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Lipid Therapy: Lowering Blood Fats & Protecting the Heart

Lipid therapy includes medical measures to lower elevated blood fat levels, reducing the risk of cardiovascular disease such as heart attack and stroke.

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Things worth knowing about "Lipid therapy"

Lipid therapy includes medical measures to lower elevated blood fat levels, reducing the risk of cardiovascular disease such as heart attack and stroke.

What is Lipid Therapy?

Lipid therapy refers to all medical and therapeutic measures aimed at normalizing abnormal blood lipid levels. This includes elevated cholesterol and triglyceride levels, as well as reduced HDL cholesterol (often called the “good cholesterol”). The primary goal is to significantly reduce the risk of serious cardiovascular diseases such as heart attack and stroke.

Causes of Elevated Blood Lipid Levels

Elevated lipid levels can have various causes:

Primary (genetic) causes: Familial hypercholesterolaemia or other inherited lipid metabolism disorders
Secondary causes: Conditions such as diabetes mellitus, hypothyroidism, kidney disease, or obesity
Lifestyle factors: An unbalanced diet, physical inactivity, excessive alcohol consumption, and smoking
Medications: Certain drugs such as corticosteroids or beta-blockers can influence lipid metabolism

Diagnosis

A lipid metabolism disorder is diagnosed through a blood test that provides a lipid profile, which includes:

Total cholesterol
LDL cholesterol (low-density lipoprotein, the “bad cholesterol”)
HDL cholesterol (high-density lipoprotein, the “good cholesterol”)
Triglycerides

Blood samples are ideally taken in a fasting state to ensure reliable results. Target values for LDL cholesterol are set individually based on the patient's personal cardiovascular risk profile.

Treatment

Non-pharmacological Measures

The foundation of any lipid therapy is lifestyle modification:

Dietary changes: Reducing saturated fats and trans fats, increasing fibre, vegetables, and unsaturated fatty acids (e.g., omega-3 fatty acids)
Regular physical activity: At least 150 minutes of moderate aerobic exercise per week
Weight reduction: Even moderate weight loss can significantly improve lipid levels
Smoking cessation: Raises HDL cholesterol and improves the overall cardiovascular risk profile
Alcohol reduction: Particularly effective for lowering elevated triglyceride levels

Pharmacological Therapy

When lifestyle changes alone are insufficient, lipid-lowering medications are used:

Statins (e.g., atorvastatin, simvastatin): Inhibit cholesterol synthesis in the liver and are the most commonly used drugs in lipid therapy
Ezetimibe: Inhibits cholesterol absorption in the intestine and is often combined with statins
PCSK9 inhibitors (e.g., evolocumab, alirocumab): Monoclonal antibodies that very effectively lower LDL cholesterol; used in patients with high cardiovascular risk or statin intolerance
Fibrates (e.g., fenofibrate): Primarily lower triglyceride levels and raise HDL cholesterol
High-dose omega-3 fatty acids: Approved for the treatment of very high triglyceride levels
Inclisiran: A novel siRNA-based medication that inhibits PCSK9 production in the liver

Advanced and Specialised Treatment Options

For patients with severe familial hypercholesterolaemia or intolerance to multiple medications, specialised procedures are available:

LDL apheresis: An extracorporeal procedure that removes LDL cholesterol directly from the blood, similar to dialysis
Bempedoic acid: A newer oral medication for patients with statin intolerance

Therapy Goals and Monitoring

The goals of lipid therapy are set according to the individual cardiovascular risk profile. According to the guidelines of the European Society of Cardiology (ESC), LDL target values for very high-risk patients are below 1.4 mmol/L (55 mg/dL). Regular blood tests and medical follow-up are essential to monitor treatment success and detect potential side effects at an early stage.

References

Mach F et al. - 2019 ESC/EAS Guidelines for the management of dyslipidaemias. European Heart Journal, 2020; 41(1): 111-188.
Grundy SM et al. - 2018 AHA/ACC Guideline on the Management of Blood Cholesterol. Journal of the American College of Cardiology, 2019; 73(24): e285-e350.
World Health Organization (WHO) - Global Atlas on Cardiovascular Disease Prevention and Control. WHO Press, Geneva, 2011.

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