Table 2 Lipid management treatment approaches

Lifestyle Modifications

Dietary Changes

Lowers LDL-C, triglycerides; increases HDL-C and fiber intake

General management of lipid levels

Mediterranean diet, DASH diet

Essential first-line approach; improves lipid profiles significantly

[128]

Physical Activity

Reduces LDL-C and triglycerides; increases HDL-C

General management, especially for overweight/obesity

150 min of moderate exercise per week

Aerobic exercise is highly recommended for improving cardiovascular health

[129]

Weight Management

Reduces LDL-C, triglycerides; increases HDL-C

Obesity-related dyslipidemia

Behavioral weight loss programs

Even modest weight loss can lead to substantial improvements in lipid profiles

[130]

Smoking Cessation

Increases HDL-C; reduces oxidative stress

High cardiovascular risk, improves overall health

Smoking cessation programs

Essential for cardiovascular risk reduction; improves lipid levels and vascular function

[131]

Alcohol Moderation

Reduces triglycerides; decreases cardiovascular risk

Management of triglyceride levels

Limiting intake to moderate levels

Excessive alcohol intake significantly impacts triglyceride levels and overall health

[132]

Pharmacological Therapies

Statins

Inhibit HMG-CoA reductase; decrease cholesterol synthesis

High LDL-C, atherosclerosis, cardiovascular disease risk

Atorvastatin, Rosuvastatin, Pitavastatin

Most effective first-line therapy; newer statins like rosuvastatin show greater LDL-C reduction and improved safety profiles.

[133]

Ezetimibe

Blocks cholesterol absorption in the small intestine

High LDL-C, used in combination with statins or alone

Ezetimibe

Enhances LDL-C lowering when combined with statins; effective for statin-intolerant patients.

[134]

PCSK9 Inhibitors

Prevent degradation of LDL receptors; increase LDL-C clearance

Severe hypercholesterolemia, familial hypercholesterolemia

Alirocumab, Evolocumab

Latest class of lipid-lowering drugs; highly effective for those with severe LDL-C elevations.

[135]

Fibrates

Activate PPAR-α; increase HDL-C, reduce triglycerides

Hypertriglyceridemia, mixed dyslipidemia

Fenofibrate, Pemafibrate

Newer fibrates like pemafibrate offer improved efficacy and safety over older agents.

[136]

Niacin

Inhibits hepatic VLDL secretion; raises HDL-C, lowers triglycerides

Low HDL-C, high triglycerides

Extended-release niacin

New formulations reduce flushing; effectiveness in raising HDL-C and lowering triglycerides can be significant but may be limited by side effects.

[137]

Bile Acid Sequestrants

Bind bile acids; increase hepatic cholesterol uptake

High LDL-C, often used with statins for additive effect

Colesevelam, Cholestyramine

Newer agents like colesevelam have better tolerability; effective in lowering LDL-C and improving glycemic control.

[138]

Omega-3 Fatty Acids

Reduce hepatic triglyceride production; anti-inflammatory effects

Severe hypertriglyceridemia

Icosapent ethyl, Omega-3 carboxylic acids

Prescription omega-3s such as icosapent ethyl show significant cardiovascular risk reduction and triglyceride lowering.

[139]

Bempedoic Acid

Inhibits ATP-citrate lyase; reduces cholesterol synthesis

High LDL-C, especially when used with statins or in statin-intolerant patients

Bempedoic acid

New agent that offers LDL-C reduction; can be used in conjunction with other therapies.

[140]

Advanced Interventions

Lipoprotein Apheresis

Removes LDL and other lipoproteins from the blood

Severe FH, refractory to pharmacotherapy

-

Used for patients with extreme dyslipidemia; requires regular treatments to maintain LDL-C reductions.

[141]

Gene Therapy

Corrects genetic mutations affecting lipid metabolism

Familial hypercholesterolemia (under research)

-

Promising experimental approach for addressing genetic causes of dyslipidemia; ongoing research into efficacy and safety.

[142]

RNA-based Therapies

Target specific RNA molecules to modulate lipid metabolism

High LDL-C, specific genetic profiles

Inclisiran, other small interfering RNAs

Inclisiran targets PCSK9 mRNA to lower LDL-C; shows promise for long-term LDL-C reduction with biannual dosing.

[143]

Monoclonal Antibodies

Target specific proteins involved in lipid metabolism

Severe hypercholesterolemia, mixed dyslipidemia

Evinacumab (in clinical trials)

Targets ANGPTL3 to lower LDL-C and triglycerides; novel approach with potential for high-risk populations.

[144]

Cholesterol Ester Transfer Protein (CETP) Inhibitors

Increase HDL-C by preventing cholesterol transfer from HDL to LDL

Low HDL-C, atherosclerosis

Anacetrapib (development phase)

CETP inhibitors are in development; aim to raise HDL-C and reduce cardiovascular risk.

[145]

Regular Monitoring and Follow-Up

Monitoring & Adjustments

Assesses treatment response and side effects; adjusts therapy

Ongoing management of lipid disorders

Routine lipid panels, advanced imaging

Essential for optimizing treatment efficacy and adapting to changes in lipid levels

[146]