2019 ESC-EAS Dyslipidaemia Guidelines


PCSK9 inhibitors endorsed in 2019 ESC/EAS Dyslipidaemia Guidelines2

The 2019 update of the ESC/EAS Dyslipidaemia Management Guidelines features several important changes from the previous 2016 guidelines. Read on for a summary of the main changes or click here to access the full guidelines.
Highlights of the 2019 ESC/EAS Guidelines include:
  • Endorsement of PCSK9 inhibitors as the standard of care with the highest level of recommendation (I A) for very-high-risk secondary prevention patients who have not achieved their recommended LDL-C goals on optimised statin and ezetimibe therapy2
  • Support for a “lower is better” approach through the setting of new, lower LDL-C goals2
    View all LDL-C treatment targets
  • A new very-high-risk category encompassing patients with recurrent CV events2
    View all CV risk categories and definitions
  • PCSK9 inhibitors endorsed for patients unable to achieve LDL-C targets with maximally tolerated statin and ezetimibe, including patients hospitalised with acute coronary syndrome2
    View treatment algorithm
The higher the CV risk, the lower the LDL-C goals2

2019 ESC/EAS LDL-C treatment goals across categories of total CV risk2

The lower the better2

2016 vs 2019 ESC/EAS LDL-C treatment goals for very-high-risk patients2,3

In ACS patients, the earlier the LDL-C reduction the better2
ACS patients often do not achieve LDL-C targets despite potent statin treatment4
Consider early in-hospital initiation of PCSK9i in patients with ACS on max tolerated statin and ezetimibe not reaching LDL-C goal (IIa C)2

25% RRR reported as the key secondary endpoint: composite of cardiovascular death, MI or stroke. HR: 0.75; 95% CI: 0.62-0.91; p=0.003. ARR: 3.2%; 95% CI: 1.2-5.2.
ACS = Acute coronary syndrome; ARR = Absolute risk reduction; ASCVD = Atherosclerotic cardiovascular disease; CV = Cardiovascular; EAS = European Atherosclerosis Society; ESC = European Society of Cardiology; EVOPACS = EVOlocumab for Early Reduction of LDL-cholesterol Levels in Patients With Acute Coronary Syndromes; FH = Familial hypercholesterolaemia; LDL-C = Low-density lipoprotein cholesterol; MI = Myocardial infarction; PCSK9 = Protein convertase subtilisin/kexin type 9; RRR = Relative risk reduction.
  1. European Cardiovascular Disease Statistics 2017. Fifth Edition: February 2017. European Heart Network, Brussels.
  2. Mach F, et al. Eur Heart J. 2020;41:111-88.
  3. Catapano AL, et al. Eur Heart J. 2016;37:2999-3058.
  4. De Backer G et al. Atherosclerosis. 2019;285:135-46.
  5. Gencer B, et al. JAMA Cardiol. 2020;5(8):1-6.