Prevention & lipidsSecondary analysis
Effect of bempedoic acid on cardiovascular risk in patients with metabolic dysfunction-associated steatotic liver disease
- Secondary analysis of the CLEAR Outcomes randomised trial
- post-hoc exploratory analysis
Authors' conclusion
Liver steatosis and fibrosis assessed with non-invasive tests are associated with an increased risk of MACE4. Bempedoic acid reduced MACE4 risk, with an additional benefit in patients with elevated steatosis scores.
Study context
- Population
- CLEAR Outcomes participants assessed with non-invasive tests of liver steatosis (Framingham Steatosis Index (FSI)) and fibrosis (FIB-4, NAFLD fibrosis score (NFS))
- Participants
- 13,970 participants
- Comparison
- Bempedoic acid vs Placebo
- Primary endpoint
- 4-component MACE (MACE4)
- Follow-up
- Median 40.6 months
Primary result
As reported in the abstract
MACE4 by non-invasive liver scores (adjusted)
- liver steatosis · per 1 unit of FSI increase, placebo group
- HRFSI 1.13 (95% CI 1.08–1.18)
- liver fibrosis · per 1 unit of increase in score
- HRFIB4 1.21 (95% CI 1.09–1.34)
- liver fibrosis · per 1 unit of increase in score
- HRNFS 1.16 (95% CI 1.10–1.23)
- bempedoic acid · per 1-unit FSI increase, patients at risk for liver steatosis
- HRFSI_BA 1.04 (95% CI 0.99–1.09)
- HRFSI_PBO · per 1-unit FSI increase, patients at risk for liver steatosis, placebo
- HRFSI_PBO 1.14 (95% CI 1.09–1.18)
Original publication
Effect of bempedoic acid on cardiovascular risk in patients with metabolic dysfunction-associated steatotic liver disease. Eur J Prev Cardiol. Published 16 February 2026. doi:10.1093/eurjpc/zwag102
Summarised from the published abstract; every number is checked against it