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Table 6 Treatment goals for different patient categories

Patient category Prevention goals (STEP 1) Intensified/additional prevention goalsa (STEP 2) Apparently healthy persons For BP and lipids: initiation of drug treatment based on CVD risk assessment (Table 5) or SBP >160 mmHg

<50 years Stop smoking and lifestyle optimization

SBP <140 down to 130 mmHg if toleratedb LDL-C <2.6 mmol/L (100 mg/dL) SBP <130 mmHg if toleratedb

LDL-C <1.8 mmol/L (70 mg/dL) and >_50% reduction

in high-risk patients LDL-C <1.4 mmol/L (55 mg/dL) and >_50% reduction

in very-high-risk patients

50 - 69 years Stop smoking and lifestyle optimization SBP <140 down to 130 mmHg if toleratedb

LDL-C <2.6 mmol/L (100 mg/dL) SBP <130 mmHg if toleratedb

LDL-C <1.8 mmol/L (70 mg/dL) and >_50% reduction

in high-risk patients LDL-C <1.4 mmol/L (55 mg/dL) and >_50% reduction

in very-high-risk patients

>_70 years Stop smoking and lifestyle optimization

SBP <140 mmHg if toleratedb LDL-C <2.6 mmol/L (100 mg/dL) For specific risk factor management in patients >_70

years old, please see relevant sections in section 4.

Patients with CKD Stop smoking and lifestyle optimization

SBP <140 down to 130 mmHg if toleratedb LDL-C <2.6 mmol/L (100 mg/dL) and >_50% LDL-C

reduction Otherwise according to ASCVD and DM history LDL-C <1.8 mmol/L (70 mg/dL) in high-risk patients

and <1.4 mmol/L (55 mg/dL) in very-high risk patients (see Table 4)

Patients with FH Stop smoking and lifestyle optimization SBP <140 down to 130 mmHg if toleratedb

LDL-C <2.6 mmol/L (100 mg/dL) and >_50% LDL-C

reduction Otherwise according to ASCVD and DM history LDL-C <1.8 mmol/L (70 mg/dL) in high-risk patients and <1.4 mmol/L (55 mg/dL) in very-high risk patients

(see Table 4)

People with type 2 DM Well-controlled short-standing DM (e.g. <10 years), no evidence of TOD and no additional ASCVD risk factors Stop smoking and lifestyle optimization Without established ASCVD or severe TOD (see Table 4 for definitions) Stop smoking and lifestyle optimization

SBP <140 down to 130 mmHg if toleratedb LDL-C <2.6 mmol/L (100 mg/dL) HbA1c <53 mmol/mol (7.0%) SBP <130 mmHg if toleratedb

LDL-C <1.8 mmol/L (70 mg/dL) and >_50% reduction SGLT2 inhibitor or GLP-1RA

With established ASCVD and/or severe TOD (see Table 4 for definitions) Stop smoking and lifestyle optimisation SBP <140 down to 130 mmHg if toleratedb

LDL-C <1.8 mmol/L (70 mg/dL) HbA1c <64 mmol/mol (8.0%) SGLT2 inhibitor or GLP1-RA CVD: antiplatelet therapy SBP <130 mmHg if toleratedb

LDL-C <1.4 mmol/L (55 mg/dL) and >_50% reduction SGLT2 inhibitor or GLP-1RA if not already on May additionally consider novel upcoming treatments: DAPT, dual pathway inhibition,a colchicine, icosapent ethyl

Patients with established ASCVD Stop smoking and lifestyle optimization

SBP <140 down to 130 mmHg if toleratedb Intensive oral lipid-lowering therapy aiming at >_50% LDL-C reduction and LDL-C <1.8 mmol/L (70 mg/dL) Antiplatelet therapy SBP <130 mmHg if toleratedb

LDL-C <1.4 mmol/L (55 mg/dL) May additionally consider novel upcoming treatments: DAPT, dual pathway inhibition, colchicine, icosapent ethyl, etc.

ASCVD = atherosclerotic cardiovascular disease; BP = blood pressure; CKD = chronic kidney disease; CVD = cardiovascular disease; DAPT = dual antiplatelet therapy; DBP = diastolic blood pressure; DM = diabetes mellitus; EAS = European Atherosclerosis Society; ESC = European Society of Cardiology; FH = familial hypercholesterolaemia; GLP- 1RA = glucagon-like peptide-1receptor agonist; HbA1c = glycated haemoglobin; LDL-C = low-density lipoprotein cholesterol; SBP = systolic blood pressure (office); SGLT2 = sodium-glucose cotransporter 2; TOD = target organ damage. aDepending on 10-year (residual) risk and/or estimated lifetime benefit (see Table 4 for details), comorbidities, and patient preference. Levels of evidence of intensified goals vary, see recommendation tables in sections 4.6 and 4.7. For CKD and FH, LDL-C targets are taken form the 2019 ESC/EAS Guidelines for the treatment of dyslipidaemias.3 bOffice DBP treatment target range <80 mmHg. ESC 2021 Downloaded from academic.oup.com/eurheartj/article/42/34/3227/6358713 by guest on 07 October 2026