Should Patients with Diagnosed Hyperlipidemia Take Hibemibe (Cesme) Long-Term, or Can They Stop Once Lipid Levels Normalize?

After a diagnosis of hyperlipidemia, many patients wonder whether treatment with bempedoic acid (brand name Nexletol, marketed in China as Saishimei) should be continued indefinitely or discontinued once lipid levels normalize. Current clinical evidence and guidelines support long-term, often lifelong, therapy for most individuals.

Bempedoic acid is a first-in-class ATP-citrate lyase (ACL) inhibitor that lowers low-density lipoprotein cholesterol (LDL-C) by reducing hepatic cholesterol synthesis. Unlike statins, it acts upstream in the cholesterol biosynthesis pathway and is not metabolized by the cytochrome P450 system—making it a valuable option for patients who cannot tolerate statins or require additional LDL-C reduction despite maximally tolerated statin therapy.

Clinical trials—including the pivotal CLEAR Outcomes study—demonstrated that bempedoic acid significantly reduces major adverse cardiovascular events (MACE), including myocardial infarction, stroke, and cardiovascular death, particularly in high- and very-high-risk patients. These benefits were observed irrespective of baseline LDL-C levels and persisted only while the drug was actively administered.

Importantly, lipid-lowering medications like bempedoic acid treat the underlying pathophysiology—not just the laboratory value. Elevated LDL-C reflects chronic dysregulation of cholesterol homeostasis; stopping therapy typically leads to rapid rebound in LDL-C levels within weeks, restoring cardiovascular risk to pretreatment levels. Therefore, discontinuation solely because lipid parameters have normalized is not recommended without careful individualized reassessment.

Decisions about treatment duration must be guided by comprehensive cardiovascular risk stratification—including presence of established atherosclerotic cardiovascular disease (ASCVD), diabetes, familial hypercholesterolemia, or other high-risk conditions—as well as shared decision-making between patient and clinician. In most cases, ongoing pharmacologic therapy remains essential to sustain risk reduction and prevent future cardiovascular events.