Lower, Earlier, Longer and Personalized: Rethinking Lipid‐Lowering Therapy for Cardiovascular Prevention

ABSTRACT

Atherosclerotic cardiovascular disease remains the leading cause of morbidity and mortality worldwide. Lipid‐lowering therapy represents the cornerstone of cardiovascular prevention, with low‐density lipoproteins (LDL) identified as a causal factor in atherosclerosis. Last decades have seen a rapid expansion in therapeutic options beyond statins, including ezetimibe, bempedoic acid, proprotein convertase subtilisin/kexin Type 9 inhibitors, both monoclonal antibodies and small interfering RNA therapies, and emerging agents targeting novel pathways. Current treatment paradigms emphasize early risk stratification, aggressive LDL‐cholesterol (LDL‐C) control in high‐risk individuals and systematic combination therapy when treatment goals cannot be achieved with statins alone. In addition, growing attention is being paid to residual cardiovascular risk associated with triglyceride‐rich lipoproteins and lipoprotein (a) [Lp(a)]. Novel pharmacological approaches targeting these pathways are currently under investigation and may substantially modify the future landscape of lipid management. This review summarizes current strategies for lipid‐lowering therapy across different cardiovascular risk categories and discusses emerging therapies targeting LDL‐C, triglyceride‐rich lipoproteins and Lp(a), highlighting future directions in precision lipidology.