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Lipids: how low to go? How and when?

ESC Congress News 2019 - Paris, France

Ahead of the presentation of the 2019 ESC/EAS Guidelines for the management of dyslipidaemias tomorrow (08:30 – 10:00; Paris – Main Auditorium), Professor François Mach (Geneva University Hospital, Geneva, Switzerland), one of the Guideline Task Force Chairs, and Professor Eva Prescott (Center for Cardiovascular Research, Bispebjerg Frederiksberg Hospital, University of Copenhagen, Denmark), member of the Congress Programme Committee, will whet our appetite about what’s new in dyslipidaemias and what lies in store at ESC Congress 2019.

Risk Factors and Prevention

Prof. François Mach Prof. Eva PrescottProf. Mach explains, “We now know that low-density lipoprotein-cholesterol (LDL-C) has a causal relationship with atherosclerotic cardiovascular disease (ASCVD). Emerging evidence from observational studies, Mendelian randomisation studies and randomised controlled trials have helped us to dismiss the ‘LDL-C hypothesis’—now it is not a hypothesis—we have established evidence that high levels of LDL-C are causally related to ASCVD and that by lowering LDL particles as far as possible, through long-standing treatments like statins and ezetimibe and also newer treatments, such as proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors, cardiovascular events can be reduced. Outcomes trials with anti-PCSK9 monoclonal antibodies appear to show that very low LDL-C levels are safe, although these trials only lasted for ~3 years, which is not sufficient to be conclusive.”

An individual’s risk of ASCVD is determined by the number and magnitude of risk factors and also the total duration of exposure and this is why we should think of risk reduction in a life-course perspective emphasises Prof. Prescott. “We know from genetic risk modelling studies that we must consider lifetime risk. This highlights that we should encourage all individuals to lead healthy lives from childhood but also leads to questions on whether we should be starting therapy earlier on in life. I think many cardiologists and GPs are struggling with this. Tomorrow, we will hear from Professor Eugene Braunwald who will share his perspective on current lipid-lowering concepts, including his thoughts on the right age to start lipid-lowering therapy (14:30 – 15:15; Colette – The Hub).”

On Tuesday, a lively debate session entitled ‘Controversies in secondary prevention: treating residual risk’ will see Professor John Kastelein and Professor Paul Ridker offer different opinions on driving LDL-C as low as possible beyond high-intensity statins (14:30 – 15:40; Duras – The Hub). Professor Ph. Gabriel Steg and Professor Jane Armitage will then debate ‘Fish oil: It’s all about triglycerides.’ Also on Tuesday, the very latest evidence on targeting triglycerides to prevent ASCVD will be presented (14:30 – 15:40; Reykjavik – Village 2) and a session entitled ‘Evolving concepts in lipidology’ will look at a range of issues from the side effects of statins to new ways of lowering lipids (08:30 – 10:00; Prague – Village 2).

Prof. Mach concludes, “With the new ESC Guidelines on dyslipidaemia management and a range of stimulating sessions, the stage is set for enhanced understanding of how we can modify lipids to improve ASCVD prevention.”

Want to learn more about the secondary prevention of ASCVD?

A range of resources are available as part of the ESC Prevention of CVD Programme at:



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Notes to editor

About the European Society of Cardiology

The European Society of Cardiology brings together healthcare professionals from more than 150 countries, working to advance cardiovascular medicine and help people lead longer, healthier lives.

About ESC Congress 2019

ESC Congress is the world’s largest and most influential cardiovascular event contributing to global awareness of the latest clinical trials and breakthrough discoveries. ESC Congress 2019 takes place 31 August to 4 September at the Paris Expo Porte de Versailles, Paris - France. Explore the scientific programme