Statins are the cornerstone of lipid-modifying therapy for dyslipidemias and reducing cardiovascular events. Recent US guidelines have shifted away from the concept of cholesterol targets and are encouraging moderate-to-high statin intensity. However, residual risk and statin intolerance remains a significant challenge. Therapies beyond the statins, for combination or monotherapy, include fibrates, ezetimibe, bile acid sequestrants, n-3 fatty acids and niacin. Both the antisense oligonucleotide, mipomersen, and the microsomal triglyceride transfer protein inhibitor, lomitapide, have been approved by the US FDA for use in homozygous familial hypercholesterolemia. The first gene replacement therapy for lipoprotein lipase deficiency has also been approved. The cardiovascular benefit of treating elevated lipoprotein(a) in cardiovascular disease risk prevention remains unproven. © Informa UK, Ltd.