Hypercholesterolemia is a major modifiable risk factor for atherosclerotic cardiovascular disease (ASCVD), affecting a significant proportion of the adult population worldwide. This narrative review provides a comprehensive and up-to-date overview of hyperlipidemia management, spanning from epidemiological trends and underlying pathophysiological mechanisms to the limitations of conventional therapies such as statins and ezetimibe. Particular emphasis is placed on cardiovascular risk assessment, current stratification tools, and international guideline-based interventions. The present paper, focusing primarily on the biological mechanisms of dyslipidemia and the clinical use of traditional lipid-lowering agents, serves as the first part of a two-part series, preceding a forthcoming review of novel pharmacological approaches. Our data synthesis is based on a structured literature search conducted across Google Scholar, PubMed, and Scopus, including studies published up to June 2025. The review also includes aspects related to non-pharmacological strategies, pharmacoeconomic considerations, and pharmacogenetic influences on treatment response. Ultimately, this work aims to equip clinicians with evidence-based, nuanced insights essential for optimizing lipid management and reducing cardiovascular risk, while setting the foundation for understanding how emerging therapies may overcome current therapeutic limitations.

Cardiovascular disease (CVD) remains the leading cause of mortality worldwide, with hypercholesterolemia identified as a major, but modifiable risk factor. This review serves as the second part of a comprehensive analysis of dyslipidemia management. The first installment laid the groundwork by detailing the key pathophysiological mechanisms of lipid metabolism, the development of atherosclerosis, major complications of hyperlipidemia, and the importance of cardiovascular risk assessment in therapeutic decision-making. It also examined non-pharmacological interventions and conventional therapies, with a detailed focus on statins and ezetimibe. Building upon that foundation, the present article focuses exclusively on emerging pharmacological therapies designed to overcome limitations of standard treatment. It explores the mechanisms, clinical applications, safety profiles, and pharmacogenetic aspects of novel agents such as proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors (alirocumab, evolocumab), small interfering RNA (siRNA) therapy (inclisiran), adenosine triphosphate–citrate lyase (ACL) inhibitor (bempedoic acid), microsomal triglyceride transfer protein (MTP) inhibitor (lomitapide), and angiopoietin-like protein 3 (ANGPTL3) inhibitor (evinacumab). These agents offer targeted strategies for patients with high residual cardiovascular risk, familial hypercholesterolemia (FH), or statin intolerance. By integrating the latest advances in precision medicine, this review underscores the expanding therapeutic landscape in dyslipidemia management and the evolving potential for individualized care.

Background: Olmesartan medoxomil (OLM) is the prodrug of olmesartan, an angiotensin II type 1 receptor blocker that has antihypertensive and antioxidant activities and renal protective properties. It exhibits low water solubility, which leads to poor bioavailability and limits its clinical potential. To improve the solubility of OLM, a host–guest inclusion complex (IC) between heptakis(2,6-di-O-methyl)-β-cyclodextrin (DMβCD) and the drug substance was obtained. Along with active substances, excipients play a crucial role in the quality, safety, and efficacy of pharmaceutical formulations. Therefore, the compatibility of OLM/DMβCD IC with several pharmaceutical excipients was evaluated. Methods: IC was characterized in both solid and liquid states, employing thermoanalytical techniques, universal-attenuated total reflectance Fourier-transform infrared spectroscopy, powder X-ray diffractometry, UV spectroscopy, and saturation solubility studies. Compatibility studies were carried out using thermal and spectroscopic methods to assess potential physical and chemical interactions. Results: The 1:1 OLM:DMβCD stoichiometry ratio and the value of the apparent stability constant were determined by means of the phase solubility method that revealed an A_L-type diagram. The binary system showed different physicochemical characteristics from those of the parent entities, supporting IC formation. The geometry of the IC was thoroughly investigated using molecular modeling. Compatibility studies revealed a lack of interaction between the IC and all studied excipients at ambient conditions and the thermally induced incompatibility of IC with magnesium stearate and α-lactose monohydrate. Conclusions: The results of this study emphasize that OLM/DMβCD IC stands out as a valuable candidate for future research in the development of new pharmaceutical formulations, in which precautions should be considered in choosing magnesium stearate and α-lactose monohydrate as excipients if the manufacture stage requires temperatures above 100 °C.

Cyclodextrins (CDs) have emerged as important encapsulation platforms in dermatologic and cosmetic sciences, addressing critical challenges related to the solubility and stability of bioactive compounds. This review (Part I) systematically explores the relationship between the molecular architecture of CDs and their functional performance at the skin interface. A comprehensive analysis of the physicochemical properties of natural and derivative cyclodextrins is presented, alongside an evaluation of their interaction mechanisms with the skin barrier and current regulatory frameworks. This study highlights how the hydrophobic cavity of CDs enables the successful encapsulation of botanical extracts, significantly enhancing their bioavailability and photostability. Furthermore, the mechanistic insights provided clarify how appropriately selected and formulated CDs can modulate skin penetration while maintaining acceptable epidermal barrier compatibility. A critical synthesis of safety data and toxicological profiles confirms the suitability of specific CD types for topical application, supported by an overview of the evolving European and international legislative landscapes. Understanding the molecular design and safety constraints of cyclodextrin-based systems is essential for developing next-generation dermocosmetics. This foundational analysis provides the necessary framework for the clinical and technological applications discussed in the subsequent part of this review.

Carvedilol (CARV) is a nonselective beta and alpha-1 adrenoceptor antagonist commonly indicated for chronic heart failure and hypertension. Its clinical potential is limited by its low aqueous solubility, resulting in poor bioavailability. Encapsulation of CARV by cyclodextrins (CDs) was performed to exceed its solubility-related barriers. This study examines the impact of the CD type and ethanol, as a co-solvent used in the preparation step, on the complexation of CARV with two β-CD derivatives. The inclusion complexes (ICs) were prepared employing the kneading method and investigated using different analytical techniques, including thermoanalytical methods, powder X-ray diffractometry (PXRD), universal attenuated total reflectance Fourier transform infrared (UATR-FTIR) spectroscopy, UV spectroscopy and saturation solubility studies. The binary products of CARV with heptakis(2,6-di-O-methyl)-β-cyclodextrin (DM-β-CD) and randomly methylated β-cyclodextrin (RM-β-CD) exhibit different thermal behavior, different FTIR spectral and diffractometric profiles from those of the parent compounds, emphasizing the interaction between the components and the IC formation. CARV solubility increased 1.78 to 3.32 times as a result of drug complexation with CDs. Analytical data indicate a significant influence of both solvent systems and CD type on the IC solubility, highlighting the CARV/DM-β-CD IC as a promising entity for further research to obtain new formulations containing CARV with improved bioavailability.

Carvedilol (CARV) belongs to the group of non-selective beta and alpha-1 adrenergic receptor antagonists and is indicated for hypertension and chronic heart failure