Cardiovascular disease continues to be the leading cause of death in the United States. About 1:250 people in the US have heterozygous familial hypercholesterolemia and about 20% of Americans have an elevated Lp(a). Although statins continue to be foundational to primary and secondary prevention of ASCVD in all patients, there are several newer medications such as ezetimibe, PCSK9 inhibitors, inclisiran, and bempedoic acid that are highly effective and underutilized. Patients may not tolerate statins or may require multiple pharmacologic agents to reach their treatment targets, especially in the context of familial hypercholesterolemia. Therefore, a strong understanding of these medications and when to prescribe them is an essential part of the latest, evidence-based ASCVD treatment approach.