Lipid Logic: An Update on Current and Future Pharmacologic Approaches to Dyslipidemia Management

Dyslipidemia management requires a multifaceted approach that includes both lifestyle modifications and pharmacotherapy. The primary goal of treatment is to reduce LDL-C levels to lower cardiovascular (CV) risk. Additionally, some patients may require other therapies to address residual CV risk associated with elevated triglycerides or elevated lipoprotein(a) [Lp(a)].

The 2018 AHA/ACC/Multisociety cholesterol guideline emphasized the importance of lowering LDL-C as the primary treatment target. This guideline focuses on populations where statin therapy has been proven to lower both LDL-C and CV event risk, known as the four statin benefit groups. In 2022, the ACC published an Expert Consensus Decision Pathway for nonstatin therapy, recommending specific LDL-C thresholds for all four statin benefit groups, rather than just two as per the 2018 guideline. While statin therapy is effective in reducing CV risk and LDL-C levels, some patients may require additional nonstatin therapies to achieve optimal LDL-C reduction. Several nonstatin therapies, including ezetimibe, bempedoic acid, PCSK9 monoclonal antibodies, and inclisiran, are available and effective in further lowering LDL-C. This program will review these LDL-C lowering therapies and their optimal use to improve patient outcomes.

Even when LDL-C is reduced to recommended levels, patients with elevated triglycerides or Lp(a) remain at increased risk for CV events. Clinicians should be aware of the evidence linking elevated triglycerides and Lp(a) with CV events, as well as the latest innovations and outcomes data related to current and emerging drug therapies for these conditions. This session will review outcomes data on the use of omega-3 fatty acids in patients with elevated triglycerides. Additionally, it will cover two medications in phase III trials, pelacarsen and olpasiran, which lower Lp(a) in conjunction with statin therapy.