Background: Hyperlipidemia represents a fundamental metabolic disturbance underlying atherosclerosis and cardiovascular disease (CVD), which remain leading causes of global mortality. Although lipid-lowering pharmacotherapy—particularly statins—has substantially reduced cardiovascular risk, persistent residual risk, drug intolerance, and long-term adverse effects necessitate exploration of complementary therapeutic paradigms. Ayurveda, the classical medical system of India, provides a comprehensive metabolic framework that may offer multi-targeted intervention strategies. Objective: To critically reinterpret hyperlipidemia through Ayurvedic patho-physiology and synthesize contemporary experimental and clinical evidence supporting Ayurvedic pharmacological, detoxificatory, and lifestyle-based interventions. Methods: A structured narrative synthesis was performed using classical Ayurvedic treatises—including Charaka Samhita, Sushruta Samhita, and Ashtanga Hridaya—alongside indexed biomedical literature from PubMed, Scopus, and AYUSH databases. Experimental studies, clinical trials, mechanistic investigations, and translational analyses focusing on lipid biomarkers were included. Results: Hyperlipidemia corresponds primarily to Medoroga, Sthaulya, Kapha-Meda Dushti, and Dhatvagni Mandya in Ayurvedic nosology. Botanical agents such as Terminalia chebula, Terminalia bellirica, Phyllanthus emblica, Piper nigrum, Piper longum, Zingiber officinale, Commiphora mukul, Allium sativum, Curcuma longa and Go-mutra exhibit lipid-modulatory effects mediated through regulation of HMG-CoA reductase activity, PPAR signaling, FXR modulation, bile acid turnover, antioxidant enzyme activation, and inflammatory pathway suppression. Panchakarma procedures including Virechana and Lekhana Basti demonstrate metabolic re-regulatory potential. Conclusion: Ayurveda offers a network-based therapeutic model targeting metabolic inflammation, oxidative stress, hepatic lipid synthesis, and adipose deregulation. Integrative application alongside conventional therapy warrants further large-scale randomized and molecular validation studies.