Lipid clinics worldwide: harmonization and guidance on how to optimally organize and fund. European Atherosclerosis Society consensus statement across 55 countries and more than 500 lipid clinics.

Lipoprotein(a) plasma levels and coagulation biomarkers: Results from a comprehensive laboratory assessment in an angiographically controlled cardiovascular cohort.

Familial hypercholesterolaemia in children and adolescents: a European Atherosclerosis Society consensus statement.

The complex relationship between cardiologists and lipid-lowering dietary supplements: Hate or love?

ObjectivesThis real-world study investigated the changes of lipid lowering therapy (LLT) usage in patients with high or very high cardiovascular (CV) risk in the UK and the group of all other European countries in the SANTORINI study up to 1 year from baseline and the impact this treatment had on the attainment of low-density lipoprotein cholesterol (LDL-C) risk-adjusted goals set by the National Institute for Health and Care Excellence (NICE) and those in the 2019 European Society of Cardiology (ESC)/European Atherosclerosis Society (EAS) dyslipidaemia guidelines.DesignSecondary analysis of the SANTORINI dataset (an international, prospective, observational, non-interventional study (NCT04271280)).SettingPrimary and secondary care centres in the UK and the group of other European countries (Austria, Belgium, Denmark, Finland, France, Germany, Ireland, Italy, the Netherlands, Portugal, Spain, Sweden and Switzerland).Participants663 UK patients with high and very high CV risk were included in this analysis and 8502 from the group of other European countries. Of these, 380 UK patients and 6830 from the group of other European countries had LDL-C information available at baseline and 1-year follow-up.Primary outcome measuresThe primary objectives were to describe patients’ lipid management, LDL-C levels at 1-year follow-up and their attainment of 2023 NICE (≤2.0 mmol/L) and 2019 ESC/EAS LDL-C 2019 guideline-recommended LDL-C goals (<1.4 mmol/L for very high-risk patients and <1.8 mmol/L for high-risk patients) within this time frame.ResultsOver the course of 1-year follow-up, the overall proportion of UK patients on no LLT reduced from 20.4% at baseline to 7.1%, similar to that observed in the group of other European countries (baseline–20.9%, 1 year–3.0%). The proportion of UK patients receiving LLT monotherapy increased from 74.8% at baseline to 84.9%, higher at both time points than that observed for the group of other European countries (baseline: 52.0%, 1 year: 55.0%). The use of any combination therapy increased slightly from baseline to 1 year in the UK overall cohort (4.9% vs 7.1%) and overall in the group of all other European countries, the cohort increased from baseline (27.1%) to 1 year (40.2%). Overall, mean (SD) LDL-C levels in the UK were 2.5 (1.2) mmol/L at baseline and 2.1 (1.0) mmol/L at 1 year and for the group of other European countries were 2.4 (1.2) mmol/L at baseline and 2.0 (0.9) mmol/L at 1 year. The overall proportions of UK patients achieving the UK NICE treatment goal and ESC/EAS 2019 guidelines at baseline versus 1-year follow-up were 40.3% vs 52.6% and 22.9% vs 32.9%, respectively; 21.1% and 30.9% of patients in the group of other European countries achieved the ESC/EAS 2019 guidelines at baseline and 1-year follow-up, respectively.ConclusionsIn this UK-focused analysis of the SANTORINI study, use of LLT increased modestly over 1 year, accompanied by a reduction in average LDL-C levels. However, mean LDL-C remained above the NICE goal, and attainment of both NICE and ESC/EAS LDL-C thresholds remained suboptimal. The findings highlight continued opportunities to optimise lipid management in UK clinical practice, including the potential for broader use of combination therapies.

