Pharmaceuticals used to treat abnormal cholesterol levels in the blood are known as lipid regulators (fibrates and statins), and their use is in constant growth. Treatment plants are usually unable to efficiently remove these compounds from wastewater, where their degradation rate is considerably slow, making them an emerging concern for aquatic systems. The present work reviews previously published research concerning the effects of these pharmaceuticals on several finfish species worldwide. Results suggest that both short- and long-term exposure to lipid regulators may have negative effects on fish health, affecting their metabolism and immune system and causing reproductive and developmental disorders. However, the information on these compounds in the available literature is still limited, and additional research is needed to fully understand the threat that their presence in aquatic systems may pose to the production of finfish by the aquaculture industry. The most documented fibrates are gemfibrozil, clofibrate and bezafibrate, while for statins, the majority of the published literature focuses on atorvastatin and simvastatin. The present work reviews previously published research concerning the effects of these hypocholesterolaemic pharmaceuticals on fish, with a particular focus on commercially important species, commonly produced by the European aquaculture industry, specifically in recirculated aquaculture systems (RAS). Overall, results suggest that both acute and chronic exposures to lipid-lowering compounds may have adverse effects on fish, disrupting their capacity to excrete exogenous substances, as well as both lipid metabolism and homeostasis, causing severe ontogenetic and endocrinological abnormalities, leading to hampered reproductive success (e.g., gametogenesis, fecundity), and skeletal or muscular malformations, having serious repercussions on fish health and welfare. Nonetheless, the available literature focusing on the effects of statins or fibrates on commonly farmed fish is still limited, and further research is required to understand the implications of this matter on aquaculture production, global food security and, ultimately, human health.