Beyond LDL: Novel Methods for Lipid Management In Cardiovascular Treatment

Cardiovascular diseases (CVDs) remain the leading cause of global mortality, accounting for nearly one-third of all deaths worldwide. Once viewed predominantly as disorders of hemodynamics or vascular obstruction, CVDs are now recognized as complex, multifactorial conditions driven by intricate molecular, genetic, and cellular mechanisms. Advances in molecular biology, genomics, proteomics, and systems biology have revealed that pathogenic molecular alterations precede overt clinical manifestations and critically influence disease progression. Key dysregulated pathways involve lipid metabolism, inflammatory signaling, oxidative stress, endothelial dysfunction, maladaptive gene expression, and epigenetic modifications, all of which interact with environmental exposures and lifestyle factors. Genetic contributions to CVD encompass both rare monogenic disorders, such as inherited cardiomyopathies and channelopathies, and common polygenic diseases including coronary artery disease and hypertension. Additionally, epigenetic mechanisms—such as DNA methylation, histone modifications, and non-coding RNAs—play a pivotal role in cardiovascular remodeling and disease susceptibility. Understanding these molecular underpinnings has facilitated the emergence of precision cardiovascular medicine, enabling the development of targeted therapies and novel biomarkers. This chapter provides a comprehensive overview of the molecular basis of cardiovascular diseases, emphasizing the integration of genetic, epigenetic, and cellular pathways that shape cardiovascular pathology and inform modern diagnostic and therapeutic strategies.