2025 ESC/EAS Dyslipidemia Guidelines Focused Update: Intensifying Prevention, Risk Stratification, and Therapy.

Risk estimation tools have been developed to predict coronary heart disease (CHD) in type 2 diabetes (T2D). To evaluate augmentation following the addition of lipoprotein(a) [Lp(a)] to risk calculation, we performed a pilot study. A total of 90 successive T2D patients were included. Details of clinical and biochemical features were obtained. Lp(a) was determined using ELISA. CHD risk estimation was performed using Framingham, QRISK-3, SCORE-2D, INTERHEART, and European Atherosclerosis Society (EAS) algorithms with and without Lp(a). Descriptive statistics are reported. Mean age of patients was 55.0 ± 8 years, BP systolic/diastolic 133.7 ± 12/95.0 ± 9 mm Hg, body mass index (BMI) 26.0 ± 1.9 kg/m2, waist-hip ratio 0.96 ± 0.08, fasting glucose 198.0 ± 38 mg/dL, HbA1c 9.3 ± 1.3%, total cholesterol 197.0 ± 26 mg/dL, LDL cholesterol 114.2 ± 25 mg/dL, non-HDL cholesterol 153.8 ± 27 mg/dL, and triglycerides 197.8 ± 44 mg/dL. Lp(a) was mean 23.1 ± 9.7 mg/dL and median 22.0 (25-75 IQR 15.9-29.5) mg/dL. Mean risk scores were Framingham 11.2 ± 8.7, QRISK-3 28.6 ± 15.3, INTERHEART 21.0 ± 6.0, SCORE-2D 14.9 ± 8.3, and EAS 29.2 ± 15.2. Patients with raised Lp(a) >30 mg/dL had higher levels of total, LDL, and non-HDL cholesterol and triglycerides (p < 0.01). Spearman's correlation of Lp(a) with risk scores was Framingham 0.127, QRISK-3 0.174, INTERHEART 0.137, SCORE-2D 0.050, and EAS 0.320, while EAS-Lp(a) was 0.397. In different risk algorithms, high risk for CHD were: Framingham 14.4%, QRISK-3 64.4%, INTERHEART 45.6%, SCORE-2D 30.0%, EAS 71.1%, and EAS with Lp(a) 74.4%. Area under the curve (AUC) for Lp(a) with various scores were Framingham 0.53 (CI: 0.39-0.68; p = 0.644), QRISK-3 0.57 (CI: 0.42-0.71), INTERHEART 0.55 (CI: 0.39-0.69), SCORE-2D 0.47 (CI: 0.32-0.61), EAS 0.65 (CI: 0.50-0.79), and EAS-Lp(a) 0.68 (CI: 0.54-0.83). In addition, adding Lp(a) to the EAS risk calculator increased risk reclassification by a range of 4.6-19.3%. Substantial variation in coronary artery disease (CAD) risk prediction using various clinical algorithms is observed in T2D. The EAS algorithm provides the most robust estimate. The addition of Lp(a) to the risk algorithms augments risk stratification significantly. The results of this pilot study need confirmation with larger prospective studies.

Challenges in achieving LDL-C goals: Insights from the Italian SANTORINI study cohort.

The 2025 focus update of the European society of cardiology (ESC) and European atherosclerosis society (EAS) guidelines for dyslipidemia management highlight a significant evolution in patient care, shifting from an intensive, target-driven approach to earlier and more personalized strategies. The transition from SCORE to SCORE2 and SCORE2-OP has improved risk stratification accuracy by including non-fatal cardiovascular events and expanding the evaluable population, particularly among older adults. The introduction of the "extreme risk" category and the early adoption of combination therapies allow previously theoretical LDL targets (< 40mg/dL) to be achieved through the synergistic use of non-statin lipid-lowering agents. Additionally, the 2025 update emphasizes the role of biomarkers such as lipoprotein(a) and elevated triglycerides, as well as traditionally underrepresented populations, including HIV-positive and oncology patients, with recommendations grounded in recent clinical evidence. At the same time, the lack of efficacy of supplements and nutraceuticals without scientific support is reaffirmed. This update consolidates the paradigm of "earlier, more intensive, more personalized" management, underscoring that the current challenge lies not only in scientific knowledge but also in its clinical implementation, with the goal of optimizing cardiovascular prevention and improving patient prognosis and quality of life.

The 2025 update of the European Society of Cardiology (ESC)/European Atherosclerosis Society (EAS) guidelines on dyslipidemia introduce important innovations based on new evidence. The risk assessment is now conducted using the systematic coronary risk evaluation 2 (SCORE2) and SCORE2-OP (older persons), which enable improved stratification, particularly in older individuals. In addition, risk modifiers,such as family history, ethnicity, comorbidities and the biomarkers elevated highly sensitive C‑reactive protein (hs-CRP) or lipoprotein(a) (Lpa), have been introduced. Risk categories have been refined while low-density lipoprotein cholesterol (LDL-C) target values and the principle of stepwise treatment remain unchanged. Amajor focus is on the acute coronary syndrome: the immediate initiation of high-intensity statin treatment, mostly in combination with ezetimibe is recommended. Increasingly more important are elevated Lp(a) levels and special subgroups: in people with human immunodeficiency virus (HIV), statin treatment is recommended over the age of 40years regardless of the LDL‑C as well as in high-risk patients undergoing anthracycline treatment. The use of dietary supplements and vitamins for prevention, however, are discouraged. The update reinforces the principle of risk-adapted LDL‑C target values, expands the treatment options and emphasizes the need for early, consistent lipid-lowering with practical recommendations.

