New Guidelines Emphasize Intensive, Personalized approach to Dyslipidemia Management
The European Society of Cardiology (ESC) and European Atherosclerosis Society (EAS) have released their 2025 update for the management of dyslipidemia, marking a notable shift towards more aggressive and personalized cardiovascular prevention.A key change is the suggestion for worldwide testing of Lipoprotein(a) [LP(A)] in all adults as part of standard cardiovascular risk evaluation.The updated guidelines underscore the importance of rapidly achieving LDL-C targets, notably following a coronary event, to reduce recurrence and improve survival. The guidance acknowledges that achieving these targets often requires more than a single medication, justifying an intensive therapeutic approach.
The update also addresses the use of dietary supplements. Evidence analysis reveals no demonstrated efficacy or safety of supplements - including omega-3 fatty acids, plant sterols, and vitamins – in reducing LDL-C or preventing cardiovascular events. The guidelines specifically caution against red rice yeast, marketed as a natural statin option, due to associated severe side effects and restrictions on high doses within the European Union. Patients are encouraged to focus on validated therapies and a cardioprotective diet.
Family Hypercholesterolemia (FH), a genetic condition affecting approximately 1 in 300 people and leading to early-onset high LDL-C and accelerated atherosclerosis, remains a high priority. The 2025 update classifies FH patients with atherosclerotic cardiovascular disease or other major risk factors as “very high risk,” and others as “high risk.” Recommendations include early statin initiation, potentially even in childhood, with escalation to Ezetimib, PCSK9 inhibitors, or bempedoic acid if targets are not met. For those with homozygous FH, Evincumab, an anti-angptl3 monoclonal antibody, is now recognized as an effective treatment option. Cascade screening is emphasized as a crucial strategy for identifying undiagnosed cases. The combination of FH and elevated LP(A) necessitates a particularly aggressive and early intervention due to the compounded genetic risk.
The integration of universal LP(A) determination, expanded statin indications, recommendations for early combined therapy, and strengthened FH strategies signal a move towards a more individualized approach to cardiovascular prevention, tailored to each patient’s unique risk profile. Clinicians are urged to incorporate genetic factors into risk assessment and initiate early, intensified treatment to reduce the burden of cardiovascular disease both in Europe and globally.
