Background: Bempedoic Acid (BA) is a novel drug that has a potential to serve as an alternative to statins to decrease lipid levels and improve cardiovascular disease (CVD) outcomes, particularly for statin-intolerant individuals. However, insufficient statistical power has limited our understanding of the efficacy and safety of BA. This meta-analysis utilizes the latest data to improve our knowledge of BA's effects on lipids and CVD with increased statistical power.

Methods: MEDLINE, Embase, Cochrane Central, Clinicaltrials.gov, abstracts of national and international conferences, and reference lists of studies were searched for relevant studies. Rayyan was used to screen the search results, and Revman 5.3 was used for the meta-analysis and sensitivity analysis.

Results: Our final analysis included seven randomized control trials (RCTs) with 17,782 participants, 53.6% in the BA group (n=9,535) and 46.4% in the placebo group (n=8,247). BA significantly decreased major adverse cardiovascular events (MACE) (OR: 0.86; 95% CI 0.78-0.95; p=0.03), non-fatal myocardial infarction (OR 0.72; 95% CI 0.61-0.85; p=0.0001), and new onset/worsening diabetes (OR:0.55;95% CI 0.30-0.98, p=0.04), while reducing low-density lipoprotein cholesterol (LDL-C) levels by 22.5% (MD: -22.53%; 95% CI -25.54 to -19.52, p < 0.00001).

Conclusion: The findings of this meta-analysis suggest that BA is a promising and effective alternative to statin therapy, particularly for statin-intolerant and high CVD-risk patients. However, further studies with diverse populations are needed to quantify the long-term efficacy and safety endpoints.