Abstract:

Dyslipidemia, marked by elevated low-density lipoprotein cholesterol (LDL-C), is a key contributor to atherosclerotic cardiovascular disease (ASCVD) and remains a global health challenge. Advances in lipid management have transitioned from statin monotherapy to combination therapies with ezetimibe and PCSK9 inhibitors, achieving LDL-C reductions of up to 85% and significantly lowering major adverse cardiovascular events (MACE). Emerging agents, including bempedoic acid and RNA-directed therapies such as inclisiran and antisense oligonucleotides targeting lipoprotein(a), offer alternative solutions for statin-intolerant populations and those with residual cardiovascular risk. Intracoronary imaging demonstrates the benefits of aggressive LDL-C lowering on plaque regression and stabilization, reinforcing the importance of early initiation and sustained control. Simplified regimens, such as single-pill combinations, improve adherence and address barriers like cost and access, essential for maximizing therapeutic outcomes. Additionally, tools such as coronary artery calcium (CAC) scoring and advanced imaging enable personalized care and refined risk stratification. This meta-analysis synthesizes evidence to highlight a paradigm shift towards aggressive, individualized lipid management strategies that bridge gaps between clinical trials and real-world practice. By integrating pharmacological innovations with lifestyle interventions, these advancements offer transformative potential to reduce ASCVD risk globally.

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