ESC/EAS GUIDELINES European Heart Journal (2019) 00,1À78 doi:10.1093/eurheartj/ehz455 2019 ESC/EAS Guidelines for the management of dyslipidaemias: lipid modification to reduce Downloaded from https://academic.oup.com/eurheartj/advance-article-abstract/doi/10.1093/eurheartj/ehz455/5556353 by guest on 31 August 2019 cardiovascular risk The Task Force for the management of dyslipidaemias of the European Society of Cardiology (ESC) and European Atherosclerosis Society (EAS) Authors/Task Force Members: Franc¸ois Mach* (Chairperson) (Switzerland), Colin Baigent* (Chairperson) (United Kingdom), Alberico L. Catapano1* (Chairperson) (Italy), Konstantinos C. Koskinas (Switzerland), Manuela Casula1 (Italy), Lina Badimon (Spain), M. John Chapman1 (France), Guy G. De Backer (Belgium), Victoria Delgado (Netherlands), Brian A. Ference (United Kingdom), Ian M. Graham (Ireland), Alison Halliday (United Kingdom), Ulf Landmesser (Germany), Borislava Mihaylova (United Kingdom), Terje R. Pedersen (Norway), Gabriele Riccardi1 (Italy), Dimitrios J. Richter (Greece), Marc S. Sabatine (United States of America), Marja-Riitta Taskinen1 (Finland), Lale Tokgozoglu1 (Turkey), Olov Wiklund1 (Sweden) The three chairpersons contributed equally to the document. *Corresponding authors: Franc¸ois Mach, Cardiology Department, Geneva University Hospital, 4 Gabrielle-Perret-Gentil, 1211 Geneva, Switzerland. Tel: þ41 223 727 192, Fax: þ41 223 727 229, Email: [email protected]. Colin Baigent, Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Roosevelt Drive, Oxford OX3 7LF, United Kingdom. Tel: þ44 1865 743 741, Fax: þ44 1865 743 985, Email: [email protected]. Alberico L. Catapano, Department of Pharmacological and Biomolecular Sciences, University of Milan, Via Balzaretti, 9, 20133 Milan, and Multimedica IRCCS, Milan, Italy. Tel: þ39 02 5031 8401, Fax: þ39 02 5031 8386, Email: [email protected]. ESC Committee for Practice Guidelines (CPG), National Cardiac Societies document reviewers and Author/Task Force Member affiliations: listed in the Appendix. 1Representing the EAS. ESC entities having participated in the development of this document: Associations: Acute Cardiovascular Care Association (ACCA), Association of Cardiovascular Nursing & Allied Professions (ACNAP), European Association of Cardiovascular Imaging (EACVI), European Association of Preventive Cardiology (EAPC), European Association of Percutaneous Cardiovascular Interventions (EAPCI). Councils: Council for Cardiology Practice, Council on Hypertension, Council on Stroke. Working Groups: Aorta and Peripheral Vascular Diseases, Atherosclerosis and Vascular Biology, Cardiovascular Pharmacotherapy, e-Cardiology, Thrombosis. The content of these European Society of Cardiology (ESC) Guidelines has been published for personal and educational use only. No commercial use is authorized. No part of the ESC Guidelines may be translated or reproduced in any form without written permission from the ESC. Permission can be obtained upon submission of a written request to Oxford University Press, the publisher of the European Heart Journal and the party authorized to handle such permissions on behalf of the ESC (journals.permissions@oxfordjour- nals.org). Disclaimer. The ESC/EAS Guidelines represent the views of the ESC and EAS, and were produced after careful consideration of the scientific and medical knowledge, and the evidence available at the time of their publication. The ESC and EAS is not responsible in the event of any contradiction, discrepancy, and/or ambiguity between the ESC/EAS Guidelines and any other official recommendations or guidelines issued by the relevant public health authorities, in particular in relation to good use of healthcare or therapeutic strategies. Health professionals are encouraged to take the ESC/EAS Guidelines fully into account when exercising their clinical judgment, as well as in the determination and the implementation of preventive, diagnostic, or therapeutic medical strategies; however, the ESC/EAS Guidelines do not override, in any way whatsoever, the individual responsibil- ity of health professionals to make appropriate and accurate decisions in consideration of each patient’s health condition and in consultation with that patient and, where appro- priate and/or necessary, the patient’s caregiver. Nor do the ESC/EAS Guidelines exempt health professionals from taking into full and careful consideration the relevant official updated recommendations or guidelines issued by the competent public health authorities, in order to manage each patient’s case in light of the scientifically accepted data pur- suant to their respective ethical and professional obligations. It is also the health professional’s responsibility to verify the applicable rules and regulations relating to drugs and medical devices at the time of prescription. VC The European Society of Cardiology and the European Atherosclerosis Association 2019. All rights reserved. For permissions please email: [email protected]. 