Focused Update of the 2019 ESC/EAS Guidelines for the management of dyslipidaemias
31 Aug 2025
Focused Update of the 2019 ESC/EAS Guidelines for the management of dyslipidaemias Since the publication of the 2019 ESC/EAS Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular (CV) risk,1 there have been major developments with the potential to change patient management ahead of the next scheduled full dyslipidaemia guidelines.
Today, Professor François Mach (Geneva University Hospital - Geneva, Switzerland), Doctor Konstantinos Koskinas (Bern University Hospital – Bern, Switzerland) and Professor Jeanine Roeters van Lennep (Erasmus MC University Medical Center - Rotterdam, Netherlands) presented a Focused Update incorporating new risk-prediction algorithms, novel risk modifiers and data from key lipid-lowering therapy trials.2
In line with current 2021 ESC Guidelines on CVD prevention,3 the Focused Update endorses the use of SCORE2 and SCORE2-OP (instead of the SCORE algorithm) for estimation of the 10-year risk of a major CV event in persons without known CVD or diabetes, aged between 40 and 89 years. Of note, low-density lipoprotein cholesterol (LDL-C) treatment goals and targets for persons in each risk category have not changed from the 2019 ESC/EAS Guidelines. The intensity of the recommended LDL-C lowering continues to be determined by a person’s level of risk.
The 2025 Focused Update includes a new recommendation that the presence of subclinical atherosclerosis by imaging or increased coronary artery calcium score, if measured, should be considered as risk modifiers in individuals at moderate risk or around treatment decision thresholds. Similarly, it is now reasonable to consider elevated Lp(a) levels >50 mg/dL (> 105 nmol/L) to refine CV risk estimation and potentially re-classify risk in individuals at moderate risk or close to treatment decision thresholds.
Regarding new LDL-C-lowering therapies, bempedoic acid is now recommended in patients who are unable to take statins to achieve their LDL-C goal. The addition of bempedoic acid to the maximally tolerated dose of statin with or without ezetimibe should be considered in patients at high or very high risk of CVD. Evinacumab should be considered in patients with homozygous familial hypercholesterolaemia aged 5 years or older who are not at LDL-C goal despite receiving maximum doses of lipid-lowering therapy. Regarding triglyceride-lowering therapies, new Class IIa (Level B) recommendations are given for the use of high-dose icosapent ethyl for the treatment of high-risk or very high-risk patients with moderately elevated triglyceride levels to reduce the risk of CV events and for the use of volanesorsen in patients with familial hyperchylomicronaemia syndrome and severe hypertriglyceridaemia to prevent pancreatitis.
In line with current 2023 ESC Guidelines for the management of patients with acute coronary syndrome (ACS),4 the Focused Update proposes that a strategy of early, intensive LDL-C lowering is considered in all patients with ACS, with immediate initiation of statins and combination treatment with one or more classes of non-statin therapy with proven CV benefit as needed, depending on the patient’s lipid-lowering therapy prior to the ACS event.
Special populations are considered, with recommendations for statins in primary CVD prevention for people with HIV infection and for patients with cancer at high or very high chemotherapy-related CV toxicity risk. The Focused Update includes guidance that dietary supplements or vitamins without documented safety and significant LDL-C-lowering efficacy are not recommended to lower the risk of atherosclerotic CVD.
Want to know more? Full details can be found in the European Heart Journal.
References
- Mach F, et al. 2019 ESC/EAS Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk. Eur Heart J. 2020;41:111–188.
- Mach F, et al. 2025 Focused Update of the 2019 ESC/EAS Guidelines for the management of dyslipidaemias. Eur Heart J. 2025. doi:10.1093/eurheartj/ehaf190.
- Visseren FLJ, et al. 2021 ESC Guidelines on cardiovascular disease prevention in clinical practice. Eur Heart J. 2021;42:3227–3337.
- Byrne RA, et al. 2023 ESC Guidelines for the management of acute coronary syndromes. Eur Heart J. 2023;44:3720–3826.
