A stepwise approach to prescribing novel lipid-lowering medications.

• There are many patients who will not reach LDL-C goals with statins. • Several novel lipid-lowering agents have come to the market recently. • Clinicians need to be familiar with the use of novel LLTs in their practice. • Lipids other than LDL-C [HDL-C or Lp(a)] are the pharmacotherapy targets for future. Dyslipidemia is a major modifiable risk factor for developing atherosclerotic cardiovascular disease. Despite increasing high intensity statin prescription and adherence to statin therapy, a considerable number of patients will not reach the guideline directed goals due to statin intolerance, lack of adherence or treatment efficacy. Several new lipid lowering medications have received approval by regulatory agencies in the past decade including proprotein convertase subtilisin/kexin type 9 modulators, ATP-citrate lyase inhibitors, angiopoietin-like 3 inhibitors, lomitapide, and icosapent ethyl. Although approved by regulatory agencies, these medications are still under-prescribed worldwide which may be related to cost issues, lack of cardiovascular outcome results, or clinicians not being familiar with their use. In this review, we propose a practical stepwise approach including each class' efficacy, place in therapy, adverse effects, warnings and precautions, and monitoring parameters. This information can help the clinicians to prescribing these novel lipid lowering medications to achieve treatment goals and reduce the risk of atherosclerotic cardiovascular disease. The aim is to shift the paradigm for high-intensity statins from watch and wait to initial combination therapy for high-risk patients. The stepwise approach to prescribing novel lipid-lowering medications; AF: Atrial Fibrillation; ASCVD : Atherosclerotic Cardiovascular Disease; CV: Cardiovascular; GI: Gastrointestinal; HDL-C : High Density Lipoprotein-Cholesterol; HoFH : Homozygous Familial Hypercholesterolemia; IPE : Icosapent Ethyl; LDL-C: Low Density Lipoprotein-Cholesterol; LLT : Lipid Lowering Therapy; mAb: Monoclonal Antibody; PCSK9 : Proprotein Convertase Subtilisin/Kexin type 9; TG : Triglyceride. [Display omitted] [ABSTRACT FROM AUTHOR]