Efficacy and safety of bempedoic acid in women with hypercholesterolemia: Pooled analyses from phase 3 trials

Background and aimsSex-specific differences in the response to lipid-lowering therapies have been reported. Here, we assessed the effect of bempedoic acid in women and men using pooled, patient-level data from four phase 3 clinical trials of bempedoic acid. MethodsPatients were grouped into two pools: atherosclerotic cardiovascular disease (ASCVD) and/or heterozygous familial hypercholesterolemia (HeFH) "on statins", and "low-dose or no statin". Percent changes from baseline to at least week 12 in low-density lipoprotein-cholesterol (LDL-C), non-high-density lipoprotein-cholesterol (non-HDL-C), total cholesterol (TC), apolipoprotein B (Apo B), and high-sensitivity C-reactive protein (hsCRP), as well as safety, were analyzed by statin pool and sex. ResultsOverall, 3623 patients were included (bempedoic acid, 2425; placebo, 1198). Significant reductions in lipid parameters and hsCRP were observed with bempedoic acid vs. placebo in both sexes in the ASCVD and/or HeFH on statins (n = 3009) and the low-dose or no statin (n = 614) pools (p[≤]0.002). Compared with men, women had significantly greater placebo-corrected reductions in LDL-C (-21.2% vs. -17.4%; p=0.044), non-HDL-C (-17.3% vs. -12.1%; p=0.003), TC (-13.8% vs. -10.5%; p=0.012), and Apo B (-16.0% vs. -11.3%; p=0.004) in the ASCVD and/or HeFH on statins pool. Women had numerically greater reductions than men in lipid parameters in the low-dose or no statin pool and hsCRP in both pools. The safety of bempedoic acid was comparable between sexes. ConclusionsIn this pooled analysis, women experienced significant improvements in levels of LDL-C and other lipid parameters with bempedoic acid.