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After monooxygenation (phase I), further reactions in the human body may produce menthofuran, which leads to hepatotoxic and pneumotoxic effects of pulegone at higher concentrations.[ 38 , 39 , 40 , 41 ] In the subsequent phase II, the previously generated metabolites are conjugated with polar groups to increase hydrophilicity and thus facilitate excretion

It upregulates the Anti-Inflammatory Gene Transcription Factor, and Growth Hormone receptors, all leading to better systemic repair response

In 2021, results from the DA VINCI study in Europe indicated that only 17% of very high-risk primary-prevention patients and 22% in secondary prevention met their LDL targets according to the 2019 European guidelines, with much worse results for Central and Eastern European (CEE) countries, where only 13% of very high-risk patients in secondary prevention met the LDL-C target of 40% in phase 3 trials [51] and 21.6% placebo corrected in the CLEAR Outcomes trial [48]), and compared with placebo, bempedoic acid had similar efficacy for reducing CVD risk across hsCRP and LDL-C strata [52]