High LDL-cholesterol values are still one of the most important cardiovascular risk factors as was shown in the INTERHEART study in 2004 [1]. As from 1994, when the 4S Study [2] was published and, for the first time, lowering LDL cholesterol proved to reduce myocardial infarction, statins were the cornerstone of lipid-lowering treatment for the last decades. Apart from ezetimibe, they were the only approved measure for lipid cholesterol lowering, which proved its clinical efficacy with the IMPROVE-IT study [3]. A new most efficacious treatment arrived with the discovery of the PCSK9 inhibition [4‒6].

Bempedoic acid is a new player on the ground. The review by Drexel et al. [7] describes its mechanism and its clinical benefit based on the most recent data. Bempedoic acid is certainly of great value, especially in patients who suffer from muscle pain, which is the most frequent adverse effect of statins. However, the monotherapy with bempedoic acid is probably not effective enough with LDL-lowering in the order of 20–30%. The combination of bempedoic acid with ezetimibe has been shown to lower LDL cholesterol by about 50%, which is recommended by the ESC Guidelines on lipid lowering [8] and is thus a valuable new option for lipid lowering.

Before retirement, W.F.R. was a member of the following advisory boards: Pfizer, MSD, Sanofi-Aventis, Daiichi Sankyo, Recordati, and Amgen. There were no other conflicts of interest to declare.

No funding was received.

W.F.R. was responsible for the ideation, structure, and writing as well as approval of this contribution.

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