triPle Oral thERapy With Bempedoic Acid vs uSual Care in Early Lipid Management of Patients With acUte coronAry synDromE

Trial details

Who runs it

Heart Care Foundation

Trial code

NCT07440381EU 2026-525740-15-00

Record updated

27 February 2026

Original description

Early and intensive LDL-cholesterol (LDL-c) reduction is associated with improved short-term and long-term outcomes. Bempedoic acid is an oral ATP citrate lyase inhibitor that lowers LDL-c upstream of HMG-CoA reductase. When added to maximally tolerated statins, it has demonstrated significant LDL-c reduction and cardiovascular benefit, particularly in statin-intolerant or high-risk patients. However, evidence on early initiation of bempedoic acid during the index ACS hospitalization is currently lacking. The investigators therefore would like to see whether early (pre-discharge) initiation of an oral triple lipid-lowering therapy including bempedoic acid, high-intensity statin (HIS), and ezetimibe is superior to usual care in reducing LDL-c levels at 8 weeks after randomization in patients hospitalized for ACS.Read full original descriptionShow less

triPle Oral thERapy With Bempedoic Acid vs uSual Care in Early Lipid Management of Patients With acUte coronAry synDromE (PERSUADE) Trial

Early and intensive LDL-cholesterol (LDL-c) reduction is associated with improved short-term and long-term outcomes. Bempedoic acid is an oral ATP citrate lyase inhibitor that lowers LDL-c upstream of HMG-CoA reductase. When added to maximally tolerated statins, it has demonstrated significant LDL-c reduction and cardiovascular benefit, particularly in statin-intolerant or high-risk patients. However, evidence on early initiation of bempedoic acid during the index ACS hospitalization is currently lacking. The investigators therefore would like to see whether early (pre-discharge) initiation of an oral triple lipid-lowering therapy including bempedoic acid, high-intensity statin (HIS), and ezetimibe is superior to usual care in reducing LDL-c levels at 8 weeks after randomization in patients hospitalized for ACS.

Inclusion: Age ≥18 years; Male and females at birth; Admitted for ACS caused by an atherothrombotic coronary event; Calculated LDL-c: 70-140 mg/dL within 24 hours from admission for the ACS index event; Lipid lowering therapy on admission consisting of a low/moderate intensity statin or a high intensity statin (HIS); or no lipid lowering therapy (naïve patients); Lipid-lowering therapy at discharge (at the time of randomization) consisting of HIS or HIS + ezetimibe; Scheduled home discharge; Written informed consent provided; patients who are unable to give informed consent for any reason will be excluded from the study.

Exclusion: Patients already treated with HIS+Ezetimibe on admission for the ACS event,; Patients currently, previously or planned to be treated with PCSK9i or inclisiran,; Current enrolment in another investigational device or drug study,; Known allergy, sensitivity or intolerance to bempedoic acid and/or study drugs' formulation ingredients (e.g. lactose intolerance),; Patients with history of documented intolerance to statins, ezetimibe or bempedoic acid; Patients with plasma triglycerides concentration exceeding 400 mg/dL (4.52 mmol/L),; Severe renal dysfunction (eGFR <30 ml/min/1.73m2 using the CKD-EPI formula),; Active liver disease or hepatic dysfunction (AST or ALT levels > 3xUNL),; Patients treated currently or in the last 3 months with bempedoic acid or in whom this treatment is planned in the following 8 weeks,; Patients with known Familial Hypercholesterolemia (FH; heterozygous or homozygous),; Patients with dysbetalipoproteinemia (type III hyperlipoproteinemia),; Unstable clinical status (hemodynamic or electrical instability),; Current pregnancy, lactation or women of childbearing potential, unless using highly effective contraception,; Patients unlikely to comply with the protocol or unable to understand the nature, scope and possible consequences of the study.

ClinicalTrials.gov NCT07440381 · EU CTIS 2026-525740-15-00