{"id":8581,"date":"2025-09-11T11:43:11","date_gmt":"2025-09-11T08:43:11","guid":{"rendered":"https:\/\/jordan-cardiac.org\/?p=8581"},"modified":"2025-09-11T11:43:11","modified_gmt":"2025-09-11T08:43:11","slug":"esc-2025-dyslipidaemia-guidelines-final-comprehensive-summary","status":"publish","type":"post","link":"https:\/\/jordan-cardiac.org\/en\/esc-2025-dyslipidaemia-guidelines-final-comprehensive-summary\/","title":{"rendered":"ESC 2025 Dyslipidaemia Guidelines \u2013 Final Comprehensive Summary"},"content":{"rendered":"
ESC 2025 Dyslipidaemia Guidelines \u2013 Final Comprehensive Summary<\/div>\n
<\/div>\n
1. Risk Assessment & Imaging<\/div>\n
\u2022 SCORE2 & SCORE2-OP (estimate 10-year risk of fatal + non-fatal CV events in adults without CVD or diabetes, guiding prevention intensity) \u2192 HeartScore Calculator<\/span><\/div>\n
(calculated using age, sex, smoking status, systolic blood pressure, and non-HDL or total cholesterol)<\/div>\n
\u2022 SCORE2: for adults 40\u201369 years.<\/span><\/div>\n
\u2022 SCORE2-OP: for adults \u226570 years (\u201cOlder Persons\u201d).<\/span><\/div>\n
\u2022 Risk thresholds:<\/span><\/div>\n
\u2022 Very high risk: \u226520%<\/span><\/div>\n
\u2022 High risk: 10%\u2013<20%<\/span><\/div>\n
\u2022 Moderate risk: 2%\u2013<10%<\/span><\/div>\n
\u2022 Low risk: <2%<\/span><\/div>\n
\u2022 Refinement tools: In moderate-risk patients, use coronary calcium scoring (CT) or vascular ultrasound (carotid\/femoral) (Class IIa).<\/span><\/div>\n
\u2022 If plaques or calcifications are present \u2192 risk upgraded (e.g., moderate \u2192 high).\u00a0<\/span><\/div>\n
<\/div>\n
(https:\/\/www.escardio.org\/Education\/Practice-Tools\/CVD-prevention-toolbox\/SCORE-Risk-Charts)<\/div>\n
<\/div>\n
2. Lp(a) \u2013 Lipoprotein(a)<\/div>\n
\u2022 Testing: Once in every adult\u2019s lifetime (levels are genetically determined and stable).<\/span><\/div>\n
\u2022 Threshold: \u226550 mg\/dL (\u2248105 nmol\/L) = risk-enhancing factor (Class IIa).<\/span><\/div>\n
\u2022 High Lp(a) can shift patients from moderate \u2192 higher risk.<\/span><\/div>\n
\u2022 Repeat testing rarely needed (exceptions: new assay, unclear family history).<\/span><\/div>\n
<\/div>\n
3. Risk Modifiers (Class IIa)<\/div>\n
\u2022 Obstructive sleep apnoea<\/span><\/div>\n
\u2022 Autoimmune inflammatory diseases<\/span><\/div>\n
\u2022 HIV infection<\/span><\/div>\n
\u2022 Physical inactivity<\/span><\/div>\n
\u2022 Preeclampsia, premature menopause, PCOS (in women)<\/span><\/div>\n
\u2022 Elevated Lp(a) \u226550 mg\/dL<\/span><\/div>\n
<\/div>\n
4. LDL-C Targets<\/div>\n
\u2022 High\/very high risk: <55 mg\/dL (unchanged from 2019, Class I).<\/span><\/div>\n
\u2022 Extreme risk: <40 mg\/dL (Class IIb), for recurrent vascular events despite maximal therapy or polyvascular disease.<\/span><\/div>\n
<\/div>\n
5. Pharmacological Treatments<\/div>\n
\u2022 Bempedoic acid: Class I, for primary\/secondary prevention in statin-intolerant or contraindicated patients.<\/span><\/div>\n
\u2022 Evinacumab (Evkeeza): Monoclonal antibody inhibiting ANGPTL3 (a liver protein that raises TG and LDL-C; blocking it lowers both, even in HoFH).<\/span><\/div>\n
\u2022 Class IIa, for HoFH patients.<\/span><\/div>\n
\u2022 Especially useful when LDL-C targets not reached despite maximal therapy.<\/span><\/div>\n
\u2022 Works independently of PCSK9 and LDL receptor (effective in null mutations).<\/span><\/div>\n
\u2022 Volanesorsen (Waylivra): Antisense drug (blocks mRNA for a protein that impairs triglyceride breakdown).<\/span><\/div>\n
\u2022 Class IIa, only for FCS with severe HTG (>750 mg\/dL) to prevent pancreatitis.<\/span><\/div>\n
\u2022 Dose: 300 mg SC weekly.<\/span><\/div>\n
\u2022 Not for general HTG.<\/span><\/div>\n
\u2022 Note: Antisense drugs are short synthetic strands that bind to mRNA and block protein production.<\/span><\/div>\n
\u2022 Pitavastatin: Class I, for HIV patients >40 years (REPRIEVE trial).<\/span><\/div>\n
<\/div>\n
6. Gene Therapy vs Antisense Drugs<\/div>\n
