, Spain (A.A., A.A. Andr\u00e9mar, J.R.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6911-7480","authenticated-orcid":true,"given":"Aitor","family":"Uribarri","sequence":"additional","affiliation":[{"name":"Cardiology Department, University Hospital Vall D\u2019Hebron, Barcelona, Spain (A.U., M.V.B.)"},{"name":"CIBER-CV, Madrid, Spain (A.U., M.V.B.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5411-3700","authenticated-orcid":true,"given":"Pablo","family":"Jorge P\u00e9rez","sequence":"additional","affiliation":[{"name":"Cardiology Department, University Hospital of Canarias, Tenerife, Spain (P.J.P., M.M.M.C.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0573-4321","authenticated-orcid":true,"given":"Pablo Jos\u00e9","family":"Ant\u00fanez Muinos","sequence":"additional","affiliation":[{"name":"Cardiology Department, University Hospital Montecelo, Pontevedra, Spain (P.J.A.M., M.C.G.C.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clara","family":"Bonanad Lozano","sequence":"additional","affiliation":[{"name":"Cardiology Department, University Clinical Hospital of Valencia and INCLIVA Health Research Institute, Spain (C.B.L., D.B.)"},{"name":"University of Valencia, Spain (C.B.L.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Carrasquer","sequence":"additional","affiliation":[{"name":"Cardiology Department, University Hospital Joan XXIII of Tarragona, Spain (A.C.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7194-8419","authenticated-orcid":true,"given":"Ana","family":"Viana-Tejedor","sequence":"additional","affiliation":[{"name":"Cardiology Department, University Hospital Joan XXIII of Tarragona, Spain (A.C.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9885-9459","authenticated-orcid":true,"given":"Pablo","family":"Dom\u00ednguez Erquicia","sequence":"additional","affiliation":[{"name":"Cardiology Department, University Hospital \u00c1lvaro Cunqueiro and Instituto de Investigaci\u00f3n Sanitaria Galicia Sur, Vigo, Spain (S.R.R., P.D.E., A.A. 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Abej\u00f3n, A.I.R.)"},{"name":"Cardiology Department, University Hospital Central de Asturias, Oviedo, Spain (A.A., A.A. 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