Evolving paradigms in the management of dyslipidemia: comparison between the 2019 ESC/EAS guidelines and the 2025...

The 2025 focus update of the European society of cardiology (ESC) and European atherosclerosis society (EAS) guidelines for dyslipidemia management highlight a significant evolution in patient care, shifting from an intensive, target-driven approach to earlier and more personalized strategies. The transition from SCORE to SCORE2 and SCORE2-OP has improved risk stratification accuracy by including non-fatal cardiovascular events and expanding the evaluable population, particularly among older adults. The introduction of the "extreme risk" category and the early adoption of combination therapies allow previously theoretical LDL targets (< 40 mg/dL) to be achieved through the synergistic use of non-statin lipid-lowering agents. Additionally, the 2025 update emphasizes the role of biomarkers such as lipoprotein(a) and elevated triglycerides, as well as traditionally underrepresented populations, including HIV-positive and oncology patients, with recommendations grounded in recent clinical evidence. At the same time, the lack of efficacy of supplements and nutraceuticals without scientific support is reaffirmed. This update consolidates the paradigm of "earlier, more intensive, more personalized" management, underscoring that the current challenge lies not only in scientific knowledge but also in its clinical implementation, with the goal of optimizing cardiovascular prevention and improving patient prognosis and quality of life.