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ESC/EAS Guidelines on management of dyslipidaemia 2019

2019 ESC/EAS Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk:

The Task Force for the management of dyslipidaemias of the European Society of Cardiology (ESC) and European Atherosclerosis Society (EAS)

Authors/Task Force Members: François Mach* (Chairperson) (Switzerland), Colin Baigent* (Chairperson) (United Kingdom), Alberico L. Catapano1* (Chairperson) (Italy), Konstantinos C. Koskinas (Switzerland), Manuela Casula1 (Italy), Lina Badimon (Spain), M. John Chapman1 (France), Guy G. De Backer (Belgium), Victoria Delgado (Netherlands), Brian A. Ference (United Kingdom), Ian M. Graham (Ireland), Alison Halliday (United Kingdom), Ulf Landmesser (Germany), Borislava Mihaylova (United Kingdom), Terje R. Pedersen (Norway), Gabriele Riccardi1 (Italy), Dimitrios J. Richter (Greece), Marc S. Sabatine (United States of America), Marja-Riitta Taskinen1 (Finland), Lale Tokgozoglu1 (Turkey), Olov Wiklund1 (Sweden).

The three chairpersons contributed equally to the document.

1 Representing the EAS.

Introduction

The previous ESC/EAS lipid Guidelines were published in August 2016. The emergence of a substantial body of evidence over the last few years has required new, up-to-date Guidelines.

New evidence has confirmed that the key initiating event in atherogenesis is the retention of low-density lipoprotein (LDL) cholesterol (LDL-C) and other cholesterol-rich apolipoprotein (Apo) B-containing lipoproteins within the arterial wall.2 Several recent placebo-controlled clinical studies have shown that the addition of either ezetimibe or anti-proprotein convertase subtilisin/kexin type 9 (PCSK9) monoclonal antibodies (mAbs) to statin therapy provides a further reduction in atherosclerotic cardiovascular disease (ASCVD) risk, which is directly and positively correlated with the incrementally achieved absolute LDL-C reduction. Furthermore, these clinical trials have clearly indicated that the lower the achieved LDL-C values, the lower the risk of future cardiovascular (CV) events, with no lower limit for LDL-C values, or ‘J’-curve effect. In addition, studies of the clinical safety of these very low achieved LDL-C values have proved reassuring, albeit monitoring for longer periods is required. For raising high-density lipoprotein (HDL) cholesterol (HDL-C), recent studies have indicated that the currently available therapies do not reduce the risk of ASCVD. Finally, human Mendelian randomization studies have demonstrated the critical role of LDL-C, and other cholesterol-rich ApoB-containing lipoproteins, in atherosclerotic plaque formation and related subsequent CV events. Thus, there is no longer an ‘LDL-C hypothesis’, but established facts that increased LDL-C values are causally related to ASCVD, and that lowering LDL particles and other ApoB-containing lipoproteins as much as possible reduces CV events.

In order to be aligned with these new findings, the ESC/EAS Task Force members who have written these Guidelines have proposed new LDL-C goals, as well as a revised CV risk stratification, which are especially relevant to high- and very-high-risk patients.

These novel ESC/EAS Guidelines on lipids provide important new advice on patient management, which should enable more clinicians to efficiently and safely reduce CV risk through lipid modification.

Publication in full

Slideset

What's new - video explaning the key messages

In the video below, the EAS contributors Professor Alberico L. Catapano, Professor Lale Tokgozoglu, and Professor Olov Wiklund describe key changes and what they will mean for practicing clinicians.

What's new - in depth interviews

Prof. Alberico Catapano about new recommendations and concepts in the new guidelines.

Prof. Tokgözoğlu summarises the approach of high- and very high risk patients in the new guidelines.

Prof. Wiklund about Management of dyslipidaemias in different clinical settings.

Prof Gabriele Riccardi - Professor of endocrinology and metabolic diseases at the University of Naples, and member of the ESC-EAS Task force writing the ESC/EAS guidelines on management of dyslipidaemias – lifts from the guidelines important aspects related to lifestyle .

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