Giuseppe Derosa^{1, 2,}, Pamela Maffioli¹, Angela D’Angelo^{3, 4}, Federico Naj⁵, Riccardo Naj⁵, Giorgio Rubino⁵, Matteo Bressani⁵, Luca Bellazzi⁵, Mario Giacometti⁵, Fortunato Capaccioni⁵, Alessandro Rubino⁵

Background Dyslipidemia is a major risk factor for cardiovascular disease, and achieving LDL-C targets is crucial in primary prevention. However, many patients remain above target due to statin intolerance or inadequate response to therapy. This study evaluates the effectiveness of bempedoic acid, alone or with ezetimibe, in achieving LDL-C goals in a real-world primary prevention population managed by general practitioners (GPs). Methods A total of 254 dyslipidemic patients at moderate cardiovascular risk (LDL-C target: 100 mg/dl) were enrolled. 87.8% were statin-tolerant, while 10.2% were statin-intolerant. Patients received bempedoic acid alone or in combination with ezetimibe for nine months, and changes in lipid profile, glycemic parameters, and safety markers were assessed. Results LDL-C levels significantly decreased from 144.9 ± 27.3 mg/dl to 93.2 ± 11.6 mg/dl (p<0.01), successfully bringing all patients within the target of 100 mg/dl. Triglycerides (p= 0.71) did not decline significantly and TC (p<0.01) declined significantly, while FPG remained stable (−2.2%; p= 0.77). Notably, 61.4% of patients were prediabetic, making the neutral metabolic impact of bempedoic acid particularly relevant. The treatment was well tolerated, with no significant hepatic or muscular adverse effects. Conclusions Bempedoic acid, alone or with ezetimibe, effectively lowers LDL-C to guideline-recommended targets in primary prevention patients, including those with statin intolerance. The study highlights the key role of general practitioners in optimizing lipid management, reinforcing the importance of early and targeted interventions to reduce cardiovascular risk in real-world primary care settings.

Keywords: bempedoic acid, hypercholesterolemia, combined dyslipidemia, general practitioner, statin intolerance, primary prevention