2 ESC/EAS Guidelines Document Reviewers: Christian Mueller (ESC Review Coordinator) (Switzerland), Heinz Drexel (EAS Review Coordinator) (Austria), Victor Aboyans (France), Alberto Corsini1 (Italy), Wolfram Doehner (Germany), Michel Farnier (France), Bruna Gigante (Sweden), Meral Kayikcioglu1 (Turkey), Goran Krstacic (Croatia), Ekaterini Lambrinou (Cyprus), Basil S. Lewis (Israel), Josep Masip (Spain), Philippe Moulin1 (France), Steffen Petersen (United Kingdom), Anna Sonia Petronio (Italy), Massimo Francesco Piepoli (Italy), Xavier Pinto1 (Spain), Lorenz Raber€ (Switzerland), Kausik K. Ray1 Downloaded from https://academic.oup.com/eurheartj/advance-article-abstract/doi/10.1093/eurheartj/ehz455/5556353 by guest on 31 August 2019 (United Kingdom), Zeljko Reiner1 (Croatia), Walter F. Riesen (Switzerland), Marco Roffi (Switzerland), Jean-Paul Schmid (Switzerland), Evgeny Shlyakhto (Russian Federation), Iain A. Simpson (United Kingdom), Erik Stroes1 (Netherlands), Isabella Sudano (Switzerland), Alexandros D. Tselepis1 (Greece), Margus Viigimaa1 (Estonia), Cecile Vindis (France), Alexander Vonbank (Austria), Michal Vrablik1 (Czech Republic), Mislav Vrsalovic (Croatia), Jose´ Luis Zamorano Gomez (Spain), Jean-Philippe Collet (ESC CPG Supervisor) (France) The disclosure forms of all experts involved in the development of these Guidelines are available on the ESC website www.escardio.org/guidelines For the Supplementary Data which include background information and detailed discussion of the data that have provided the basis for the Guidelines see https://academic.oup.com/eurheartj/article-lookup/doi/ 10.1093/eurheartj/ehz455#supplementary-data ................................................................................................................................................................................................... Keywords Guidelines • dyslipidaemias • cholesterol • triglycerides • low-density lipoproteins • high-density lipopro- teins • apolipoprotein B • lipoprotein(a) • lipoprotein remnants • total cardiovascular risk • treatment (lifestyle) • treatment (drugs) • treatment (adherence) • very low-density lipoproteins • familial hypercholesterolaemia . 5.3.4 Lipoprotein(a) and risk of atherosclerosis . 19 Table of contents . 5.4 Laboratory measurement of lipids and lipoproteins . 19 Abbreviationsandacronyms........................................ 4 . 5.4.1Lipoproteinmeasurement ............................... 19 . 1Preamble......................................................... 6 . 5.4.2Lipidmeasurements..................................... 20 2Introduction...................................................... 8 . 5.4.3Fastingornon-fasting? ................................... 20 . 2.1Whatisnewinthe2019Guidelines? .......................... 8 . 5.5 Recommendations for measuring lipids and lipoproteins to 3Whatiscardiovasculardiseaseprevention? ........................ 8 . estimate risk of atherosclerotic cardiovascular disease . 20 . 3.1Definitionandrationale....................................... 8 . 6Treatmenttargetsandgoals...................................... 21 . 3.2 Development of the Joint Task Force Guidelines for the . 7 Lifestyle modifications to improve the plasma lipid profile . 22 managementofdyslipidaemias.................................... 8 . 7.1 Influence of lifestyle on total cholesterol and low-density . 4Totalcardiovascularrisk .......................................... 8 . lipoproteincholesterollevels.................................... 24 4.1Totalcardiovascularriskestimation ........................... 8 . 7.2Influenceoflifestyleontriglyceridelevels ..................... 24 . 4.1.1 Rationale for assessing total cardiovascular disease risk . 11 . 7.3 Influence of lifestyle on high-density lipoprotein cholesterol 4.1.2 How to use the risk estimation charts . 14 . levels........................................................... 25 . 4.2Risklevels................................................... 15 . 7.4 Lifestyle recommendations to improve the plasma lipid 4.2.1 Role of non-invasive cardiovascular imaging . profile.......................................................... 25 . techniques in the assessment of total cardiovascular . 7.4.1Bodyweightandphysicalactivity......................... 25 diseaserisk................................................... 16 . 7.4.2Dietaryfat .............................................. 25 . 4.2.2Risk-basedinterventionstrategies.......................