[Updated European guidelines for the management of hypercholesterolaemia]

The management of dyslipidaemias, especially of LDL hypercholesterolaemia (LDL-c), is at the forefront in the prevention of atherosclerotic cardiovascular disease (ASCVD). The latest international guidelines specifically devoted to dyslipidaemias were published in 2019. They allocated the people in four cardiovascular risk categories : very high risk, high risk, moderate risk and low risk. However, in the last recommendations for the prevention of ASCVD published in 2021 by the European Society of Cardiology, only three risk categories are recognized : very high, high and low-to-moderate. Current guidelines propose target LDL-c levels that are lowered according to the risk category : very high risk : LDL-c < 55 mg/dL; high risk : < 70 mg/dL; low-to-moderate risk : < 100 mg/dL. They support a step-by-step approach with a progressive intensification of the pharmacological treatment, moving from a monotherapy with statin to a combined therapy (addition of ezetimibe and/or PCSK9 inhibitor) in order to reach the recommended target levels. However, an earlier use of combined therapies should be recommended in secondary prevention and in primary prevention at very high risk.