Increased levels of low-density lipoprotein cholesterol (LDL-C) are recognized as a primary risk factor for atherosclerotic cardiovascular disease, which remains the leading cause of death worldwide. Lowering LDL-C levels clearly reduces the risk of cardiovascular events, with benefits related to both absolute reduction and duration of treatment; however, a threshold below which low LDL-C levels can be dangerous has never been established. Since the discovery of statins, cardiovascular research has focused on developing new lipid-lowering agents. Ezetimibe and proprotein convertase subtilisin–kexin type 9 inhibitors have been found to further reduce LDL-C values and subsequent cardiovascular risk. Novel recently approved inclisiran and bempedoic acid, currently being tested in cardiovascular outcomes studies, are further expanding our pharmacological armamentarium, enabling the clinician to diminish residual risk related to LDL-C. Moreover, new agents are paving the way to successful treatment of homozygous familial hypercholesterolemia. This review summarizes the main characteristics of current and emerging lipid-lowering therapies to assist with comprehensive evidence-based decision making.

低密度脂蛋白胆固醇 (LDL-C) 水平升高被认为是动脉粥样硬化性心血管疾病的主要危险因素，而动脉粥样硬化性心血管疾病仍然是全球死亡的主要原因。降低 LDL-C 水平明显降低心血管事件的风险，其益处与绝对降低和治疗持续时间有关；然而，从未建立过低于低 LDL-C 水平可能是危险的阈值。自从发现他汀类药物以来，心血管研究一直专注于开发新的降脂药物。已发现依折麦布和前蛋白转化酶枯草杆菌蛋白酶-kexin 9 型抑制剂可进一步降低 LDL-C 值和随后的心血管风险。最近批准的新型 inclisiran 和 bempedoic acid，目前正在心血管结果研究中进行测试，正在进一步扩大我们的药理学设备，使临床医生能够减少与 LDL-C 相关的残留风险。此外，新的药物正在为成功治疗纯合子家族性高胆固醇血症铺平道路。这篇综述总结了当前和新兴降脂疗法的主要特征，以帮助制定全面的循证决策。