The treatment of raised cholesterol levels has changed fundamentally in recent years. Today, highly effective therapies can substantially reduce the risk of heart attack, stroke and other vascular diseases. Modern lipid therapy is guided by each patient's individual risk.

Why is LDL cholesterol so important?

LDL cholesterol plays a central role in the development of atherosclerosis. Over the years, cholesterol particles are deposited in the vessel walls. This can lead to heart attack, stroke, coronary heart disease and circulatory disorders.

Which LDL target values are recommended today?

According to the current European guidelines, patients at very high risk should reach LDL values below 1.4 mmol/l. After repeated cardiovascular events, values below 1.0 mmol/l are even under discussion.

Statins: still the foundation of therapy

Statins are the best-studied drugs for lowering LDL cholesterol. They reduce heart attacks, strokes and mortality, and remain the basis of every lipid therapy.

Ezetimibe: a useful addition

Ezetimibe reduces cholesterol absorption in the gut and is often used in addition to statins.

PCSK9 inhibitors: highly effective LDL lowering

The antibodies evolocumab and alirocumab can lower LDL cholesterol by a further 50 to 60% and improve the prognosis of high-risk patients.

Inclisiran: only two injections a year

Inclisiran uses RNA technology to inhibit PCSK9. After the initial phase, only two injections a year are needed.

Lipoprotein(a): the often overlooked risk factor

Raised Lp(a) levels are genetically determined and increase the risk of heart attack, ischaemic stroke, aortic valve stenosis and premature atherosclerosis. The ESC recommends at least one measurement in adulthood.

Individual therapy rather than a standard solution

The optimal therapy depends on your overall risk, existing vascular disease, familial risk factors and concomitant conditions.

Common patient questions

Can you lower cholesterol through diet alone? A healthy diet is important, yet for many high-risk patients it is not enough.

Are very low LDL values dangerous? Large studies show that even very low LDL values are safe.

Who benefits most from PCSK9 inhibitors? Patients after a heart attack, with familial hypercholesterolaemia, or with insufficient LDL lowering despite therapy with statins or ezetimibe.

The key points at a glance

  • LDL cholesterol is a central risk factor for cardiovascular disease.
  • Statins remain the foundation of therapy.
  • PCSK9 inhibitors and inclisiran allow very effective LDL lowering.
  • Lp(a) should be measured at least once in a lifetime.
  • Therapy is tailored to your personal risk.