Atherosclerosis 290 (2019) 140–205 Contents lists available at ScienceDirect Atherosclerosis journal homepage: www.elsevier.com/locate/atherosclerosis 2019 ESC/EAS guidelines for the management of dyslipidaemias: Lipid ☆ T modification to reduce cardiovascular risk ∗ ∗∗ Authors/Task Force Members (François Macha, ,2, Colin Baigentb, ,2, ∗∗∗ Alberico L. Catapanoc, ,1,2, Konstantinos C. Koskinad, Manuela Casulae,f,1, Lina Badimong, M. John Chapmanh,i,cm,1, Guy G. De Backerj, Victoria Delgadok, Brian A. Ferencel, Ian M. Grahamm, Alison Hallidayn, Ulf Landmessero,p,q, Borislava Mihaylovar,s, Terje R. Pedersent, Gabriele Riccardiu,1, Dimitrios J. Richterv, Marc S. Sabatinew, Marja-Riitta Taskinenx,1, Lale Tokgozogluy,1, Olov Wiklundz), ESC Committee for Practice Guidelines (CPG) (Stephan Windeckeraa, Victor Aboyansab, Colin Baigentac, Jean-Philippe Colletab, Veronica Deanab, Victoria Delgadoad, Donna Fitzsimonsac, Chris P. Galeac, Diederick Grobbeead, Sigrun Halvorsenae, Gerhard Hindricksaf, Bernard Iungab, Peter Jüniag, Hugo A. Katusaf, Ulf Landmesseraf, Christophe Leclercqab, Maddalena Lettinoah, Basil S. Lewisai, Bela Merkelyaj, Christian Muelleraa, Steffen Petersenac, Anna Sonia Petronioah, Dimitrios J. Richterak, Marco Roffiaa, Evgeny Shlyakhtoal, Iain A. Simpsonac, Miguel Sousa-Uvaam, Rhian M. Touyzac), ESC National Cardiac Societies (Djamaleddine Nibouchean, Parounak H. Zelveianao, Peter Siostrzonekap, Ruslan Najafovaq, Philippe van de Bornear, Belma Pojskicas, Arman Postadzhiyanat, Lambros Kyprisau, Jindřich Špinarav, Mogens Lytken Larsenaw, Hesham Salah Eldinax, Margus Viigimaaay, Timo E. Strandbergaz, Jean Ferrièresba, Rusudan Agladzebb, Ulrich Laufsbc, Loukianos Rallidisbd, László Bajnokbe, Thorbjörn Gudjónssonbf, Vincent Maherbg, Yaakov Henkinbh, Michele Massimo Guliziabi, Aisulu Mussagaliyevabj, Gani Bajraktaribk, Alina Kerimkulovabl, Gustavs Latkovskisbm, Omar Hamouibn, Rimvydas Slapikasbo, Laurent Visserbp, Philip Dinglibq, Victoria Ivanovbr, Aneta Boskovicbs, Mbarek Nazzibt, Frank Visserenbu, Irena Mitevskabv, Kjetil Retterstølbw, Piotr Jankowskibx, Ricardo Fontes-Carvalhoby, Dan Gaitabz, Marat Ezhovca, Marina Foscolicb, Vojislav Gigacc, Daniel Pellacd, Zlatko Frasce, Leopoldo Perez de Islacf, Emil Hagströmcg, Roger Lehmannch, Leila Abidci, Oner Ozdogancj, Olena Mitchenkock, Riyaz S. Patelcl) a Cardiology Department, Geneva University Hospital, 4 Gabrielle-Perret-Gentil, 1211, Geneva, Switzerland b Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Roosevelt Drive, Oxford OX3 7LF, UnitedKingdom c Department of Pharmacological and Biomolecular Sciences, University of Milan, Multimedica IRCCS, Via Balzaretti, 9, 20133, Milan, Italy d Cardiology, Bern University Hospital (Inselspital), Bern, Switzerland e Epidemiology and Preventive Pharmacology Service (SEFAP), Department of Pharmacological and Biomolecular Sciences (DiSFeB), University of Milan, Milan, Italy f IRCCS MultiMedica, Sesto S. Giovanni, Milan, Italy g Cardiovascular Program-ICCC and CiberCV, IR-Hospital de la Santa Creu i Sant Pau, Barcelona, Spain h National Institute for Health and Medical Research (INSERM), Paris, France i Division of Endocrinology- Metabolism, Pitie-Salpetriere University Hospital, Paris, France j Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium k Cardiology, Leiden University Medical Center, Leiden, Netherlands l Centre for Naturally Randomized Trials, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom m Cardiology, Trinity College, Dublin, Ireland ☆ The Task Force for the management of dyslipidaemias of the European Society of Cardiology (ESC) and European Atherosclerosis Society (EAS). The disclosure forms of all experts involved in the development of these Guidelines are available on the ESC website www.escardio.org/guidelines. ∗ Corresponding author. ∗∗ Corresponding author. ∗∗∗ Corresponding author. https://doi.org/10.1016/j.atherosclerosis.2019.08.014 Available online 31 August 2019 0021-9150/ © 2019 European Society of Cardiology and Elsevier B.V. All rights reserved. F. Mach, et al. Atherosclerosis 290 (2019) 140–205 n Nuffield Department of Surgery, University of Oxford, NIHR Oxford Biomedical Research Centre, Oxford, UnitedKingdom o Department of Cardiology, Charite Universitätsmedizin Berlin, Berlin, Germany p Berlin Institute of Health (BIH), Berlin, Germany q German Center of Cardiovascular Research (DZHK), Berlin, Germany r Nuffield Department of Population Health, NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UnitedKingdom s Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom t Preventive Cardiology, Oslo University Hospital, Aker, Oslo, Norway u Clinical Medicine and Surgery, Federico