\u2022 Volanesorsen is not gene therapy.<\/span><\/div>\n
\u2022 Antisense oligonucleotides block mRNA temporarily (reversible).<\/span><\/div>\n
\u2022 Gene therapy alters DNA permanently.<\/span><\/div>\n
<\/div>\n
7. Combination Therapy<\/div>\n
\u2022 LDL-C reductions:<\/span><\/div>\n
\u2022 Ezetimibe alone: ~20%<\/span><\/div>\n
\u2022 High-intensity statin + ezetimibe + bempedoic acid + PCSK9 inhibitor: up to ~86%<\/span><\/div>\n
\u2022 Ezetimibe addition recommended routinely (effective, safe, inexpensive).<\/span><\/div>\n
<\/div>\n
8. Acute Coronary Syndrome (ACS) Management<\/div>\n
\u2022 Intensify lipid-lowering therapy before hospital discharge.<\/span><\/div>\n
\u2022 High-intensity statin + ezetimibe; add PCSK9 inhibitor if needed (Class I\u2013IIa).<\/span><\/div>\n
\u2022 Bempedoic acid may substitute if statins contraindicated.<\/span><\/div>\n
\u2022 Avoid stepwise strategy; upfront intensive therapy preferred.<\/span><\/div>\n
<\/div>\n
9. Omega-3 & Other Therapies<\/div>\n
\u2022 Icosapent ethyl (2\u00d72 g\/d): Class IIa, in high\/very high-risk patients with TG >135 mg\/dL; reduces major CV events (REDUCE-IT: \u201323%).<\/span><\/div>\n
\u2022 Fibrates: Mainly for very severe HTG (\u2265500\u20131000 mg\/dL) to prevent pancreatitis; not for routine CV risk reduction.<\/span><\/div>\n
\u2022 Inclisiran: Not yet included for primary prevention; awaiting outcomes.<\/span><\/div>\n
\u2022 Supplements (vitamins, red yeast rice, etc.): Not recommended (Class III).<\/span><\/div>\n
\u2022 HDL-C is no longer considered protective.<\/span><\/div>\n
<\/div>\n
10. AI & Digital Tools<\/div>\n
\u2022 ESC Chat: AI chatbot launched in 2025, providing answers directly from ESC guidelines.<\/span><\/div>\n
\u2022 AI promising in coronary CT & vascular Doppler interpretation, reducing cost and expanding personalised care.<\/span><\/div>\n
<\/div>\n
11. Comparative Therapies for Hypertriglyceridaemia<\/div>\n
\u2022 Statins remain the first-line therapy for hypertriglyceridemia, with strongest ASCVD risk reduction evidence.<\/span><\/div>\n
\u2022 Non-statin agents are reserved for persistent or severe TG elevations.<\/span><\/div>\n
\u2022 Fibrates: For very severe HTG (\u2265500\u20131000 mg\/dL) to prevent pancreatitis; not for routine CV prevention.<\/span><\/div>\n
\u2022 Icosapent ethyl: For high\/very high CV risk with TG >135 mg\/dL on statins; purified EPA lowering TG and CV events (Class IIa).<\/span><\/div>\n
\u2022 Volanesorsen: For FCS with TG >750 mg\/dL; antisense drug blocking mRNA for a protein that impairs TG breakdown (Class IIa).<\/span><\/div>\n","protected":false},"excerpt":{"rendered":"

ESC 2025 Dyslipidaemia Guidelines \u2013 Final Comprehensive Summary 1. Risk Assessment & Imaging \u2022 SCORE2 & SCORE2-OP (estimate 10-year risk of fatal + non-fatal CV events in adults without CVD or diabetes, guiding prevention intensity) \u2192 HeartScore Calculator (calculated using age, sex, smoking status, systolic blood pressure, and non-HDL or total cholesterol) \u2022 SCORE2: for […]<\/p>\n","protected":false},"author":145,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[],"class_list":["post-8581","post","type-post","status-publish","format-standard","hentry","category-uncategorized"],"_links":{"self":[{"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/posts\/8581","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/users\/145"}],"replies":[{"embeddable":true,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/comments?post=8581"}],"version-history":[{"count":1,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/posts\/8581\/revisions"}],"predecessor-version":[{"id":8582,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/posts\/8581\/revisions\/8582"}],"wp:attachment":[{"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/media?parent=8581"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/categories?post=8581"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/tags?post=8581"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}