Metabolic & Cardiometabolic
bempedoic acid decreases LDL cholesterol (~20-25%)
In plain terms: Does bempedoic acid lower LDL cholesterol, and by how much?
Part of: 💊 bempedoic acid
Yes — consistently ~15-25% LDL-C reduction (≈17-18% on a statin background, ~21-28% as monotherapy/statin-intolerant; ~38% with ezetimibe), proven across the CLEAR phase 3 program and multiple meta-analyses.
Evidence ladder
How far up the ladder this claim has climbed. A high consensus on a low rung means "consistent so far," not "proven in people."
Top evidence so far: All trials, pooled (Meta-analysis)
How the studies fall
The evidence (12)
| Source | Grade | Stance | Quality | Finding |
|---|---|---|---|---|
| Zhao 2020 · BMC Pharmacol Toxicol | meta-analysis | supports | moderate | Meta-analysis (mono and combination): bempedoic acid significantly lowered LDL-C alone and additively with statins/ezetimibe. |
| Yamashita 2025 · Circ J | RCT | supports | moderate | CLEAR-J (Japanese phase 3): bempedoic acid significantly lowered LDL-C vs placebo, replicating Western trials in a distinct population. |
| Ray 2019 · N Engl J Med | RCT | supports | high | CLEAR Harmony (n=2230, on max-tolerated statin): LDL-C -16.5% from baseline, placebo-corrected -18.1 percentage points at wk 12. |
| Laufs 2019 · J Am Heart Assoc | RCT | supports | high | CLEAR Serenity (n=345 statin-intolerant): LDL-C placebo-corrected -21.4% at wk 12; well tolerated, myalgia not increased vs placebo. |
| Ballantyne 2018 · Atherosclerosis | RCT | supports | moderate | CLEAR Tranquility (n=269 statin-intolerant, on ezetimibe): bempedoic acid added to ezetimibe lowered LDL-C ~-23.5% placebo-corrected (combo ~38% total). |
| Nissen 2023 · N Engl J Med | RCT | supports | high | CLEAR Outcomes (n=13,970 statin-intolerant): bempedoic acid cut LDL-C ~21% vs placebo at 6 mo (baseline 139 mg/dL), durable over trial. |
| Ballantyne 2022 · Am J Cardiol | RCT | supports | moderate | CLEAR Harmony open-label extension: LDL-C and hsCRP reductions sustained through up to 2.5 years of continuous treatment. |
| Ridker 2023 · J Clin Lipidol | RCT | supports | high | CLEAR Harmony biomarker substudy (n=817): LDL-C -21.1% placebo-corrected; pattern of lipid+inflammation lowering near-identical to statins. |
| Venkatraman 2023 · Eur J Clin Pharmacol | meta-analysis | supports | moderate | Systematic review/meta-analysis: bempedoic acid consistently and significantly reduced LDL-C across lipid-lowering indications. |
| Uddin 2023 · Curr Probl Cardiol | meta-analysis | supports | high | 7 RCTs (n=17,816): LDL-C mean difference -22.4% (95% CI -25.9 to -18.8) vs placebo; total cholesterol -13.9%. |
| De Filippo 2023 · Cardiovasc Diabetol | meta-analysis | supports | high | Meta-analysis of RCTs: bempedoic acid significantly reduced LDL-C and other atherogenic lipids vs placebo across populations. |
| Goldberg 2019 · JAMA | RCT | supports | high | CLEAR Wisdom (n=779, on max-tolerated statin): LDL-C placebo-corrected -17.4% at wk 12; also lowered non-HDL-C, ApoB, hsCRP. |
Disagree, or know a study we missed?
We grade by evidence, not opinions. The way to weigh in is to point us to a study we haven't cited (check the evidence table above first), or to flag a problem with one we have. Every submission is reviewed; if it holds up, the grade updates and shows in Science Changes Its Mind.
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Educational only, not medical advice. Grades and scores reflect published evidence weighted by study design and quality; see the methodology.