Bempedoic Acid

Bempedoic acid is a medication that helps lower LDL cholesterol by targeting how cholesterol is made in the liver. Your body produces cholesterol through a multi-step process, and many cholesterol-lowering drugs work by blocking different steps in that process. Statins, for example, block an enzyme called HMG-CoA reductase, which is a key player in the cholesterol production pathway.

Bempedoic acid works a bit earlier in that pathway by blocking an enzyme called ATP-citrate lyase (ACLY). ACLY is involved in converting nutrients from food—like sugars and fats—into building blocks the liver uses to make cholesterol. By blocking ACLY, bempedoic acid reduces the supply of these building blocks, which slows down cholesterol production at its source.

What makes bempedoic acid unique is that it starts out as an inactive compound. It only becomes active when it enters liver cells, thanks to a specific enzyme (called ACSVL1) that’s found mainly in the liver. This means that the drug doesn’t activate in muscle cells, which is thought to be one reason it causes fewer muscle-related side effects than statins sometimes do.

Lowering LDL cholesterol is important because high levels can lead to plaque buildup in your arteries, which increases the risk of heart attacks and strokes. By decreasing cholesterol production in the liver, bempedoic acid helps reduce this risk, especially in people who either can't take statins or need additional help controlling their cholesterol.