[Lipid-lowering therapy in transition: implications of the ESC/EAS focused update]

In 2025, the focused update of the ESC/EAS guidelines on dyslipidemia management introduced clinically relevant refinements in cardiovascular risk stratification and lipid-lowering therapy. The updated recommendations emphasize the integration of additional risk modifiers, including comorbidities, biomarkers and imaging findings, enabling a more individualized assessment of cardiovascular risk.

In patients with acute coronary syndrome, the updated guidance highlights the importance of rapid and intensive LDL cholesterol reduction during the index hospitalization, including prompt initiation of high-intensity statin therapy and early combination treatment to facilitate target achievement. Recent evidence further supports early intensive LDL cholesterol lowering, with outcome data for bempedoic acid and PCSK9 inhibitors extending the role of LDL cholesterol lowering beyond secondary prevention.

At the same time, emerging evidence on statin safety indicates that a substantial proportion of commonly reported adverse effects are not causally related to statin therapy, underscoring the relevance of patient education and structured communication to improve adherence.

Beyond LDL cholesterol, other lipid fractions have gained increasing clinical relevance. Lipoprotein(a) has emerged as an important genetically determined cardiovascular risk factor, and several therapies capable of markedly reducing lipoprotein(a) levels are currently being evaluated in large, randomized outcome trials.

In hypertriglyceridemia, conventional therapies have shown limited benefit regarding cardiovascular outcomes. Novel targeted approaches, particularly therapies directed against apolipoprotein C-III, therefore represent promising future treatment strategies.

Overall, recent developments highlight a shift toward earlier, more intensive, and more individualized lipid-lowering strategies, with emerging therapies likely to further expand cardiovascular prevention in the coming years.