Lipid lowering in coronary artery disease - not just statins.

Coronary artery disease has a high degree of morbidity and mortality internationally and, after a cardiovascular event, patients require intensified management of modifiable risk factors, with optimal lipid control being an important cornerstone of secondary prevention. This is both a primary and a secondary care responsibility. Familiarity with indications for and prescription of non-statin medications, including injectables, is vital for patient outcomes. Fewer than 30% of patients reach LDL-c targets with statins alone. This is a public health matter, and non-statin therapies that all clinicians need to be aware of are oral therapies such as ezetimibe and bempedoic acid, and injectable therapies such as inclisiran and PCKS9 inhibitors. Icosapent ethyl is also available in those with high fasting triglycerides with specific LDL-c values. Understanding when to refer to the lipid clinic enables patients to be managed appropriately in the correct setting. Future therapies under development include cholesterol ester transfer protein inhibitors, oral PCSK9 inhibitors, and gene editing therapy targeting ANGPTL3 and PCSK9. Lipid optimisation leads to significant reduction in major adverse cardiac events, and familiarity with all available treatment options - including non-statins and injectables - will facilitate best primary and secondary care.