Bempedoic acid is a first-in-class ATP citrate lyase (ACL) inhibitor that reduces LDL cholesterol production in the liver, offering a non-statin option for patients with hypercholesterolemia or high cardiovascular risk. Approved by the FDA in February 2020, it activates specifically in liver cells via conversion to its active form, upregulating LDL receptors to clear more cholesterol from the blood. Clinical trials demonstrate LDL-C reductions of about 18-21% alone and up to 38% with ezetimibe, alongside lowered apolipoprotein B and inflammation markers. It's indicated for statin-intolerant adults with established heart disease or heterozygous familial hypercholesterolemia, often alongside diet and other therapies. Developed by Esperion Therapeutics, bempedoic acid targets an enzyme upstream of statins, minimizing muscle-related issues.