What is the first-line treatment for patients with hyperlipidemia?

Statins are considered the first-line treatment for patients with hyperlipidemia primarily due to their effectiveness in lowering low-density lipoprotein (LDL) cholesterol levels and reducing the risk of cardiovascular events. They work by inhibiting the enzyme HMG-CoA reductase, which plays a pivotal role in the synthesis of cholesterol in the liver. This reduction in cholesterol production leads to an increase in the liver’s uptake of LDL from the bloodstream, resulting in lower circulating levels of LDL cholesterol.

In addition to their cholesterol-lowering effects, statins also have beneficial effects on endothelial function, inflammatory markers, and overall cardiovascular risk. Several clinical studies and guidelines support the use of statins as the first line of therapy for managing hyperlipidemia, particularly in individuals who have existing cardiovascular disease or are at high risk for developing it.

Other treatments for hyperlipidemia, such as fibrates, niacin, and bile acid sequestrants, have their specific indications and may be used in certain scenarios, but they are not typically regarded as the initial treatment option for most patients with elevated cholesterol levels. These medications can be useful adjuncts or alternatives in specific populations, particularly when statins are contraindicated or not tolerated.