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[European dyslipidemia guidelines 2019 : What is new?]
J L Katzmann1, A Tünnemann-Tarr2, U Laufs2
1Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Liebigstraße 20, 04103, Leipzig, Deutschland. julius.katzmann@medizin.uni-leipzig.de.
Insights
The 2019 ESC/EAS dyslipidemia guidelines emphasize early, maximal reduction of low-density lipoprotein cholesterol (LDL-C) to prevent atherosclerotic cardiovascular disease (ASCVD). New, lower LDL-C targets are set for various risk groups, including very high-risk patients.
Area of Science:
- Cardiology
- Atherosclerosis Research
- Lipid Metabolism
Background:
- Updated European Society of Cardiology (ESC) and European Atherosclerosis Society (EAS) dyslipidemia guidelines published in August 2019.
- New randomized trials, particularly involving proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors, and genetic analyses have emerged since 2016.
- These advancements demonstrate additional atherosclerotic cardiovascular disease (ASCVD) risk reduction beyond existing treatments.
Purpose of the Study:
- To present the updated 2019 ESC/EAS guidelines for dyslipidemia management.
- To incorporate new evidence on PCSK9 inhibitors and genetic factors into ASCVD risk reduction strategies.
- To establish revised, lower low-density lipoprotein cholesterol (LDL-C) targets for different cardiovascular risk categories.
Main Methods:
- Review and synthesis of data from recent large randomized trials and genetic analyses.
- Development of updated recommendations for managing dyslipidemia.
- Establishment of specific LDL-C goals based on cardiovascular risk stratification.
Main Results:
- The primary strategy is early and maximal absolute reduction of LDL-C.
- Lower LDL-C goals are introduced: <1.4 mmol/l (55 mg/dl) for very high risk, <1.8 mmol/l (70 mg/dl) for high risk, <2.6 mmol/l (100 mg/dl) for moderate risk, and <3.0 mmol/l (116 mg/dl) for low risk.
- A new category for patients with recurrent ASCVD events on maximally tolerated statin therapy is introduced with an LDL-C goal of <1.0 mmol/l (40 mg/dl).
Conclusions:
- The updated guidelines advocate for more aggressive LDL-C reduction to mitigate ASCVD risk.
- Novel recommendations include precise risk classification using cardiovascular imaging, guidance for familial hypercholesterolemia, and screening for lipoprotein(a) and apolipoprotein B.
- These updates reflect advancements in understanding lipid metabolism and therapeutic options, aiming for improved patient outcomes.
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 LDL‑C goals are amended to lower values. Patients at very high cardiovascular risk are recommended to achieve LDL‑C <1.4 mmol/l (55 mg/dl). For patients with high, moderate, and low cardiovascular risks, LDL‑C goals are set at <1.8 mmol/l (70 mg/dl), <2.6 mmol/l (100 mg/dl) and <3.0 mmol/l (116 mg/dl), respectively. A new classification of patients with recurrent cardiovascular events despite maximum tolerated statin-based therapy is introduced. For these patients the LDL‑C goal is <1.0 mmol/l (40 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.
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