Abstract: Coronary artery disease is the leading cause of death worldwide, with precision lipid management being central to its prevention and treatment. Proprotein convertase subtilisin/kexin type 9 (PCSK9), a key player in lipid metabolism regulation, can be effectively inhibited to significantly reduce low-density lipoprotein cholesterol (LDL-C) and other atherosclerosis-related lipoproteins. Recent evidence shows that LDL-C-targeted lipid-lowering strategies have shown their limitations, while the novel small interfering RNA (siRNA) drug inclisiran can achieve long-lasting lipid control by silencing PCSK9 mRNA, achieving synergistic regulation of such lipid profile indicators as LDL-C, apolipoprotein B, and lipoprotein (a). Based on the ORION series of studies, this review systematically examines inclisiran,s unique hepatocyte-targeted delivery mechanism, its effects on multi-dimensional lipid parameters, and breakthroughs in dosing frequency and patient compliance compared to traditional PCSK9 monoclonal antibodies. It also summarizes safety profiles in specific populations, providing valuable insights for optimizing personalized lipid-lowering strategies in clinical practice.