p.5 抽出テキスト

enhance comprehension of recommendations after publication, and to reinforce transparency in the Guidelines development process. The tables are published in their own section of the Focused Update and reference specific recommendation tables. After an iterative process of deliberations, a first Task Force vote on all recommendations is conducted prior to the initiation of rounds of review. A second Task Force vote on all recommendations is conducted after the final round of review and revision. For each vote, the Task Force follows ESC voting procedures and all recommendations require at least 75% agreement among voting members to be approved. Voting restrictions may be applied based on declarations of interests. The writing and reviewing panels provide declaration of interest forms for all relationships that might be perceived as real or potential sources of conflicts of interest. Their declarations of interest are reviewed according to the ESC declaration of interest rules which can be found on the ESC website (http://www.escardio.org/doi) and are compiled in a report published in a supplementary document with the Guidelines. Funding for the development of this ESC/EAS Focused Update was derived entirely from the ESC and EAS with no involvement of the healthcare industry. The ESC CPG Committee supervises and co-ordinates the preparation of new Guidelines and Focused Updates and approves their publication. In addition to review by the ESC CPG Committee, this ESC/EAS Focused Update underwent multiple rounds of peer review on a dedicated online review platform. The review was conducted by topic experts, including members from ESC National Cardiac Societies and from relevant ESC Subspecialty Communities. The Focused Update Task Force considered all review comments and was required to respond to all those classified as major. After appropriate revisions, the Task Force and the ESC CPG Committee members and the EAS Executive Committee approved the final document for publication in the European Heart Journal and in Atherosclerosis. Unless otherwise stated, the Focused Update content refers to sex, understood as the biological condition of being male or female, defined by genes, hormones and sexual organs. Off-label use of medication may be presented in this Focused Update if a sufficient level of evidence shows that it can be considered medically appropriate for a given condition. However, decisions on off-label use must be made by the responsible health professional giving special consideration to ethical rules concerning healthcare, the specific situation of the patient, patient consent, and country-specific health regulations.

2 Introduction

Since the publication of the 2019 ESC/EAS Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular (CV) risk,1 there have been several randomized controlled trials that might change patient management ahead of the next scheduled full dyslipidaemia Guidelines. This 2025 Focused Update addresses changes in recommendations for the treatment of dyslipidaemias based on new evidence published up until 31 March 2025. All major randomized controlled clinical trials and meta-analyses published after the publication of the 2019 ESC/EAS Guidelines were presented and discussed in detail before a consensus was reached about any possible classes of recommendations (see Table 1) and levels of evidence (see Table 2) to be assigned; these were then voted upon for inclusion by all Task Force members. Members with declared conflicts of interests in specific topics were asked to abstain from voting on those topics. The Task Force considered and discussed the following new studies, trials, and any meta-analyses: Systematic Coronary Risk Evaluation 2 (SCORE2) and Systematic Coronary Risk Evaluation 2-Older Persons (SCORE2-OP) for estimation of 10 year CV risk;2,3 CLEAR Outcomes [Cholesterol Lowering via Bempedoic Acid, an ACL (adenosine triphosphate-citrate lyase)-Inhibiting Regimen];4 ELIPSE HoFH (Evinacumab Lipid Studies in Patients with Homozygous Familial Hypercholesterolemia);5 APPROACH (Reduction of Triglyceride Levels in Familial Chylomicronemia Syndrome);6 REPRIEVE (Pitavastatin to Prevent Cardiovascular Disease in HIV Infection);7 STRENGTH (Long-Term Outcomes Study to Assess Statin Residual Risk with Epanova in High Cardiovascular Risk Patients with Hypertriglyceridemia);8 STOP-CA (Atorvastatin for Anthracycline- Associated Cardiac Dysfunction);9 SPORT (Supplements, Placebo, or Rosuvastatin Study);10 and OMEMI (Omega-3 Fatty acids in Elderly with Myocardial Infarction).11 Beside these trials, the Task Force also considered and discussed: combination therapy with high-dose statin plus ezetimibe and intensification of lipid-lowering therapy during the index hospitalization for patients presenting with acute coronary syndromes (ACS), as well as new data on lipoprotein(a) [Lp(a)] as a risk modifier.

Only results that would lead to new or changed Class I/IIa or Class III recommendations were selected for inclusion in Recommendation Tables. All new recommendations included in this Focused Update are additive to the recommendations of the 2019 ESC/EAS Guidelines for the management of dyslipidaemias, and all changed recommendations substitute those of the 2019 ESC/EAS Guidelines for the management of dyslipidaemias. After due deliberation, the Task Force decided to update recommendations for the following sections of the 2019 ESC/EAS Guidelines for the management of dyslipidaemias: • Recommendations for CV risk estimation, with implementation of the new SCORE2 and SCORE2-OP risk prediction algorithms. • Recommendations on low-density lipoprotein cholesterol (LDL-C)-lowering therapies, including two new agents for LDL-Clowering treatment (bempedoic acid and evinacumab specifically for patients with homozygous familial hypercholesterolaemia)(FH). • Recommendations for lipid-lowering therapy during index hospitalization of ACS. • Recommendations on Lp(a). • Recommendations for drug treatment in patients with hypertriglyceridaemia. • Recommendations for statin therapy in primary CV disease (CVD) prevention for people with human immunodeficiency virus (HIV) infection. • Recommendations for statin therapy for patients with cancer at high or very high chemotherapy-related CV toxicity risk. • Recommendations for dietary supplements.

3 Estimation of total

cardiovascular risk and implications for dyslipidaemia management

Atherosclerosis is caused by the progressive deposition of LDL-C and other apolipoprotein-B (ApoB)-containing lipoproteins within the artery wall, which triggers a cascade of inflammatory reactions leading to the formation and progression of atherosclerotic plaque. As more atherogenic lipoproteins become accumulated within the arterial wall over time, the atherosclerotic plaque gradually enlarges and the risk of having an acute atherosclerotic CV event increases. LDL-C is not only a risk factor for atherosclerotic CV disease (ASCVD), but like other ApoB-containing lipoproteins is a direct cause of ASCVD;12

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