Lipids in Coronary Heart Disease: From Epidemiology to Therapeutics

Dyslipidemia is a major contributor to the large burden of atherosclerotic cardiovascular disease (ASCVD) in the United States and around the world. The 2013 ACC/AHA guidelines recommend statins as first line pharmacologic therapy, with the intensity of statins matched to the absolute ASCVD risk of the patient. In special circumstances, other lipid-lowering therapies may be considered for add-on therapy. However, many high-risk patients treated with statins still have a significant residual burden of atherogenic lipoprotein particles or cannot tolerate a maximal statin dose. In these cases, newer therapies stemming from rapid adoption of translational research (such as PCSK9 (. proprotein convertase subtilisin/kexin type 9) inhibitors) show potential promise, while others (such as CETP (cholesteryl ester transfer protein) inhibitors) give reason for pause. In this chapter, we will review the epidemiology of the major lipid fractions (LDL-C (low-density lipoprotein cholesterol), HDL-C (high-density lipoprotein cholesterol), and triglycerides) with ASCVD risk, discuss therapeutic interventions from lifestyle and pharmacologic therapies, and highlight promising areas of translational research as it pertains to future drug developments for the management of patients with or at high-risk for coronary artery disease.