Effect of bempedoic acid on incretin axis and systemic and liver inflammation: a pilot, monocentric study

Background and aims: Bempedoic Acid (Bemp-Ac) is able to reduce LDL cholesterol and cardiovascular events in hypercholesterolemic subjects with a wide risk profile, and is the recommended first line therapy when statins are not tolerated. We explored its efficacy, tolerability, metabolic, systemic and liver anti-inflammatory effects in non-diabetic individuals. Methods and results: Twenty-five statin-intolerant subjects were treated for three months with Bemp-Ac 180 mg/day. Metabolic profile, hormones regulating glucose metabolism and inflammatory markers were measured. Liver status was assessed through Fibroscan. Data were compared with those obtained in twelve subjects treated with Ezetimibe 10 mg/day, following the same protocol. Bemp-Ac reduced total cholesterol by about 25 %. Kidney function did not vary. The relevant anti-inflammatory effect of Bemp-Ac was confirmed by the significant improvement of liver condition (reduced CAP and LS, p = 0.042 and p = 0.008 respectively), persisting after adjustment for confounders; a reduction in white blood cells and cytokines levels was also observed. A detailed evaluation of glucose metabolism unveiled a significant reduction of GLP-1 and insulin, while glucagon and GIP were not influenced by the treatment with Bemp-Ac. Conclusion: Beside its hypolipidemic effects, Bemp-Ac reduces liver steatosis and inflammation and modulates glucoregulatory hormones in statin-intolerant, non-diabetic individuals.