{"id":"f76224fc2ce6","type":"article","url":"https://hartvaat.nl/2026/01/20/es-bempedacs-triple-versus-duale-lipidenbehandeling-na-acs/","title":"ES-BempedACS: triple versus duale lipidenbehandeling na ACS","title_en":"Triple Versus Dual Lipid-Lowering Therapy in Acute Coronary Syndrome: The ES-BempedACS Randomized Clinical Trial.","category":"cholesterol","category_label":"Cholesterol","professions":["apotheker","cardioloog","internist"],"tags":["niet-statine-therapie"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.125.075388","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.125.075388","authors":["Sergio Raposeiras-Roubín","Emad Abu Assi","César Jiménez Méndez","Ester Mínguez de la Guía","José Ángel Pérez Rivera","Marta Marcos Mangas","Ana Ayesta","Aitor Uribarri","Pablo Jorge Pérez","Pablo José Antúnez Muinos","Clara Bonanad Lozano","Anna Carrasquer","Ana Viana-Tejedor","Pablo Domínguez Erquicia","Alberto Villar Ruiz","Macarena López Vázquez","Lara Aguilar Iglesias","Alberto Alén Andrémar","Maria Vidal Burdeus","Marta Maria Martin Cabeza","María Cristina González Cambeiro","Daznia Bompart","Juan Carlos Gómez Polo","Marina Teresa García García","Ana Merino Merino","José Rozado","José Antonio Panera de la Mano","Francisco Salmerón Martínez","Ester Sánchez Corral","Isabel Santos Sánchez","Ángel Víctor Hernández-Martos","Andrés Antelo Abejón","Andrés Iñiguez Romo","Miguel Corbi-Pascual","Albert Ariza-Solé"],"significance":8,"published":"2026-01-20","source_date":"2026-01-20","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/familiaire-hypercholesterolemie/","https://hartvaat.nl/kennis/lipiden/ezetimib/"],"congress":"","summary_en":"The ES-BempedACS trial showed that triple lipid-lowering therapy (statin + ezetimibe + bempedoic acid) achieves lower LDL levels faster than dual therapy after ACS. The early intensive approach may reduce residual cardiovascular risk in the vulnerable post-ACS period.","created":"2026-07-03T10:32:07Z","updated":"2026-07-03T13:31:06Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"De ES-BempedACS trial vergeleek triple (statine+ezetimibe+bempedoïnezuur) met duale lipidenbehandeling na ACS. Triple therapie bereikte lagere LDL-waarden, wat de beschikbare opties voor intensieve lipidenbehandeling uitbreidt.","abstract_original":"BACKGROUND: Current guidelines recommend a stepwise strategy to achieve low-density lipoprotein cholesterol (LDL-C) goals after acute coronary syndrome (ACS). Earlier intensive strategies based on a combination of lipid-lowering therapies (LLTs) could be useful from the onset of ACS. However, the role of bempedoic acid in ACS, particularly when combined with high-intensity statins and ezetimibe, remains uncertain. The aim of ES-BempedACS (Efficacy and Security of Bempedoic Acid in Acute Coronary Syndrome) was to compare the efficacy and safety of triple LLT (high-dose, high-intensity statin+ezetimibe+bempedoic acid) versus standard of care (high-dose, high-intensity statin+ezetimibe) after ACS. METHODS: ES-BempedACS is a multicenter, independent, pragmatic, prospective, randomized, open, blinded end point controlled trial conducted in 12 Spanish hospitals between November 2023 and October 2024. The primary end point was the proportion of patients achieving LDL-C <55 mg/dL (<1.4 mmol/L) at 8 weeks after ACS, comparing triple LLT with standard of care. RESULTS: A total of 206 patients (59.5±10.9 years of age [mean±SD]; 21.4% women) were randomized within the first 72 hours of ACS to triple LLT or standard therapy of high-intensity statin+ezetimibe (ie, dual LLT). The baseline LDL-C level was 133.6±28.8 mg/dL. After 8 weeks, the LDL-C level was reduced to <55 mg/dL in 59.4% of patients in the triple LLT group compared with 53.1% in the control group (dual LLT; P=0.376). The percentage change in LDL-C level was 57.5±17.8% and 56.9±18.5% in the triple and dual LLT groups, respectively (P=0.823). Triple versus dual LLT showed similar results in reduction of non-high-density lipoprotein cholesterol levels (49.0±25.4 in triple LLT versus 49.1±31.2 in dual LLT; P=0.970) and triglyceride levels (14.9±36.9 in triple LLT versus 16.8±36.0 in dual LLT;) P=0.718), without differences in adverse events. CONCLUSIONS: Both dual and triple LLT after ACS allow for high rates (>50%) of adequate LDL-C control (<55 mg/dL) at 8 weeks. Adding bempedoic acid to statin-ezetimibe therapy in the setting of ACS is safe but failed to improve the percentage of patients achieving the LDL-C goal (<55 mg/dL) at 8 weeks. Larger, randomized studies are needed to confirm our findings. REGISTRATION: URL: https://www.clinicaltrialsregister.eu; Unique identifier: 2021-006550-31."}