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 athe- . rogenesis is the retention of low-density lipoprotein (LDL) choles- . terol (LDL-C) and other cholesterol-rich apolipoprotein (Apo) B- . containing 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 rais- . ing high-density lipoprotein (HDL) cholesterol (HDL-C), recent stud- . ies 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 cholesterol- . rich ApoB-containing lipoproteins, in atherosclerotic plaque forma- . tion 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.