Transatlantic guidelines on dyslipidemia and cardiovascular risk: key differences across the pond.

PURPOSE OF REVIEW: The purpose of this review is to compare and contrast the key messages from the 2018 American Heart Association (AHA)/American College of Cardiology (ACC) Multisociety Guideline on the Management of Blood Cholesterol and the 2019 European Society of Cardiology (ESC)/European Atherosclerosis Society (EAS) Guidelines for the Management of Dyslipidemias. We also review some of the evidence that served as the basis for these guidelines and share our opinion regarding these guidelines. RECENT
FINDINGS: Patients with atherosclerotic cardiovascular disease (ASCVD), severe hypercholesterolemia, familial hypercholesterolemia, or diabetes should be treated aggressively with lipid-lowering therapy. In addition to traditional risk factors included in risk scores, assessment of risk enhancers/modifiers may improve risk stratification. The addition of ezetimibe ± proprotein convertase subtilisin/kexin type 9 inhibitors plays an integral role in the management of very-high-risk ASCVD patients; the ESC/EAS guidelines support more aggressive use of these medications.
SUMMARY: Both the AHA/ACC Multisociety and ESC/EAS guidelines provide an evidence-based approach to management of blood cholesterol. The greatest difference between these two guidelines is the classification and recommended management of very-high-risk patients. Implementation of either guideline will likely lead to improved ASCVD outcomes compared with current treatment practice. VIDEO ABSTRACT: http://links.lww.com/COE/A22.