Innovative lipid therapy in cardiovascular risk patients

Effective reduction of low-density lipoprotein cholesterols (LDL-C) is a key element to reduce the risk of ischemic events. This is particularly important in patients with high or very-high cardiovascular risk. Recent guidelines from the European Society of Cardiology (ESC) and the European Atherosclerosis Society (ESA) recommend a reduction of LDL-C < 55 mg/dL (1.4 mmol/L) in the very-high risk group. Regarding the causal relationship between the plasma level of LDL-C and cardiovascular events, the general principle of "the lower - the better" ensues. Innovative lipid-lowering agents substantially reduce LDL-C, especially in combination with high-intensity statin treatment and ezetimibe. These agents include the proprotein convertase subtilisin kexin-9 (PCSK-9) antibodies alirocumab und evolocumab, the small-interfering ribonucleic acid (si-RNA) inclisiran and the cholesterol biosynthesis inhibitor bempedoic acid. In this review paper, we summarize current guidelines and review innovative lipid-lowering agents with strong LDL-C reducing properties. Treatment strategies are discussed from a cardiologic, endocrinologic, neurologic and vascular medicine point of view. In addition, potential improvements in the interface between the specialized clinical centers and the long-term treatment by local practitioners are discussed.