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............................................................................................................................................................................. version of the Guidelines, which is freely available via the ESC and EAS websites and hosted on their journals’ websites (EHJ and Atherosclerosis Journal). The National Cardiac Societies of the ESC are encouraged to endorse, translate and implement all ESC Guidelines. Implementation programmes are needed because it has been shown that the outcome of disease may be favourably influenced by the thorough application of clinical recommendations.

Health professionals are encouraged to take the ESC/EAS Guidelines fully into account when exercising their clinical judgment, as well as in the determination and the implementation of preventive, diagnostic or therapeutic medical strategies. However, the ESC/EAS Guidelines do not override in any way whatsoever the individual responsibility of health professionals to make appropriate and accurate decisions in consideration of each patient’s health condition and in consultation with that patient or the patient’s caregiver where appropriate and/or necessary. It is also the health professional’s responsibility to verify the rules and regulations applicable in each country to drugs and devices at the time of prescription.

2 Introduction

The previous ESC/EAS lipid Guidelines were published in August 2016.1 The emergence of a substantial body of evidence over the last few years has required new, up-to-date Guidelines. New evidence has confirmed that the key initiating event in atherogenesis is the retention of low-density lipoprotein (LDL) cholesterol (LDL-C) and other cholesterol-rich apolipoprotein (Apo) Bcontaining lipoproteins within the arterial wall.2 Several recent placebo-controlled clinical studies have shown that the addition of either ezetimibe or anti-proprotein convertase subtilisin/kexin type 9 (PCSK9) monoclonal antibodies (mAbs) to statin therapy provides a further reduction in atherosclerotic cardiovascular disease (ASCVD) risk, which is directly and positively correlated with the incrementally achieved absolute LDL-C reduction. Furthermore, these clinical trials have clearly indicated that the lower the achieved LDL-C values, the lower the risk of future cardiovascular (CV) events, with no lower limit for LDL-C values, or ‘J’-curve effect. In addition, studies of the clinical safety of these very low achieved LDL-C values have proved reassuring, albeit monitoring for longer periods is required. For raising high-density lipoprotein (HDL) cholesterol (HDL-C), recent studies have indicated that the currently available therapies do not reduce the risk of ASCVD. Finally, human Mendelian randomization studies have demonstrated the critical role of LDL-C, and other cholesterolrich ApoB-containing lipoproteins, in atherosclerotic plaque formation and related subsequent CV events. Thus, there is no longer an ‘LDL-C hypothesis’, but established facts that increased LDL-C values are causally related to ASCVD, and that lowering LDL particles and other ApoB-containing lipoproteins as much as possible reduces CV events. In order to be aligned with these new findings, the ESC/EAS Task Force members who have written these Guidelines have proposed new LDL-C goals, as well as a revised CV risk stratification, which are especially relevant to high- and very-high-risk patients. These novel ESC/EAS Guidelines on lipids provide important new advice on patient management, which should enable more clinicians to efficiently and safely reduce CV risk through lipid modification. 2.1 What is new in the 2019 Guidelines?

New recommendations, and new and revised concepts, are presented in Table 3.

3 What is cardiovascular disease

prevention?

3.1 Definition and rationale

Cardiovascular disease (CVD), of which ASCVD is the major component, is responsible for >4 million deaths in Europe each year. It kills more women (2.2 million) than men (1.8 million), although CV deaths before the age of 65 years are more common in men (490000 vs. 193000).3 Prevention is defined as a co-ordinated set of actions, either at the population or individual level, aimed at eliminating or minimizing the impact of CV diseases and their related disabilities. More patients are surviving their first CVD event and are at high-risk of recurrences. In addition, the prevalence of some risk factors, notably diabetes (DM) and obesity, is increasing. The importance of ASCVD prevention remains undisputed and should be delivered at the general population level by promoting healthy lifestyle behaviour,4 and at the individual level by tackling unhealthy lifestyles and by reducing increased levels of causal CV risk factors, such as LDL cholesterol or blood pressure (BP) levels.

3.2 Development of the Joint Task Force

Guidelines for the management of dyslipidaemias The present Guidelines represent an evidence-based consensus of the European Task Force, including the ESC and the EAS. By appraising the current evidence and identifying remaining knowledge gaps in the management of dyslipidaemias, the Task Force has formulated recommendations to guide action in clinical practice to prevent ASCVD by modifying plasma lipid levels. This document has been developed for healthcare professionals to facilitate informed communication with individuals about their CV risk and the benefits of adopting and sustaining a healthy lifestyle, and of early modification of their lipid-related CV risk. In addition, the Guidelines provide tools for healthcare professionals to promote upto-date intervention strategies, integrate these strategies into national or regional prevention frameworks, and to translate them into locally delivered healthcare services, in line with the recommendations of the World Health Organization (WHO) Global Status Report on Noncommunicable Diseases 2014.5 A lifetime approach to CV risk should be considered.1 This implies that—apart from improving lifestyle habits and reducing risk factor levels in patients with established ASCVD, and in those at increased risk of developing ASCVD—people of all ages should be encouraged to adopt or sustain a healthy lifestyle.

4 Total cardiovascular risk

4.1 Total cardiovascular risk estimation

CV risk in the context of these Guidelines means the likelihood of a person developing an atherosclerotic CV event over a defined period Downloaded from academic.oup.com/eurheartj/article/41/1/111/5556353 by guest on 07 October 2026