Metabolic & Cardiometabolic
bempedoic acid increases uric acid and gout risk
In plain terms: Does bempedoic acid raise serum uric acid and increase gout risk?
Part of: 💊 bempedoic acid
Yes — it modestly and reversibly raises serum uric acid (via OAT2/OAT3 inhibition of renal urate excretion) and increases gout incidence roughly 1.5-3 fold, concentrated in those with prior gout or high baseline urate; absolute risk remains low.
📅 Last reviewed: 2026-07-15 ⓘ
Evidence ladder
How far up the ladder this claim has climbed. A high consensus on a low rung means "consistent so far," not "proven in people."
Top evidence so far: All trials, pooled (Meta-analysis)
How the studies fall
The evidence (19)
| Source | Grade | Stance | Quality | Finding |
|---|---|---|---|---|
| Gómez-Barrado JJ et al 2025 · Preprints.org | observational | mixed | moderate | Prospective real-world study, n=118 CCS patients on bempedoic acid 180mg/day added to intensive LLT: uric acid increased by 0.96 mg/dL over >=8 weeks, with no gout events observed. |
| d10-5281-zenodo-17710926 2025 · Zenodo (CERN European Organization for Nuclear Research) | observational | supports | low | States bempedoic acid use is associated with an increased risk of developing gout, likely due to elevated serum uric acid levels as evidenced in various studies. |
| Ray 2019 · N Engl J Med | RCT | supports | high | CLEAR Harmony: gout 1.2% vs 0.3% placebo; hyperuricemia AEs 10.9% vs 7.1%. ↩ SUPERSEDED — pooled in the review above, counted once |
| Zeng W et al 2025 · study_type: observational | observational | supports | low | Safety review of statin alternatives states bempedoic acid is associated with a small increase in plasma uric acid and slightly increased frequency of gout episodes in susceptible subjects. |
| Bonanni 2026 · Nutr Metab Cardiovasc Dis | mechanism | supports | moderate | Mechanism: bempedoic acid inhibits renal OAT2/OAT3, reducing urate excretion; the uric-acid rise is minor and reversible. |
| Bays 2024 · J Clin Lipidol | RCT | supports | moderate | CLEAR Outcomes safety analysis: confirms higher gout and uric-acid elevation rates, but absolute event numbers low and rarely treatment-limiting. |
| De Filippo 2023 · Cardiovasc Diabetol | meta-analysis | supports | high | Safety meta-analysis: increased incidence of gout/hyperuricemia among the few significant adverse-event signals for bempedoic acid. |
| Duarte Lau 2023 · JAMA Cardiol | mechanism | supports | moderate | Narrative review of ACLY inhibition notes elevated uric acid as an on-target/transporter-mediated class effect of bempedoic acid. |
| Venkatraman 2023 · Eur J Clin Pharmacol | meta-analysis | supports | moderate | Meta-analysis: elevated risk of gout and hyperuricemia identified as a consistent bempedoic acid safety signal. |
| Alunno 2023 · Front Cardiovasc Med | RCT | mixed | moderate | Systematic review: gout signal real but inconsistent across RCTs — significant in only 1 study; baseline urate/gout history poorly reported; risk likely concentrated in predisposed patients. |
| Strikic D et al 2025 · study_type: observational | observational | supports | low | Narrative review states that adverse effects such as increased uric acid and gout have been reported with bempedoic acid, requiring careful patient selection and monitoring. |
| Gomez-Barrado JJ et al 2025 · Research Square | observational | mixed | moderate | Prospective real-world study, n=118/125 CCS patients (same cohort as related preprint): uric acid rose by 0.96 mg/dL, but no gout occurred; renal function changes were small. |
| Goldberg 2019 · JAMA | RCT | supports | moderate | CLEAR Wisdom: hyperuricemia 4.2% vs 1.9% placebo among common adverse events. ↩ SUPERSEDED — pooled in the review above, counted once |
| Su PH et al 2026 · study_type: observational | observational | mixed | moderate | Retrospective cohort, 7676 propensity-matched pairs (bempedoic acid vs ezetimibe): incident hyperuricemia (UA>7.0mg/dL) HR 1.94 (95% CI 1.58-2.37) at 12 months. Anti-gout therapy initiation did not differ between groups (HR 1.06, 95% CI 0.8 |
| Uddin 2023 · Curr Probl Cardiol | meta-analysis | supports | high | 7 RCTs (n=17,816): gout RR 1.55 (1.26-1.90) and hyperuricemia RR 1.94 (1.73-2.18) vs placebo, both highly significant. |
| Yarrarapu 2024 · J Cardiol | observational | supports | moderate | Review: up to ~4x higher gout risk in patients with prior gout diagnosis or high baseline serum uric acid; recommends baseline urate monitoring. |
| Albosta M et al 2023 · study_type: observational | observational | supports | moderate | Review of CLEAR Outcomes trial data states bempedoic acid was associated with increases in uric acid levels and cholelithiasis, though numerically fewer myalgia/new-onset-diabetes events. |
| Pradhan 2023 · J Cardiovasc Dev Dis | observational | supports | moderate | Review: uric acid rises ~4x more often and acute gout ~3x more often vs placebo, via competitive renal transport at OAT2. |
| Nissen 2023 · N Engl J Med | RCT | supports | high | CLEAR Outcomes: gout 3.1% vs 2.1% (placebo) and higher hyperuricemia/uric-acid elevation in the bempedoic acid arm. |
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