Bempedoic Acid Proved More Effective Against Stroke and Revascularization than Proprotein Convertase Subtilisin/Kexin Type 9 Inhibitors

Individuals with atherosclerotic cardiovascular disease (ASCVD) without diabetes who used bempedoic acid had a lower risk of coronary revascularization and stroke over a 1-year period compared with those treated with proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors, according to real-world findings presented at ACC 2026 in New Orleans. 

Bempedoic acid and PCSK9 inhibitors are novel lipid-lowering therapies that may be added to statins to further decrease levels of atherogenic lipoproteins. These medications also constitute effective alternatives for patients who cannot tolerate statin therapy due to myotoxicity or other adverse events. Both classes of drugs have proven highly effective in reducing low-density lipoprotein cholesterol (LDL-C) levels and decreasing the rates of cardiovascular events in clinical trials. 

In a retrospective study presented at the 75th Annual Scientific Session of the American College of Cardiology, researchers from the Piedmont Athens Regional Medical Centre, in Athens, Georgia used data collected from more than 6,000 patients to retrospectively compare cardiovascular outcomes and safety data between the two drug classes. All included individuals had established ASCVD and no diabetes mellitus. After propensity score matching, the bempedoic acid group and the PCSK9 inhibitor group each included 3,085 individuals with an average age of 69 years. 

During the 1-year follow-up period, patients treated with PCSK9 inhibitors had higher odds of coronary revascularization (HR: 2.013) and stroke (HR: 1.883) than those who received bempedoic acid. However, no significant differences were observed between the two therapies in terms of major adverse cardiovascular events, mortality, or all-cause hospitalization, suggesting similar effectiveness for overall cardiovascular protection.

“These findings suggest that bempedoic acid may be a preferred therapeutic option for reducing [the risk for] specific cardiovascular interventions and stroke in this patient population,” the authors concluded, noting that prospective randomized trials could shed additional light on the effectiveness of these therapies for preventing adverse cardiovascular outcomes in patients at high risk for ASCVD.