Dyslipidemia

Use at a glance

• Treat LDL according to ASCVD risk

Treatment options

• Statin is the usual foundation

Other treatment options

• Above goal → add ezetimibe
• Still high → PCSK9 therapy/bempedoic acid
• Lifestyle + secondary causes always matter

Practical pearls

• Severe TG elevation needs pancreatitis focus

Treatment sequence

• High-risk ASCVD → high-intensity statin

Key points

• Treat all ASCVD (secondary prevention); primary prevention per LDL-C and ASCVD risk
• Statin = treatment of choice; ↓ primary/secondary ASCVD events and death
• Above goal on max statin → add ezetimibe, bempedoic acid, and/or PCSK9i (alirocumab/evolocumab)
• Inclisiran or lerodalcibep: PCSK9 mAb alternatives; CV outcomes trials ongoing
• Pregnancy/lactation: bile acid sequestrant; statin if very high ASCVD risk

Nonpharmacologic therapies

• LDL apheresis
• Modifiable risk factor management

Pearls

• Measure Lp(a) once in every adult
• Statins don't lower Lp(a); PCSK9 drugs modestly do
• Atorvastatin needs no renal dose adjustment
• Colesevelam better tolerated than cholestyramine or colestipol
• Very high-risk secondary prevention: LDL-C goal <55 mg/dL

Self-check

• How should LDL treatment intensity be chosen in dyslipidemia?
  According to ASCVD risk.
• What is commonly added if LDL remains above goal?
  Ezetimibe.

Drugs used for this (20)

All clinical uses · Open Dyslipidemia in the interactive console ↗