II University, Naples, Italy v Cardiac Department, Euroclinic, Athens, Greece w TIMI Study Group, Division of Cardiovascular Medicine, Brigham, Women's Hospital and Harvard Medical School, Boston, MA, United States of America x Research Program for Clinical and Molecular Metabolism, University of Helsinki, Helsinki, Finland y Cardiology, Hacettepe University, Ankara, Turkey z Institute of Medicine, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden cm Sorbonne University, Paris, France aa Switzerland ab France ac United Kingdom ad Netherlands ae Norway af Germany ag Canada ah Italy ai Israel aj Hungary ak Greece al Russian Federation am Portugal an Algerian Society of Cardiology, Algeria ao Armenian Cardiologists Association, Armenia ap Austrian Society of Cardiology, Austria aq Azerbaijan Society of Cardiology, Azerbaijan ar Belgian Society of Cardiology, Belgium as Association of Cardiologists of Bosnia and Herzegovina, Bosnia and Herzegovina at Bulgarian Society of Cardiology, Bulgaria au Cyprus Society of Cardiology, Cyprus av Czech Society of Cardiology, Czech Republic aw Danish Society of Cardiology, Denmark ax Egyptian Society of Cardiology, Egypt ay Estonian Society of Cardiology, Estonia az Finnish Cardiac Society, Finland ba French Society of Cardiology, France bb Georgian Society of Cardiology, Georgia bc German Cardiac Society, Germany bd Hellenic Society of Cardiology, Greece be Hungarian Society of Cardiology, Hungary bf Icelandic Society of Cardiology, Iceland bg Irish Cardiac Society, Ireland bh Israel Heart Society, Israel bi Italian Federation of Cardiology, Italy bj Association of Cardiologists of Kazakhstan, Kazakhstan bk Kosovo Society of Cardiology, Republic of Kosovo bl Kyrgyz Society of Cardiology, Kyrgyzstan bm Latvian Society of Cardiology, Latvia bn Lebanese Society of Cardiology, Lebanon bo Lithuanian Society of Cardiology, Lithuania bp Luxembourg Society of Cardiology, Luxembourg bq Maltese Cardiac Society, Malta br Moldavian Society of Cardiology, Republic of Moldova bs Montenegro Society of Cardiology, Montenegro bt Moroccan Society of Cardiology, Morocco bu Netherlands Society of Cardiology, Netherlands bv North Macedonian Society of Cardiology, North Macedonia bw Norwegian Society of Cardiology, Norway bx Polish Cardiac Society, Poland by Portuguese Society of Cardiology, Portugal bz Romanian Society of Cardiology, Romania ca Russian Society of Cardiology, Russian Federation cb San Marino Society of Cardiology, San Marino cc Cardiology Society of Serbia, Serbia cd Slovak Society of Cardiology, Slovakia ce Slovenian Society of Cardiology, Slovenia cf Spanish Society of Cardiology, Spain cg Swedish Society of Cardiology, Sweden ch Swiss Society of Cardiology, Switzerland 141 F. Mach, et al. Atherosclerosis 290 (2019) 140–205 ci Tunisian Society of Cardiology and Cardio-Vascular Surgery, Tunisia cj Turkish Society of Cardiology, Turkey ck Ukrainian Association of Cardiology, Ukraine cl British Cardiovascular Society, United Kingdom of Great Britain and Northern Ireland ARTICLE INFO Keywords: Guidelines Dyslipidaemias Cholesterol; Triglycerides Low-density lipoproteins High-density lipoproteins Apolipoprotein B Lipoprotein(a) Lipoprotein remnants Total cardiovascular risk Treatment (lifestyle) Treatment (drugs) Treatment (adherence) Very low-density lipoproteins Familial hypercholesterolaemia 1. Preamble of a given condition according to ESC Committee for Practice Guidelines (CPG) policy. A critical evaluation of diagnostic and therapeutic proce- Guidelines summarize and evaluate available evidence with the aim dures was performed, including assessment of the risk–benefit ratio. The of assisting health professionals in proposing the best management level of evidence and the strength of the recommendation of particular strategies for an individual patient with a given condition. Guidelines management options were weighed and graded according to predefined and their recommendations should facilitate decision making of health ESC scales, as outlined in the tables below. professionals in their daily practice. However, the final decisions con- The experts of the writing and reviewing panels provided declara- cerning an individual patient must be made by the responsible health tion of interest forms for all relationships that might be perceived as professional(s) in consultation with the patient and caregiver as ap- real or potential sources of conflicts of interest. These forms were propriate. (see Table 1) compiled into one file and can be found on the ESC website (http:// A great number of guidelines have been issued in recent years by the www.escardio.org/guidelines).