ESC 2019 — Updated cholesterol guidelines: go for a new low in LDL-C

  • Emily Willingham, PhD
  • Conference Reports
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  • “Go as low as you can go” when it comes to low-density lipoprotein cholesterol (LDL-C) measures, per the latest European Society of Cardiology (ESC) dyslipidemia guidelines.
  • That mantra applies especially in patients with high or very high cardiovascular disease (CVD) risk, say guidelines authors, with a recommended target
  • Full guidelines are available here; clinicians can get a pocket version here or via the ESC mobile pocket guidelines app .

Why this matters

  • The evidence is now “overwhelming” that high LDL-C “is a potent cause of heart attack and stroke,” said Colin Baigent, guidelines task force chair, in a statement. 
  • Risk for CVD falls regardless of starting LDL-C concentrations, he said, so that people with high or very high CVD risk can benefit from LDL-C reductions, even with below-average baseline levels.
  • “There is no lower limit of LDL cholesterol that is known to be unsafe,” the guidelines state.

Key highlights

  • New additions to the guidelines are listed here.
    • New LDL-C target  
    • Statins are recommended (class I) for primary prevention according to risk level in people age 75 years or less.
  • Changes from 2016 guidelines are listed here. 
  • A treatment algorithm is provided for pharmacological reduction of LDL-C. 
  • The guidelines include a list of what to do and what not to do. 
    • Among them: because of a lack of formal safety studies, statins are not recommended for women who might become pregnant.
    • Fish oil supplements make the “do” list if added to a statin for hypertriglyceridemia that persists under statin therapy.

Additional note


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