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For FH patients with ASCVD who are at very-high risk, treatment to achieve a >_50% reduction from baseline and an LDL-C <1.4 mmol/L (<55 mg/dL) is recommended. If goals cannot be achieved, a drug combination is recommended. I C Treatment with a PCSK9 inhibitor is recommended in very-high risk FH patients if the treatment goal is not achieved on a maximal tolerated statin plus ezetimibe. I C In children, testing for FH is recommended from the age of 5 years, or earlier if HoFH is suspected. I C Treatment of dyslipidaemias in older people Treatment with statins is recommended for older people with ASCVD in the same way as for younger patients. I A Treatment with statins is recommended for primary prevention, according to the level of risk, in older people aged <_75 years. I A It is recommended that the statin is started at a low dose if there is significant renal impairment and/or the potential for drug interactions, and then titrated upwards to achieve LDL-C treatment goals. I C Treatment of dyslipidaemias in DM In patients with T2DM at very-high risk,c an LDL-C reduction of >_50% from baseline and an LDL-C goal of <1.4 mmol/L (<55 mg/dL) is recommended. I A In patients with T2DM at high risk,c an LDL-C reduction of >_50% from baseline and an LDL-C goal of <1.8 mmol/L (<70 mg/dL) is recommended. I A Statins are recommended in patients with T1DM who are at high or very-high risk.c I A Statin therapy is not recommended in pre-menopausal patients with or without DM who are considering pregnancy, or not using adequate contraception. III C Management of patients with ACS In all ACS patients without any contraindication or definite history of intolerance, it is recommended that high-dose statin therapy is initiated or continued as early as possible, regardless of initial LDL-C values. I A If the LDL-C goal is not achieved after 46 weeks with the maximally tolerated statin dose, combination with ezetimibe is recommended. I B If the LDL-C goal is not achieved after 46 weeks despite maximal tolerated statin therapy and ezetimibe, adding a PCSK9 inhibitor is recommended. I B Lipid-lowering therapy for prevention of ASCVD events in patients with prior ischaemic stroke Patients with a history of ischaemic stroke or TIA are at very-high risk of ASCVD, particularly recurrent ischaemic stroke, so it is recommended that they receive intensive LDL-C-lowering therapy. I A Treatment of dyslipidaemias in chronic HF or valvular heart diseases Initiation of lipid-lowering therapy is not recommended in patients with HF in the absence of other indications for their use. III A Initiation of lipid-lowering treatment is not recommended in patients with aortic valvular stenosis without CAD to slow progression of aortic valve stenosis in the absence of other indications for their use. III A Lipid management in patients with moderate-to-severe (Kidney Disease Outcomes Quality Initiative stages 35) CKD It is recommended that patients with stage 35 CKD are considered to be at high or very-high risk of ASCVD. I A The use of statins or statin/ezetimibe combination is recommended in patients with non-dialysis-dependent stage 35 CKD. I A In patients with dialysis-dependent CKD who are free of ASCVD, commencement of statin therapy is not recommended. III A Lipid-lowering drugs in patients with PAD (including carotid artery disease) In patients with PAD, lipid-lowering therapy—including a maximum tolerated dose of a statin, plus ezetimibe, or a combination with a PCSK9 inhibitor if needed—is recommended to reduce the risk of ASCVD events. I A Lipid-lowering drugs in patients with CIID The use of lipid-lowering drugs only on the basis of the presence of CIID is not recommended. III C Lipid-lowering drugs in patients with SMI It is recommended that SMIs are used as modifiers for estimating total ASCVD risk. I C It is recommended that the same guidelines for the management of total ASCVD risk are used in patients with SMI as are used in patients without such disease. I C It is recommended that in patients with SMI, intensified attention is paid to adherence to lifestyle changes and to compliance with drug treatment. I C

ACS = acute coronary syndrome(s); Apo = apolipoprotein; ASCVD = atherosclerotic cardiovascular disease; CAD = coronary artery disease; CHD = coronary heart disease; CIID = chronic immune-mediated inflammatory diseases; CKD = chronic kidney disease; CV = cardiovascular; CVD = cardiovascular disease; DM = diabetes mellitus; FH = familial hypercholesterolaemia; HDL-C = high-density lipoprotein cholesterol; HeFH = heterozygous FH; HF = heart failure; HoFH = homozygous FH; HTG = hypertriglyceridaemia; LDL-C = low-density lipoprotein cholesterol; MetS = metabolic syndrome; PAD = peripheral arterial disease; PCSK9 = proprotein convertase subtilisin/kexin type 9; SCORE = Systematic Coronary Risk Estimation; SMI = severe mental illness; TC = total cholesterol; TG = triglycerides; TIA = transient ischaemic event; T1DM = type 1 DM; T2DM = type 2 DM. aClass of recommendation. bLevel of evidence. Downloaded from academic.oup.com/eurheartj/article/41/1/111/5556353 by guest on 07 October 2026