{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T14:30:36Z","timestamp":1786113036762,"version":"build-2736575974"},"reference-count":27,"publisher":"MDPI AG","issue":"15","license":[{"start":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T00:00:00Z","timestamp":1785888000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Sociedad Extreme\u00f1a de Cardiolog\u00eda"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>Background\/Objectives: Achieving guideline-recommended low-density lipoprotein cholesterol (LDL-C) targets in patients with chronic coronary syndrome (CCS) remains challenging despite intensive lipid-lowering therapy. Bempedoic acid (BA) offers an oral therapeutic option, although data on its clinical performance and patient-level determinants of response in real-world Spanish settings are limited. Methods: We conducted a prospective multicentre study across the four healthcare areas of C\u00e1ceres province, Spain, including consecutive CCS patients with LDL-C \u2265 55 mg\/dL despite stable intensive lipid-lowering therapy. BA 180 mg\/day was added to background treatment. Lipid parameters, metabolic profile, and safety outcomes were assessed after a median follow-up of 28 weeks (IQR 23\u201347). Multivariable analyses were performed to identify factors associated with of LDL-C reduction and target attainment. A total of 118 patients were analyzed for outcomes. Results: A total of 118 patients (mean age 62.4 \u00b1 10.0 years; 79.2% male) were included. BA reduced LDL-C by 22.8% (\u221216.36 mg\/dL; p &lt; 0.001), enabling 48.3% of patients to achieve LDL-C &lt; 55 mg\/dL. Higher baseline LDL-C (\u03b2 = \u22120.515; p = 0.001) and the presence of diabetes mellitus (B = 13.8 mg\/dL; p = 0.024) were independently associated with greater LDL-C reduction. Notably, 56.3% of patients presented with elevated baseline lipoprotein(a) levels (&gt;50 mg\/dL), describing a high underlying burden of residual risk. BA was well tolerated, with a modest increase in uric acid levels but no gout events and a high treatment persistence rate (94.4%). Conclusions: In a real-world CCS population receiving intensive lipid-lowering therapy, BA provides clinically meaningful LDL-C reduction with a favorable safety profile in this multicentre cohort from C\u00e1ceres province. Patients with higher baseline LDL-C and diabetes derive greater benefit, supporting a more personalized approach to therapy. These findings reinforce the role of BA in Spanish patients as an intermediate step in lipid-lowering strategies before escalation to more costly therapies, addressing the scarcity of local real-world data.<\/jats:p>","DOI":"10.3390\/jcm15156102","type":"journal-article","created":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T16:48:08Z","timestamp":1785948488000},"page":"6102","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Bempedoic Acid in Patients with Chronic Coronary Syndrome Not Achieving LDL Targets Despite Intensive Therapy: A Real-World Study from Spain"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4623-9952","authenticated-orcid":false,"given":"Jos\u00e9 Javier","family":"G\u00f3mez-Barrado","sequence":"first","affiliation":[{"name":"Department of Cardiology, Hospital Universitario San Pedro de Alc\u00e1ntara, 10003 C\u00e1ceres, Spain"},{"name":"Faculty of Medicine and Health Sciences Biomedical Sciences, University of Extremadura, 06006 Badajoz, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6230-9968","authenticated-orcid":false,"given":"Paula","family":"G\u00f3mez-Tur\u00e9gano","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Hospital Universitario San Pedro de Alc\u00e1ntara, 10003 C\u00e1ceres, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2911-6763","authenticated-orcid":false,"given":"Miguel","family":"Tur\u00e9gano-Yedro","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Hospital Universitario San Pedro de Alc\u00e1ntara, 10003 C\u00e1ceres, Spain"},{"name":"Primary Care Department, Centro de Salud \u201cEl Casar de C\u00e1ceres\u201d, C\u00e1ceres Healthcare Area, 10190 C\u00e1ceres, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elena","family":"Jim\u00e9nez-Baena","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Hospital Universitario San Pedro de Alc\u00e1ntara, 10003 C\u00e1ceres, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana Isabel","family":"Fern\u00e1ndez-Chamorro","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Hospital Universitario San Pedro de Alc\u00e1ntara, 10003 C\u00e1ceres, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marta","family":"G\u00f3mez-Tur\u00e9gano","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Hospital Universitario San Pedro de Alc\u00e1ntara, 10003 C\u00e1ceres, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,5]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2459","DOI":"10.1093\/eurheartj\/ehx144","article-title":"Low-density lipoproteins cause atherosclerotic cardiovascular disease: Evidence from genetic, epidemiologic, and clinical studies","volume":"38","author":"Ference","year":"2017","journal-title":"Eur. 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