Bempedoic acid (Nexletol, Nexlizet): how it works, status and trials
Approved 2020PillLowering LDL cholesterol
Bempedoic acid works on the same cholesterol-making pathway as statins, one step earlier. It switches on only inside the liver, so the muscles get little exposure.
In technical terms: Activated only in the liver (ACSVL1 is absent from skeletal muscle), so muscle exposure is low. Same downstream LDL-receptor effect as statins.
The highlighted badge marks where Bempedoic acid (Nexletol, Nexlizet) acts. Open the full map or compare every therapy.
At a glance
- Acts on
- ATP-citrate lyase (upstream of HMGCR) · liver
- How it is given
- Oral prodrug · daily
- What the main trial found
- LDL-C −18 pp on a statin, −21 pp without; MACE HR 0.87 (CLEAR Outcomes)
- Status (curated October 25, 2026)
- Approved 2020
Where it fits in the body
Cholesterol synthesis and absorption
When the liver has less cholesterol, whether because synthesis is blocked (statins, bempedoic acid) or less arrives from the gut (ezetimibe, bile acid sequestrants), SREBP-2 switches on the LDL-receptor gene and the liver pulls more LDL out of the blood. SREBP-2 also raises PCSK9, which is one reason PCSK9 inhibitors add well to statins.
Evidence
- CLEAR Outcomes (PubMed 36876740)
- CLEAR Harmony (PubMed 30865796)
Common questions
How does Bempedoic acid (Nexletol, Nexlizet) work?
Bempedoic acid works on the same cholesterol-making pathway as statins, one step earlier. It switches on only inside the liver, so the muscles get little exposure. In technical terms: Activated only in the liver (ACSVL1 is absent from skeletal muscle), so muscle exposure is low. Same downstream LDL-receptor effect as statins. It acts on ATP-citrate lyase (upstream of HMGCR) · liver.
How much does Bempedoic acid (Nexletol, Nexlizet) lower cholesterol or other lipids?
LDL-C −18 pp on a statin, −21 pp without; MACE HR 0.87 (CLEAR Outcomes). Individual results differ, and a clinician can say what to expect for one person.
Is Bempedoic acid (Nexletol, Nexlizet) approved, and what is the status?
Approved 2020 (curated October 25, 2026).
How is Bempedoic acid (Nexletol, Nexlizet) taken?
Oral prodrug · daily.
Read more
Related therapies
- Statins: Approved (generic)
- Ezetimibe (Zetia): Approved (generic)
- Bile acid sequestrants (colesevelam): Approved (generic)
- Evolocumab (Repatha) and alirocumab (Praluent): Approved 2015
Educational, not medical advice. Mechanism and status text curated October 25, 2026; registry data refreshed October 27, 2026. Registries can lag company announcements. Effects are placebo-adjusted results from the main published trial, not head-to-head comparisons. Investigational agents are available only in clinical trials. Preval Health does not practice medicine; licensed clinicians in a partner network provide care. If you have chest pain or signs of a stroke, call 911.