Dyslipidemia is an important risk factor for all atherosclerotic vascular diseases. Low-density lipoprotein cholesterol (LDL-C) has been identified as the primary target for therapeutic intervention, but triglyceride-rich lipoproteins and lipoprotein (a) should also be evaluated. According to current international guidelines, most patients with vascular disease fall into the group with very high risk, with an LDL-C target value of 55 mg/dL. In addition to lifestyle modification, pharmacological intervntion primarily with statins and ezetimibe is among the therapeutic cornerstones in vascular disease. Especially in statin-intolerant individuals, bempedoic acid represents an important alternative. Proprotein convertase subtilisin/kexin type 9 inhibitors may be necessary in high-risk individuals to reach the recommended LDL-C target values.