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BRIEF RESEARCH REPORT article

Front. Aging

Sec. Interventions in Aging

This article is part of the Research TopicInnovative Therapeutic and Nanoscale Strategies Targeting Cellular Mechanisms in Aging and Age-related DiseasesView all articles

Evaluation of Bempedoic Acid in Elderly Patients: Real-World Evidence from the REALIST Study

Provisionally accepted
Saverio MuscoliSaverio Muscoli1*Emanuele Di marcoEmanuele Di marco1fiorella puttinifiorella puttini1sara sposini ghezzisara sposini ghezzi1mihaela ifrimmihaela ifrim1mobina amtaehmobina amtaeh1emanuele rengaemanuele renga1Caterina CappelloCaterina Cappello2Giulio BaroneGiulio Barone2gaetano chiricologaetano chiricolo1giuseppe massimo sangiorgigiuseppe massimo sangiorgi1andrea nataleandrea natale1David Della-MorteDavid Della-Morte2
  • 1Department of Cardiology, Policlinico Tor Vergata, Rome, Italy
  • 2Department of Geriatrics, Policlinico Tor Vergata, Rome, Italy

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ABSTRACT Statin intolerance and PCSK9 inhibitor reimbursement restrictions limit lipid-lowering options for elderly patients at high cardiovascular (CV) risk. Bempedoic acid (BA), an ATP-citrate lyase inhibitor, is a promising alternative. This study analyzed 54 patients over 81 years, selected from 2,564 individuals with medium to very high CV risk, who received BA for 52 weeks. Lipid profiles, renal and hepatic function, and adverse events were assessed. BA significantly reduced Low-Density Lipoprotein Cholesterol (LDL-C), triglycerides, and total cholesterol while maintaining stable HDL-C levels. Renal and hepatic function remained unchanged, with increased uric acid as the only notable adverse event. No treatment discontinuations occurred. During follow-up, five patients underwent coronary angiography, two developed atrial fibrillation, and two were hospitalized for heart failure. BA demonstrated efficacy and tolerability in this high-risk, elderly population. It represents a viable lipid-lowering option for statin-intolerant patients or those ineligible for PCSK9 inhibitors. Further studies are needed to confirm long-term cardiovascular benefits.

Keywords: Bempedoic acid (BA), cardiovascular risk management, elderly patient, high cardiovascular risk, real-world data (RWD), Statin intolerance

Received: 29 Jul 2025; Accepted: 10 Feb 2026.

Copyright: © 2026 Muscoli, Di marco, puttini, sposini ghezzi, ifrim, amtaeh, renga, Cappello, Barone, chiricolo, sangiorgi, natale and Della-Morte. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Saverio Muscoli

Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

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