Lipid lowering treatment

1. Big picture

Lipid-lowering treatment is one of the most important preventive treatments in Internal Medicine because it reduces atherosclerotic cardiovascular disease (ASCVD): myocardial infarction, ischemic stroke, peripheral artery disease, and cardiovascular death. The examiner mainly wants you to know who needs treatment, what the LDL-cholesterol target is, which drug to start first, when to add ezetimibe or PCSK9 inhibition, and how to treat severe hypertriglyceridemia.

The central exam idea is:

LDL-cholesterol drives atherosclerosis → statins are first-line → intensify according to cardiovascular risk → severe triglycerides mainly kill by pancreatitis.

The European approach remains strongly target-based: very-high-risk patients need at least 50% low-density lipoprotein cholesterol (LDL-C) reduction and usually an LDL-C goal <1.4 mmol/L / <55 mg/dL; high-risk patients need at least 50% reduction and <1.8 mmol/L / <70 mg/dL. The 2025 ESC/EAS focused update specifically reviews newer evidence after the 2019 dyslipidemia guideline, including combination therapy and early intensification after acute coronary syndrome. ([European Society of Cardiology][1])