The goal in cardiovascular prevention is the reduction of morbidity and mortality through the promotion of healthy lifestyles in the general population. The management of modifiable risk factors with pharmacological and non-pharmacological interventions, based on the individual risk is the first strategy suggested by the current guidelines. Several epidemiological studies have clearly shown the direct correlation between high levels of low-density lipoprotein cholesterol (LDL-C) and incidence of cardiovascular diseases. On the other hand, numerous randomized clinical studies have reported a huge benefit in terms of major cardiovascular events achievable by the reduction of LDL-C, thus supporting the notion that “the lower is better”. Among the lipid-lowering strategies, statins are the drugs of choice in cardiovascular prevention, at both primary and secondary level. To achieve the ambitious targets suggested by the current guidelines, other lipid-lowering therapies are currently available in addition to statins, such as ezetimibe the inhibitors of the PCSK9. Pharmacological research has recently led to the development of a new drug, the bempedoic acid, which further enrich the available therapies. This drug also acts on the biosynthesis of cholesterol but at upstream level than statins. From the biochemical point of view, it has the potential to be considered before the statin with consequent titration of statins to achieve the desirable LDL-C target. In the present review, the biochemical and pharmacological characteristics of bempedoic acid are discussed. An overview of the clinical data that support its use in the management of the cardiovascular patient and its allocation in the lipid-lowering scenario will be also provided.

To investigate the clinical value of delta agent infection in HBsAg positive chronic hepatitis, we detected anti-delta antibody (anti-6) in serum and delta antigen (6-Ag) on sequential liver biopsies of nine patients with HBsAg-positive CPH and 45 patients with HBsAg-positive CAH without cirrhosis observed for at least 2 years. The initial group of patients with CAH was composed of 54 patients who were consecutively either left untreated or treated with 15 mg of prednisolone daily. Nine patients dropped out. 6-Ag was searched by the direct immunofluorescence technique. HBsAg, anti-6, HBeAg and anti-HBe were detected by RIA.All CPH patients were 6-Ag negative in the 1st liver biopsy and anti4 negative in serum. Out of these nine patients, seven remained 6-Ag negative CPH throughout the observation and the remaining two became 6-Ag positive, anti4 positive and developed CAH.The 73% of patients with CAH were 6-Ag positive on the 1st biopsy and anti-6 positive in serum. The patients in the 6-Ag positive group (24 were always 6-Ag positive and two became 6-Ag positive during the observation) more frequently than those in the 6-Ag negative group (10 were always 6-Ag negative and nine k a m e 6-Ag negative during the study) showed deterioration or died (77 vs. 16%; P

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