{"id":"543b65d9286e","type":"article","url":"https://hartvaat.nl/2026/11/05/bempedoiczuur-bij-statin-geintolerante-patienten-real-world-strategieen-en-combi/","title":"Bempedoiczuur bij statin-geïntolerante patiënten: real-world strategieën en combinatietherapie","title_en":"Bempedoic Acid in Statin-Intolerant Patients: Real-World Implementation Strategies, Cardiovascular Outcomes Beyond the CLEAR Trial, and Combination Therapy Approaches.","category":"cholesterol","category_label":"Cholesterol","professions":["apotheker","cardioloog","internist"],"tags":[],"journal":"Current atherosclerosis reports","doi":"10.1007/s11883-026-01483-3","source_url":"https://doi.org/10.1007/s11883-026-01483-3","authors":["Carlos Vergara Sanchez","Rodolfo A Lopes","Michael D Shapiro"],"significance":6,"published":"2026-11-14","source_date":"2026-11-05","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/ezetimib/","https://hartvaat.nl/kennis/lipiden/lipidenmedicatie-bij-ckd/"],"congress":"","summary_en":"This narrative review evaluates bempedoic acid for lipid lowering in statin-intolerant patients, synthesizing data from the CLEAR Outcomes trial and real-world implementation strategies. The agent effectively reduces LDL cholesterol and significantly decreases major adverse cardiovascular events in high-risk ASCVD populations, while maintaining a low risk of muscle-related adverse effects. Clinicians should distinguish true intolerance from the nocebo effect, maximize tolerated statin therapy, and utilize combination regimens with ezetimibe or PCSK9 inhibitors to close the residual lipid gap. Routine monitoring for hyperuricemia, gout, and tendon injury is recommended during long-term treatment.","created":"2026-11-07T02:54:10Z","updated":"2026-11-07T02:54:10Z","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":"Deze review analyseert bempedoiczuur als lipidendalend middel bij patiënten met statinintolerantie, gebaseerd op de CLEAR-trialreeks en real-world implementatiedata. Het middel verlaagt LDL-cholesterol effectief en CLEAR Outcomes toonde een significante reductie in MACE bij hoogcardiovasculair risicopatiënten, zonder verhoogd risico op spiergerelateerde bijwerkingen. Voor de klinische praktijk is het cruciaal om het nocebo-effect te herkennen, gedeeltelijke van volledige intolerantie te onderscheiden, en bempedoiczuur te combineren met ezetimibe of PCSK9-remmers naarmate het lipidendoel niet gehaald wordt. Regelmatige monitoring op hyperurikemie, jicht en peesletsel is nodig bij langdurig gebruik.","abstract_original":"PURPOSE OF THE REVIEW: Statin intolerance remains a significant barrier to achieving lipid goals and reducing atherosclerotic cardiovascular disease (ASCVD) risk. Bempedoic acid (BA), an oral ATP-citrate lyase inhibitor activated predominantly in the liver, offers a non-statin lipid-lowering option with a low propensity for muscle-related adverse effects. This review seeks to discuss BA use in real-world practice. RECENT FINDINGS: This review summarizes BA pharmacology, cardiovascular outcomes, safety, combination strategies, and real-world implementation in individuals who are either statin intolerant or unwilling to take statins. The CLEAR clinical trial series established BA's lipid-lowering effect and safety profile, culminating in CLEAR Outcomes, which further demonstrated fewer major adverse cardiovascular events among patients with established ASCVD or at high cardiovascular risk. Although these findings are compelling, they are limited to this population, and the impact in low- to borderline-risk populations remains unclear. In practice, clinicians should assess the potential contribution of the nocebo effect, distinguish partial versus complete statin intolerance, preserve any tolerated statin exposure, define the residual lipid-lowering gap, and align treatment intensity with cardiovascular risk and patient preferences. BA may then be considered within a guideline-directed framework that accounts for treatment access, tolerability, and shared decision-making. Combination therapy with BA and ezetimibe represents a practical oral option, whereas PCSK9-targeted therapy may be preferred when the gap to lipid goals is sufficiently large or the patient is at high ASCVD risk. Clinicians should also provide risk-based counseling and monitoring for potential adverse effects, including hyperuricemia, gout, and tendon injury. Overall, BA represents a valuable addition to the lipid-lowering armamentarium."}