Focused update of the ESC/EAS dyslipidemia guidelines – Key takeaways
ESC Congress 2025 – The ESC and EAS have released a focused update to the 2019 dyslipidemia guidelines, refining key recommendations in light of new evidence. The update endorses cardiovascular risk estimation with SCORE2 and SCORE2-OP, places stronger emphasis on earlier initiation of lipid-lowering therapies after ACS and introduces an expanded role for bempedoic acid
At ESC Congress 2025, the 2025 Focused Update of the 2019 ESC/EAS Guidelines for the Management of Dyslipidaemias was presented by Konstantinos Koskinas (Bern, Switzerland), François Mach (Geneva, Switzerland), and Jeanine Roeters van Lennep (Rotterdam, The Netherlands). The updated guidelines were published simultaneously in Atherosclerosis and the European Heart Journal.
Key updates for clinical practice
- Cardiovascular risk estimation in persons without known cardiovascular disease should be performed using SCORE2 (ages 40–69) and SCORE2-OP (≥70 years) algorithms (class I, level B).
- The presence of subclinical coronary atherosclerosis by imaging or an elevated CAC score by CT should be considered as risk modifiers to improve risk classification.
- Demographic factors, clinical conditions, and selected biomarkers can also serve as risk modifiers to improve risk classification.
- Bempedoic acid is recommended for patients who cannot use statins to lower LDL-c (class I, level B).
- In patients inadequately controlled with statin ± ezetimibe, bempedoic acid is recommended as an adjunct (class IIa, level C).
- In patients with homozygous familial hypercholesterolaemia (HoFH), evinacumab is now considered (class IIa, level B).
- Lp(a) levels greater than 50 mg/dL (105 nmol/L) should be considered as a cardiovascular risk factor.
- Stronger emphasis is placed on initiating combination therapy or intensifying lipid-lowering therapy during the index hospitalization for ACS.
- Icosapent ethyl is recommended in combination with a statin in high- or very high-risk patients with elevated triglycerides (class IIa, level B).
- Volanesorsen is considered in patients with familial chylomicronaemia syndrome and severe hypertriglyceridaemia to reduce pancreatitis risk (class IIa, level B).
- Statin therapy is now recommended for people ≥40 years of age living with HIV.
- Statins are recommended in adult patients with cancer who are at high or very high risk of chemotherapy-related cardiovascular toxicity.
- Dietary supplements or vitamins are not recommended for reducing ASCVD risk.
Summary
The 2025 ESC/EAS Focused Update reinforces SCORE2 and SCORE2-OP as the standard for cardiovascular risk stratification. It broadens the treatment options with bempedoic acid for patients with statin-intolerance and evinacumab for HoFH, and places stronger emphasis on early initiation of intensive lipid-lowering after ACS. Additional updates include new recommendations for hypertriglyceridaemia and statin use in patients with HIV or cancer, while dietary supplements are not advised.
- Our reporting is based on the information provided at the ESC Congress 2025 –