Update lipidology Evidence-based treatment of dyslipidemia

The treatment of elevated plasma lipid levels plays an important role in prevention of atherosclerosis. Lowering of low-density lipoprotein (LDL) cholesterol with statins and if required with additional ezetimibe, bempedoic acid and proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors is of utmost importance. While lifestyle modification can strongly influence the cardiovascular risk, it only plays a minor role in lowering LDL cholesterol values. The overall (absolute) cardiovascular risk determines if and in what intensity lipid-lowering treatment should be implemented. Based on new results from interventional studies the LDL cholesterol target values have been reduced in recent years. Thus, in patients with a very high risk (for example patients with established atherosclerotic disease) an LDL cholesterol level of < 55 mg/dl (< 1.4 mmol/l, conversion mg/dlx0.02586=mmol/l) and at least a 50% reduction from baseline should be strived for. With respect to elevated triglyceride levels, either alone or simultaneously with elevated LDL cholesterol levels, the treatment goals are less clearly defined, despite the fact that elevated triglyceride levels are causally linked to atherosclerotic events. Lifestyle modifications can significantly reduce triglyceride levels and are often more effective than specific triglyceride-lowering medications, such as fibrates and omega-3 fatty acids. New lipid-lowering drugs for the treatment of patients with severely elevated triglyceride levels and elevated lipoprotein(a) levels are being developed but their clinical benefits still have to be confirmed in endpoint studies.