2025 Focused Update of the 2019 ESC/EAS Guidelines for the management of dyslipidaemias

Abstract

1. Preamble 4361 2. Introduction 4363 3. Estimation of total cardiovascular risk and implications for dyslipidaemia management 4363 4. New low-density lipoprotein cholesterol-lowering therapies 4367 5. Combination of lipid-lowering therapies during index hospitalization for acute coronary syndromes 4369 6. Lipoprotein(a) 4370 7. Hypertriglyceridaemia 4371 8. Primary prevention in people with human immunodeficiency virus infection 4372 9. Patients with cancer at high or very high chemotherapy-related cardiovascular toxicity risk 4373 10. Dietary supplements 4373 11. Evidence tables 4374 12. Data availability statement 4374 13. Author information 4374 14. Appendix 4374 15. References 4375 Recommendation Table 1 — Recommendations for cardiovascular risk estimation in persons without known cardiovascular disease (see also Supplementary data online, Evidence Table 1) 4367 Recommendation Table 2 — Recommendations for pharmacological low-density lipoprotein cholesterol lowering (see also Supplementary data online, Evidence Table 2) 4369 Recommendation Table 3 — Recommendations for lipid-lowering therapy in patients with acute coronary syndromes (see also Supplementary data online, Evidence Table 3) 4370 Recommendation Table 4 — Recommendations for measurement of lipoprotein(a) (see also Supplementary data online, Evidence Table 4) 4370 Recommendation Table 5 — Recommendations for drug treatment of patients with hypertriglyceridaemia (see also Supplementary data online, Evidence Table 5) 4372 Recommendation Table 6 — Recommendations for statin therapy in primary prevention for people with human immunodeficiency virus infection (see also Supplementary data online, Evidence Table 6) 4373 Recommendation Table 7 — Recommendations for statin therapy in patients receiving cancer therapy (see also Supplementary data online, Evidence Table 7) 4373 Recommendation Table 8 — Recommendations for dietary supplements (see also Supplementary data online, Evidence Table 8) 4374 Table 1 Classes of recommendations 4362 Table 2 Levels of evidence 4362 Table 3 Cardiovascular risk categories 4364 Table 4 Intervention strategies as a function of total cardiovascular risk and untreated low-density lipoprotein cholesterol levels 4365 Figure 1 Treatment goals for low-density lipoprotein cholesterol across categories of total cardiovascular risk 4366 Figure 2 Average reduction in low-density lipoprotein cholesterol levels with different pharmacological therapies with proven cardiovascular benefits 4368 Figure 3 Association between Lp(a) levels and lifetime risk of major cardiovascular events 4371 Acute coronary syndromes Alanine aminotransferase Apolipoprotein B Apolipoprotein C-III Antiretroviral therapy Atherosclerotic cardiovascular disease Aspartate aminotransferase Aortic valve stenosis Coronary artery calcium Confidence interval Computed tomography Cardiovascular Cardiovascular disease Docosahexaenoic acid European Atherosclerosis Society European Medicines Agency Eicosapentaenoic acid European Society of Cardiology Familial chylomicronaemia syndrome US Food and Drug Administration Familial hypercholesterolaemia High-density lipoprotein cholesterol Human immunodeficiency virus Hazard ratio Low-density lipoprotein cholesterol Lipoprotein(a) Left ventricular ejection fraction Monoclonal antibody Major adverse cardiovascular event(s) Myocardial infarction Percutaneous coronary intervention Proprotein convertase subtilisin/kexin type 9 Peroxisome proliferator-activated receptor n-3 polyunsaturated fatty acid People with HIV Systematic Coronary Risk Evaluation 2 Systematic Coronary Risk Evaluation 2-Older Persons Total cholesterol Type 1 diabetes mellitus Type 2 diabetes mellitus Upper limit of normal Guidelines evaluate and summarize available evidence with the aim of assisting health professionals in proposing the best diagnostic or therapeutic approach for an individual patient with a given condition. The European Society of Cardiology (ESC) Guidelines are intended for use by health professionals but do not override their individual responsibility to make appropriate and accurate decisions in consideration of each patient's health condition and in consultation with the patient or the patient's caregiver where appropriate and/or necessary aiming at shared care decisions. It is also the health professional's responsibility to verify the rules and regulations applicable in each country to drugs and devices at the time of prescription and to respect the ethical rules of their profession. The ESC Guidelines represent the official position of the ESC on a given topic. Guideline topics are selected for updating after annual expert review of new evidence conducted by the ESC Clinical Practice Guidelines (CPG) Committee. ESC Policies and Procedures for formulating and issuing the ESC Guidelines can be found on the ESC website (https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Guidelines-development/Writing-ESC-Guidelines). Interim