[European dyslipidemia guidelines 2019 : What is new?]

In August 2019 the updated dyslipidemia guidelines of the European Society of Cardiology (ESC) and the European Atherosclerosis Society (EAS) were published. Since the last version from 2016, important large randomized trials especially with proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors and new genetic analyses have become available that show additional reduction of atherosclerotic cardiovascular disease (ASCVD) risk on top of the previously recommended treatments. Based on these data the main concept of the recommendations is achieving an early and as large as possible absolute reduction of low-density lipoprotein cholesterol (LDL-C). As a result of this knowledge and the extended pharmaceutical treatment options the LDL‑C goals are amended to lower values. Patients at very high cardiovascular risk are recommended to achieve LDL‑C <1.4 mmol/l (55 mg/dl). For patients with high, moderate, and low cardiovascular risks, LDL‑C goals are set at <1.8 mmol/l (70 mg/dl), <2.6 mmol/l (100 mg/dl) and <3.0 mmol/l (116 mg/dl), respectively. A new classification of patients with recurrent cardiovascular events despite maximum tolerated statin-based therapy is introduced. For these patients the LDL‑C goal is <1.0 mmol/l (40 mg/dl). Novel recommendations comprise a more precise classification of patients at low or moderate risk based on cardiovascular imaging, recommendations for familial hypercholesterolemia, screening for increased lipoprotein(a) and determination of apolipoprotein B as diagnostic and therapeutic goal.