Dyslipidaemia

•RCT evidence— Massive RCT base for LDL/apoB lowering

What "dyslipidaemia" covers

A heterogeneous group of disorders:

• Common polygenic high LDL (most adults with elevated LDL).
• Familial hypercholesterolaemia (FH): heterozygous ~1/250, very high LDL from childhood, early ASCVD; identified by clinical criteria (Dutch, MEDPED, Simon Broome) ± genetic testing.
• Elevated Lp(a): ~20% of adults; lifelong elevation, independent ASCVD risk.
• Hypertriglyceridaemia: marker of metabolic syndrome; severe (>500) is pancreatitis risk.
• Combined hyperlipidaemia.
• Genetic syndromes (familial chylomicronaemia, sitosterolaemia).

Why early treatment matters

ASCVD is a cumulative-exposure disease. Each decade of elevated apoB contributes to lifetime risk roughly linearly. Starting treatment a decade earlier in high-risk individuals produces substantially larger event reductions than starting late.

Treatment ladder

1. Lifestyle (Mediterranean diet, weight management, exercise, smoking cessation).
2. Statin (often high-intensity in primary prevention with high apoB / FH / strong family history).
3. Ezetimibe add-on.
4. PCSK9 inhibitor (mAb or inclisiran) for residual high-risk patients.
5. Bempedoic acid for statin intolerance.
6. Fibrates or icosapent ethyl for residual hypertriglyceridaemia or selected high-risk patients.
7. Emerging Lp(a)-lowering antisense and siRNA therapies.

Related entries

ApoB, Lp(a), Statins, PCSK9 inhibitors, Cardiovascular disease.