Metabolic & Cardiometabolic
bempedoic acid increases uric acid and gout risk
In plain terms: Does bempedoic acid raise serum uric acid and increase gout risk?
Part of: 💊 bempedoic acid
Yes — it modestly and reversibly raises serum uric acid (via OAT2/OAT3 inhibition of renal urate excretion) and increases gout incidence roughly 1.5-3 fold, concentrated in those with prior gout or high baseline urate; absolute risk remains low.
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 |
|---|---|---|---|---|
| Ray 2019 · N Engl J Med | RCT | supports | high | CLEAR Harmony: gout 1.2% vs 0.3% placebo; hyperuricemia AEs 10.9% vs 7.1%. |
| Bonanni 2026 · Nutr Metab Cardiovasc Dis | mechanism | supports | moderate | Mechanism: bempedoic acid inhibits renal OAT2/OAT3, reducing urate excretion; the uric-acid rise is minor and reversible. |
| Bays 2024 · J Clin Lipidol | RCT | supports | moderate | CLEAR Outcomes safety analysis: confirms higher gout and uric-acid elevation rates, but absolute event numbers low and rarely treatment-limiting. |
| De Filippo 2023 · Cardiovasc Diabetol | meta-analysis | supports | moderate | Safety meta-analysis: increased incidence of gout/hyperuricemia among the few significant adverse-event signals for bempedoic acid. |
| Duarte Lau 2023 · JAMA Cardiol | mechanism | supports | moderate | Narrative review of ACLY inhibition notes elevated uric acid as an on-target/transporter-mediated class effect of bempedoic acid. |
| Venkatraman 2023 · Eur J Clin Pharmacol | meta-analysis | supports | moderate | Meta-analysis: elevated risk of gout and hyperuricemia identified as a consistent bempedoic acid safety signal. |
| Alunno 2023 · Front Cardiovasc Med | meta-analysis | mixed | moderate | Systematic review: gout signal real but inconsistent across RCTs — significant in only 1 study; baseline urate/gout history poorly reported; risk likely concentrated in predisposed patients. |
| Goldberg 2019 · JAMA | RCT | supports | moderate | CLEAR Wisdom: hyperuricemia 4.2% vs 1.9% placebo among common adverse events. |
| Uddin 2023 · Curr Probl Cardiol | meta-analysis | supports | high | 7 RCTs (n=17,816): gout RR 1.55 (1.26-1.90) and hyperuricemia RR 1.94 (1.73-2.18) vs placebo, both highly significant. |
| Yarrarapu 2024 · J Cardiol | observational | supports | moderate | Review: up to ~4x higher gout risk in patients with prior gout diagnosis or high baseline serum uric acid; recommends baseline urate monitoring. |
| Pradhan 2023 · J Cardiovasc Dev Dis | observational | supports | moderate | Review: uric acid rises ~4x more often and acute gout ~3x more often vs placebo, via competitive renal transport at OAT2. |
| Nissen 2023 · N Engl J Med | RCT | supports | high | CLEAR Outcomes: gout 3.1% vs 2.1% (placebo) and higher hyperuricemia/uric-acid elevation in the bempedoic acid arm. |
Disagree, or know a study we missed?
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