LAUSR

To the Editor The recently published ‘Updated clinical evidence and place in therapy of bempedoic acid (BA) for hypercholesterolemia: aNMCO position paper’ by Colivicchi et al. reviewed the mechanism of action and the efficacy and safety studies of bempedoic acid, an emerging treatment for hypercholesterolemia; and proposed a treatment flowchart including bempedoic acid among the third-choice drugs updating ESC/EAS 2019 Guidelines. Surprisingly, bempedoic acid treatment is suggested at the same decisional knot of proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9-Is), although the authors acknowledged the current lack of an outcome study for bempedoic acid and the reliability of PCSK9-Is. However, the low-density lipoprotein (LDL) targets of 55 mg/dl or less for very high-risk patients, and even 40 mg/dl or less for patients who have experienced a second vascular event within 2 years are not reached in a significant percentage of patients. On the other hand, the PCSK9-Is have changed the treatment landscape option providing a powerful weapon for achieving such ambitious targets.