The standard lipid panel measures total cholesterol, LDL (low-density lipoprotein), HDL (high-density lipoprotein), and triglycerides. LDL is the primary target of cardiovascular risk reduction because LDL particles accumulate in arterial walls and initiate the atherosclerotic process. HDL facilitates reverse cholesterol transport — removing cholesterol from arterial walls — which is why it's called 'good cholesterol.' Triglycerides reflect dietary patterns and metabolic health, particularly insulin resistance.
LDL targets are not universal — they are risk-stratified. A patient with established cardiovascular disease has a fundamentally different LDL target than a healthy 35-year-old with no risk factors. Current AHA guidelines recommend LDL <70 mg/dL for very high-risk patients (prior MI, stroke, or peripheral arterial disease). For primary prevention, the decision to treat depends on a 10-year ASCVD risk calculation incorporating age, sex, race, blood pressure, diabetes, and smoking status.
Statins are the cornerstone of LDL-lowering therapy with the strongest cardiovascular outcomes evidence of any lipid medication. High-intensity statins (atorvastatin 40–80 mg, rosuvastatin 20–40 mg) achieve 50%+ LDL reduction. Ezetimibe, PCSK9 inhibitors, and newer agents (bempedoic acid, inclisiran) provide additional lowering when statins are insufficient or not tolerated. Statin myopathy is real but overestimated — most muscle complaints on statins are not true myositis.
Non-HDL cholesterol and apolipoprotein B (apoB) are increasingly recognized as more accurate cardiovascular risk predictors than LDL alone — particularly in patients with metabolic syndrome or insulin resistance, where LDL can appear deceptively normal. These metrics are not yet universally ordered but represent the direction of lipidology.