Bempedoic acid is used in combination with a statin or another lipid-lowering therapy if LDL-C levels cannot be achieved with the maximum tolerated dose of statins.
It can also be used as monotherapy or in combination with other lipid-lowering therapies in cases of statin intolerance or contraindication.

In stepwise therapy to achieve LDL-C target values, treatment begins with a high-efficacy statin.
If target values are not achieved, the addition of ezetimibe is recommended.
If the target levels are still not met, bempedoic acid is recommended for cost-effectiveness reasons before initiating treatment with PCSK9 inhibitors.
If the target values are not achieved even with this triple combination, a PCSK9 inhibitor is used.
In this case, discontinuation of bempedoic acid can be considered, as the combination of statin, ezetimibe, and PCSK9 inhibitor usually achieves the target values.
However, in cases of statin intolerance, therapy with bempedoic acid should definitely be continued.

The NNT (Number Needed to Treat) for the 4-point MACE (major adverse cardiovascular events) — including death from any cause, non-fatal heart attack, non-fatal stroke, or coronary revascularization — is 62.
The NNT for the 3-point MACE — including cardiovascular death, non-fatal heart attack, and non-fatal stroke — is 76.
Due to the demonstrated effectiveness in endpoint studies, bempedoic acid is expected to be included in upcoming updated guidelines.