Lipid-lowering therapies: the arrows in the quiver and future bullets

Dyslipidemia remains a central modifiable risk factor for cardiovascular disease, necessitating comprehensive and evolving management strategies. This review provides an updated overview of currently approved and emerging lipid-lowering therapies, focusing on their mechanisms of action, efficacy, and safety profiles. Traditional agents such as statins and bile acid sequestrants continue to play foundational roles, while newer therapies - including PCSK9 inhibitors, bempedoic acid, and RNA-based treatments - have expanded therapeutic options, particularly for high-risk or statin-intolerant patients. Additionally, therapies targeting triglyceride reduction, such as fibrates and omega-3 fatty acids, have demonstrated potential benefits in specific subgroups. Novel strategies such as gene editing, oral PCSK9 inhibitors, HDL-targeted treatments, and gut microbiota modulation represent promising future directions. The review also explores the utility of non-pharmacologic approaches, including lipid apheresis and bariatric surgery, in selected cases. Together, these developments highlight the importance of tailored, multi-targeted approaches to lipid management in the prevention of cardiovascular events. Continued research is essential to refine therapeutic algorithms and optimize patient outcomes.