ABSTRACT
In August 2019 the updated dyslipidemia guidelines of the European Society of Cardiology (ESC) and the European Atherosclerosis Society (EAS) were published. Since the last version from 2016, important large randomized trials especially with proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors and new genetic analyses have become available that show additional reduction of atherosclerotic cardiovascular disease (ASCVD) risk on top of the previously recommended treatments. Based on these data the main concept of the recommendations is achieving an early and as large as possible absolute reduction of low-density lipoprotein cholesterol (LDL-C). As a result of this knowledge and the extended pharmaceutical treatment options the LDLC goals are amended to lower values. Patients at very high cardiovascular risk are recommended to achieve LDLC <1.4â¯mmol/l (55â¯mg/dl). For patients with high, moderate, and low cardiovascular risks, LDLC goals are set at <1.8â¯mmol/l (70â¯mg/dl), <2.6â¯mmol/l (100â¯mg/dl) and <3.0â¯mmol/l (116â¯mg/dl), respectively. A new classification of patients with recurrent cardiovascular events despite maximum tolerated statin-based therapy is introduced. For these patients the LDLC goal is <1.0â¯mmol/l (40â¯mg/dl). Novel recommendations comprise a more precise classification of patients at low or moderate risk based on cardiovascular imaging, recommendations for familial hypercholesterolemia, screening for increased lipoprotein(a) and determination of apolipoprotein B as diagnostic and therapeutic goal.
