Importance of primary dyslipidemia in the context of current dyslipidemia guidelines and current innovations in lipid therapy

Background The core of current guidelines for the prevention of cardiovascular disease is the recommendation of a risk-based intensity of LDL-cholesterol-lowering measures. Specific primary dyslipidemias might only be particulary addressed in the guidelines. Method Selective literature review on diagnosis and clinical significance of primary dyslipidemia and new lipid-lowering agents. Results Current dyslipidemia guidelines do not adequately address the importance of congenital dyslipidemia in risk stratification. This is particularly true for genetically determined elevations of triglycerides. We discuss specific aspects of the treatment of primary dyslipidemia and new lipid-lowering agents such as bempedoic acid, icosapent-ethyl, and siRNA technology-based PCSK9 inhibition with inclisiran, which have not yet been considered in the guidelines. New data on pharmacological Lp(a)-lowering as well as triglyceride- and cholesterol-lowering effects of ANGPTL3 inhibition justify the expectation that remaining therapeutic gaps will be closed in the very near future. Conclusion From the diagnosis of a genetic lipid metabolism disorder and thus lifelong increased exposure to atherogenic lipoproteins, there are prognostic and therapeutic implications for individualized therapies with the avoidance of both under- and overtreatment. New lipid-lowering agents may improve the achievement of risk-appropriate treatment goals