A practical guide to the management of dyslipidaemia

TL;DR

This paper provides updated clinical guidance for managing dyslipidaemia to reduce cardiovascular disease risk, emphasizing new recommendations and treatment strategies.

Contribution

The paper incorporates the 2025 Focused Update of the 2019 ESC/EAS guidelines, offering novel recommendations on risk modifiers and early combination therapy.

Findings

Dyslipidaemia remains underdiagnosed and undertreated, especially in high-risk patients.

Lifestyle interventions and statins are foundational, with new therapies like PCSK9 inhibitors offering additional options.

Early combination therapy after acute coronary syndrome is now recommended to improve outcomes.

Abstract

Dyslipidaemia, especially elevated low-density lipoprotein cholesterol (LDL-C), is a major modifiable risk factor for atherosclerotic cardiovascular disease (ASCVD). Dyslipidaemia remains underdiagnosed and undertreated. Dyslipidemia is highly prevalent in Germany. Even among patients with high- and very-high cardiovascular risk, LDL-C targets are often not achieved. This paper highlights key lipid parameters beyond LDL-C, such as triglycerides and lipoprotein(a), which contribute to residual cardiovascular risk. Practical guidance to address diagnostic challenges and cardiovascular risk assessment, especially in younger adults and those with risk modifiers, is provided. Lifestyle interventions are the basis of therapy. Statins remain the first-line treatment, with additional options including ezetimibe, bempedoic acid, and PCSK9 inhibitors, alone or in combination. Novel lipid-lowering therapies are currently in development and may offer more individualized treatment options in the future. The most important messages from the 2025 Focused Update of the 2019 ESC/EAS guidelines for the management of dyslipidaemias have been incorporated into the paper. While LDL-C targets remain unchanged, important novel recommendations encompass consideration of cardiovascular risk modifiers such as lipoprotein(a) and CRP/inflammatory diseases. A second important new recommendation is the use of potent early combination therapy after an acute coronary syndrome. Improved awareness, early diagnosis, and evidence-based lipid management are critical for reducing ASCVD burden. This paper is aimed at supporting clinicians in optimizing lipid diagnostics and therapy in daily practice.

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