Pharmacological Management of Dyslipidemia in Obese and Elderly Patients: Challenges, Current Therapies, and Emerging Treatments

Dyslipidemia, a state of abnormal blood lipid levels, contributes significantly to the development of atherosclerotic cardiovascular disease (CVD), especially in obese and elderly individuals. Lipid management is challenging in older adults because age is one of the key aspects leading to worsening of CVD, and other factors such as multiple comorbidities, polypharmacy, drug interactions, and patient functionality can further complicate the clinical picture. Likewise, management in obese patients is difficult because they often exhibit an adiposopathic lipid profile, with chronic inflammation and insulin resistance further exacerbating the abnormalities. Therefore, management in such high-risk patient populations requires a strategic plan, often combining non-pharmacological and pharmacological interventions. This review aims to summarize the recent evidence on the challenges and limitations associated with dyslipidemia management in obese and elderly patients, explaining the existing therapeutic options and focusing on the newer, emerging approaches. Current treatment guidelines recommend that physicians follow a therapeutic approach based on risk stratification and target lipid achievement. Traditional agents such as statins, ezetimibe, and fibrates remain the cornerstone, but their disadvantages, like limited efficacy and adherence issues, necessitate the development of innovative therapies. Despite evolving treatment, major literature gaps exist due to the lack of sufficient clinical evidence in obese and geriatric patients, who are underrepresented in clinical trials. Novel drugs result in significant reductions in different lipid components with improved dosing and patient compliance; however, more data needs to be generated to guide personalized treatments and incorporate them into routine regimens.