International recommendations introduce new risk assessment tools, stronger therapeutic approaches and novel strategies for high-risk populations.
A new risk prediction algorithm, a paradigm shift away from the traditional stepwise approach to lipid management and endorsing the use of lipoprotein (a) measurement are just a few of the big changes to international dyslipidaemia guidelines.
The international recommendations from the European Society of Cardiology (ESC) and the European Atherosclerosis Society (EAS) were presented at the Annual Cardiology Congress in Madrid earlier this month, replacing the 2019 version.
The addition of the SCORE2 algorithm changes risk prediction from only an estimate of 10-year CV mortality, but also risk of non-fatal heart attacks, stroke and hospitalisation.
The new tools also use non-HDL-C instead of total cholesterol. SCORE2OP is the algorithm adjusted for individuals aged over 70 years.
Aggressive lipid-lowering regimens are now advised from the outset following hospitalisation for myocardial infarction or acute coronary syndrome.
Immediate initiation of a combination of high-intensity statin therapy and ezetimibe should be considered for reaching LDLcholesterol targets as quickly as possible.
Contrary to ideas of starting low and going slow, the recommendations include a proposed paradigm shift to a more aggressive approach aimed at lowering levels sooner.
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The guide explained that there were known benefits from achieving LDL-C targets quickly and known harms from delaying the intensification of therapy as in prior stepwise approaches.
Bempedoic acid has been included as a class one recommendation for statin-intolerant patients. Authors explained it offered a solution to the longstanding clinical challenge of statin intolerance while maintaining cardiovascular efficacy.
People with HIV aged 40 years or more have been universally recommendation for statin therapy, regardless of their calculated risk or LDL-C levels. This also extends to patients treated with cardiotoxic chemotherapy regimens.
Specific populations such as these require risk-independent intervention due to unique pathophysiological mechanisms, authors noted.
The guideline also stresses the necessity of utilising Lp(a), a long-overlooked cardiovascular risk factor that has recently been gaining traction.
Recognition of the role of Lp(a) established a new frontier in personalised cardiovascular risk assessment, authors noted.
Included is an explicit recommendation against the use of dietary supplements for cholesterol management that do not have documented efficacy, such as red yeast rice.
