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European Society of Cardiology (ESC) and European Atherosclerosis Society (EAS) Guidelines for the management of dyslipidaemias are published online 27 Aug 2016 in European Heart Journal  and on the ESC Website.

The new guidelines stress the need to lower lipid levels in populations and in high risk individuals. Those at high risk should be the top priority for doctors treating patients one-to-one. When it comes to recommendations for patients, the guidelines recommend an individual LDL cholesterol target based on risk (defined by comorbidities and 10-year risk of fatal CVD ). For example, in high risk patients the target is LDL cholesterol less than 2.6 mmol/L (100 mg/dL). All patients, regardless of risk, should achieve at least 50% reduction in LDL cholesterol.

This person based approach differs from US guidelines which recommend giving a statin to all high risk patients even if they have low cholesterol. The American approach would mean considerably more people in Europe being on a statin. The Task Force decided against this blanket approach. The worry is that a large population of high risk people who are inert and overweight have their cholesterol lowered by drugs but then ignore their other risk factors.

More prominence is given to lifestyle and nutrition than the previous ESC/EAS Guidelines, with goals for body mass index and weight. Recommendations are given for foods to be preferred, used in moderation, or chosen occasionally in limited amounts.

There is more emphasis on choosing foods like cereals, vegetables, fruits and fish than on saying ‘thou shalt not ever eat fat’.

Recommendations are given for combination treatment in patients with resistant high cholesterol. Statins are the first line treatment, then combination therapy with ezetimibe, and as a third line the new PCSK9 inhibitors.