CLEAR Outcomes Trial
New England Journal of Medicine (2023)
13% MACE reduction (HR 0.87) in 13,970 statin-intolerant patients over 40.6 months.
Bempedoic Acid (Nexletol)
Oral tablet (180mg)Available in all 50 statesMarketing purposes only. Actual medications, if prescribed, are dispensed by a licensed pharmacy.
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Bempedoic Acid (Nexletol)Bempedoic Acid (Nexletol)
First-in-class oral ATP-citrate lyase inhibitor that reduces cholesterol synthesis upstream of HMG-CoA reductase. Liver-specific activation (via ACSVL1) means no myopathy, critical advantage for statin-intolerant patients. CLEAR Outcomes showed 13% MACE reduction.
No myopathy (muscle lacks activating enzyme)
17 to 25% LDL reduction (38% combined with ezetimibe)
CLEAR Outcomes: 13% MACE reduction
Oral once-daily tablet
No commitment · HSA/FSA eligibleNo commitment · HSA/FSA eligible
How it works
Mechanism of action
Prodrug activated by hepatic ACSVL1 (absent in skeletal muscle) to inhibit ATP-citrate lyase, reducing acetyl-CoA supply for cholesterol synthesis. Liver-selective mechanism eliminates statin-associated muscle toxicity.
The baseline panel.
Every Marek client receives this baseline panel before a provider review. Your provider may add additional biomarkers based on your health history, symptoms, and goals, pulling from 1,000+ available markers. See more biomarkers →
Hormone Profile
12 markers
Sex hormones
- Total TestosteroneLC/MS
- Free TestosteroneEquilibrium Dialysis
- Estradiol, Sensitive / UltrasensitiveLC/MS
- Sex Hormone Binding Globulin (SHBG)
- ProgesteroneLC/MSFemale panel
- Prolactin
- Luteinizing Hormone (LH)
- Follicle-Stimulating Hormone (FSH)
- hCG, Total, QuantitativeFemale panel, pre-menopause
Adrenals & neurosteroids
- Cortisol
- DHEA-S
Growth hormone / IGF-1
- Insulin-Like Growth Factor I (IGF-1)
Thyroid Status
3 markers
Thyroid hormones
- Thyroid Stimulating Hormone (TSH)
- Free T4
- Free T3
Heart Health
9 markers
Cardiovascular health
- Total Cholesterol
- HDL Cholesterol
- LDL Cholesterol
- LDL:HDL Ratio
- VLDL Cholesterol
- Triglycerides
- Apolipoprotein-B (ApoB)
- C-Reactive Protein, High Sensitivity (hsCRP)
- Lipoprotein(a) (Lp(a))
Metabolism
3 markers
Insulin sensitivity
- Blood Glucose
- Fasting Insulin
- HbA1c
Organ Function
26 markers
Liver & pancreas
- AST
- ALT
- Bilirubin, Total
- γ-Glutamyl Transferase (GGT)
Kidney function
- BUN
- Creatinine w/ eGFR
Comprehensive Metabolic Panel (CMP)
- Glucose
- Blood Urea Nitrogen (BUN)
- Creatinine
- eGFR
- BUN/Creatinine Ratio
- Sodium
- Potassium
- Chloride
- Carbon Dioxide, Total
- Calcium
- Protein, Total
- Albumin
- Globulin, Total
- Albumin/Globulin (A/G) Ratio
- Alkaline Phosphatase (ALP)
- AST
- ALT
Prostate health
- Prostate-Specific Antigen (PSA)Male panel
- Free PSAMale panel
- % Free PSAMale panel
Nutrient Status
31 markers
Vitamins & minerals
- Vitamin D, 25-OHD (25-Hydroxy)
- Magnesium, RBC
Iron status
- Iron
- Iron Saturation
- TIBC
- UIBC
- Ferritin
Complete Blood Count (CBC)
- White Blood Count (WBC)
- Red Blood Count (RBC)
- Hemoglobin (Hgb)
- Hematocrit (HCT)
- MCV
- MCH
- MCHC
- Red Cell Distribution Width (RDW)
- Platelets
- Neutrophils
- Neutrophils (Absolute)
- Lymphocytes
- Lymphocytes (Absolute)
- Neutrophil/Lymphocyte Ratio
- Monocytes
- Monocytes (Absolute)
- Eosinophils
- Eosinophils (Absolute)
- Basophils
- Basophils (Absolute)
- Immature Cells
- Immature Granulocytes
- Immature Granulocytes (Absolute)
- NRBC, w/ Reflex for Immature Cells
Clinical evidence
The research behind Bempedoic Acid (Nexletol).
Safety profile
Monitoring & safety information.
Commonly reported side effects
- Hyperuricemia and gout
- Upper respiratory infections
- Muscle spasms
- Elevated transaminases
Less common but serious risks
- Tendon rupture (FDA warning)
- Gout exacerbation
- Drug interaction: raises simvastatin/pravastatin levels
Generally not appropriate for
- Simvastatin >20mg or pravastatin >40mg
- Active gout (relative)
- Pregnancy
Typical monitoring
- Lipid panel
- Serum uric acid
- Liver function
- Tendon symptoms
- Gout symptoms
FAQ
Quick answers.
First-in-class oral ATP-citrate lyase inhibitor that reduces cholesterol synthesis upstream of HMG-CoA reductase. Liver-specific activation (via ACSVL1) means no myopathy, critical advantage for statin-intolerant patients. CLEAR Outcomes showed 13% MACE reduction.
No myopathy (muscle lacks activating enzyme). 17 to 25% LDL reduction (38% combined with ezetimibe). CLEAR Outcomes: 13% MACE reduction. Oral once-daily tablet.
Common side effects include: hyperuricemia and gout, upper respiratory infections, muscle spasms, elevated transaminases. Most side effects are dose-dependent and may resolve with continued use or dose adjustment.
First-in-class oral ATP-citrate lyase inhibitor that reduces cholesterol synthesis upstream of HMG-CoA reductase. Liver-specific activation (via ACSVL1) means no myopathy, critical advantage for statin-intolerant patients. CLEAR Outcomes showed 13% MACE reduction.
Treatments are dependent on licensed clinical prescription. Client costs vary based on individual labs and panel in treatments and services.