Esperion (NASDAQ:ESPR) welcomed the inclusion of bempedoic acid for LDL-C lowering and cardiovascular risk reduction in the 2026 Americal College of Cardiology (ACC)/American Heart Association (AHA) Multisociety Guideline on the Management of Dyslipidemia.

"The reintroduction of guideline-directed LDL-C targets to reduce cumulative LDL-C exposure emphasizes the importance of earlier, aggressive combination therapy and the acknowledgement of statin intolerance as a significant clinical challenge to reducing cardiovascular risk addresses a critical unmet need," said Christie Ballantyne, MD, Professor of Medicine and Chief of Cardiology and Cardiovascular Research at Baylor College of Medicine. "These guidelines provide practical, evidence-based recommendations on how and when to escalate therapy beyond statins to more effectively reduce risk and improve long-term cardiovascular outcomes for patients."

"Recognition from the preeminent American cardiovascular medical associations marks a significant milestone for patients, clinicians and Esperion," said Sheldon Koenig, President and CEO of Esperion. "The multiple Class 1 recommendations for bempedoic acid underscore its validation as a rigorously studied, evidence-based therapy for patients who require additional LDL-C lowering or who are unable to tolerate statins. This level of endorsement strengthens our position within the treatment landscape and will play an essential role in accelerating adoption and expanding access to NEXLETOL® (bempedoic acid) and NEXLIZET® (bempedoic acid and ezetimibe)."

Summary of Key Bempedoic Acid Guideline Recommendations

  • Class of Recommendation 1: In adults without a history of clinical atherosclerotic cardiovascular disease (ASCVD) who experience statin-attributed muscle symptoms on the recommended intensity of statin therapy (secondary causes excluded) and are at high ASCVD risk based on a PREVENT-ASCVD equation of ≥10% or a coronary artery calcium (CAC) score ≥300 AU, or women >65 years of age or men >60 years of age with diabetes, the addition of bempedoic acid and/or ezetimibe is/are indicated to lower LDL-C to <70 mg/dL and non–HDL-C <100 mg/dL and to reduce ASCVD risk.
  • Class of Recommendation 1: In adults with clinical ASCVD who experience statin-attributed muscle symptoms on the recommended intensity of statin therapy (secondary causes excluded) and are unable to achieve recommended treatment goals, use of a reduced statin dose (if tolerable) and the addition of bempedoic acid, ezetimibe, or a PCSK9 monoclonal antibody (mAb), alone or in combination, are recommended to lower LDL-C and reduce ASCVD risk.
  • Class of Recommendation 1: In adults with diabetes who have statin-attributed side effects, initiation of ezetimibe and/or bempedoic acid or a PCSK9 mAb is recommended to lower LDL-C and reduce ASCVD risk.
  • Class of Recommendation 1: In adults with severe hypercholesterolemia with or without clinical ASCVD who meet other guideline criteria and are on maximally tolerated statin therapy, the addition of ezetimibe, a PCSK9 mAb and/or bempedoic acid is recommended to achieve the desired LDL-C goal and to reduce ASCVD risk.  
  • Class of Recommendation 2a: In adults with clinical ASCVD who are not at very high risk and on maximally tolerated statin therapy, it is reasonable to add ezetimibe, a PCSK9 mAb, or bempedoic acid (selected based on the degree of LDL-C lowering needed and patient preference) to achieve a goal LDL-C <70 mg/dL and non–HDL-C <100 mg/dL and to reduce the risk of ASCVD events.
  • Class of Recommendation 2a: In adults with clinical ASCVD who are at very high risk on maximally tolerated statin therapy, it is reasonable to add bempedoic acid, with or without ezetimibe and/or PCSK9 mAb, to reach an LDL-C goal <55 mg/dL and non–HDL-C <85 mg/dL to reduce the risk of ASCVD events.
  • Class of Recommendation 2a: In adults with subclinical atherosclerosis (a CAC score of ≥300 to 999 AU) , it is reasonable to intensify therapy by increasing the intensity of statin therapy or, if needed, adding ezetimibe, a PCSK9 mAb or bempedoic acid to achieve a goal of LDL-C <55 mg/dL and non–HDL-C <85 mg/dL.
  • Class of Recommendation 2b: In adults at high (≥10%) 10-year estimated risk for ASCVD on maximally tolerated statin with or without ezetimibe, it may be reasonable to add a PCSK9 mAb or bempedoic acid if a goal LDL-C <70 mg/dL and non–HDL-C <100 mg/dL is not achieved to lower LDL-C and reduce ASCVD risk.