Modern Approaches to Cholesterol Control

Risk Assessment

The ASCVD risk calculator estimates 10-year cardiovascular risk, guiding treatment intensity. Additional risk enhancers like family history, chronic kidney disease, or inflammatory conditions may justify earlier intervention. Lipoprotein(a) testing identifies patients with genetic risk factors.

Lifestyle Foundations

Dietary changes can lower LDL by 10-20%: reduce saturated fats, increase soluble fiber, and incorporate plant sterols/stanols. Regular aerobic exercise raises HDL while improving overall cardiovascular fitness. Even modest weight loss improves lipid profiles significantly.

Medication Options

High-intensity statins remain first-line for high-risk patients, typically lowering LDL by 50%+. Ezetimibe provides additional 15-20% reduction when needed. PCSK9 inhibitors offer powerful LDL reduction (50-60%) for familial hypercholesterolemia or statin intolerance.

Monitoring and Adherence

Lipid panels should be checked 4-12 weeks after initiating therapy and periodically thereafter. Encourage adherence through education on cardiovascular benefits and by minimizing side effects. Consider statin alternatives if patients report intolerable myalgias.

Emerging Therapies

Bempedoic acid and inclisiran represent newer non-statin options showing promise. Genetic testing and personalized medicine approaches may guide therapy in complex cases. Keeping up with evolving lipid guidelines ensures patients receive the most effective and safest care.