ACLY and familial hypercholesterolemia: A phase 2 trial showed that evinacumab reduced LDL-C levels by more than 50% compared to placebo treatment in patients with refractory hypercholesterolemia.[17] Bempedoic acid is an ATP-citrate lyase inhibitor, which is a cytosolic enzyme upstream of 3-hydroxy-3-methylglutaryl coenzyme A in the pathway for de novo cholesterol synthesis.