Systemic lupus erythematosus (SLE) is an autoimmune disease associated with an increased risk of atherosclerotic cardiovascular disease (ASCVD). However, risk stratification remains an unmet need. In 2025, the European Atherosclerosis Society (EAS) introduced a novel metabolic disorder staging system. This study aimed at assessing the prevalence and prognostic value of metabolic disorders as defined by the EAS 2025 consensus statement in a cohort of SLE patients. Consecutive SLE patients who underwent a comprehensive cardiovascular risk assessment between January 2014 and January 2024at our center were retrospectively included. Data were leveraged to classify patients at baseline according to the EAS 2025 clinical staging system (metabolically healthy, stage 1, stage 2). The risk of incident ASCVD event was compared across these subgroups using log-rank tests and bivariate cox proportional hazard ratio models. A total of 214 SLE patients were included (91% females, age 44±13 years, SLE duration 13±9 years). Patients were grouped as follows: metabolically healthy (N=121, 56%), stage 1 (N=53, 25%), stage 2 (N=40, 19%). After a median follow-up of 8 [3-10] years, 10 patients (5%) had an incident ASCVD event. On survival analysis, EAS-based metabolic stages were significantly associated with incident ASCVD events (Log-rank p=0.001) and remained so after adjustment on age, sex, SLE duration, disease activity index and damage index. The 2025 EAS clinical staging system has independent prognostic value in predicting incident cardiovascular events in SLE.

National epidemiologic data are needed to inform country-specific healthcare policies for prevention and new developing treatments. We aimed to analyze Greek epidemiologic data in clinically relevant special populations for targeted treatments and to evaluate the utility oflipoprotein(a)[Lp(a)] as a risk enhancer METHODS: Two independent cohorts were included in this analysis: (1)consecutively recruited patients assessed in a tertiary outpatients' lipid clinic (Athens Angiometabolic cohort[AAC], n=1106) with available peripheral vascular markers, and (2)sample of the Greek general population (ATTICA study[AS], n=2682) with available 20-year follow-up data for atherosclerotic cardiovascular disease(ASCVD) events. Increased Lp(a) was found in 8.3% ofthe AS (≥50mg/dL) and in 18.9% of the AAC (≥125nmol/L) (16.0% without ASCVD and 22.1% with ASCVD, P=.006). Elevated Lp(a) levels were associated with increased carotid, coronary artery, and lower extremity atherosclerosis (P<.05 for all). Both the European Atherosclerosis Society(EAS)recommendations (net reclassification index [NRI]: 0.170) and a derived sex-specific inflation factor for HellenicSCOREII+(NRI: 0.176)were efficient in incorporating Lp(a) as a risk enhancer over HellenicSCOREII+for 20-year major adverse cardiovascular events. For 10-year cardiovascular death, only the EAS consensus provided significant reclassification. Finally, Lp(a) conferred increased eligibility for more aggressive primary prevention measures both by EAS recommendations (23.6% in AAC/13.6% in AS) and by sex-specific inflation factors (25.6% in AAC/22.3% in AS). Elevated Lp(a) levels were observed in 8.3% of the general population cohort and up to 23.9% in participants withASCVDfrom the lipid clinic cohort, highlighting a risk gradient across ASCVD categories. Incorporating Lp(a) as a risk enhancer improves ASCVD risk reclassification beyond the validated HellenicSCOREII+.

Aims Our study aimed to estimate the cost-effectiveness of non-statin lipid-lowering therapies (LLTs) in patients with very-high cardiovascular risk, based on their relative efficacy and current yearly treatment costs in the Spanish setting. Materials and methods We generated a cohort of patients in secondary prevention with low-density lipoprotein cholesterol (LDL-C) levels >100 mg/dL using a Monte Carlo simulation. Based on the relative LDL-C reductions described in the literature for each studied non-statin LLTs, we estimated the percentages of cohort patients that would achieve the 2019/2025 European Society of Cardiology (ESC) and European Atherosclerosis Society (EAS) dyslipidemia guidelines treatment targets (LDL-C levels <55 mg/dL and ≥50% reduction from baseline; defined as effectively treated patients). Derived, the annual costs per effectively treated patient were calculated. Results Evolocumab 140 mg every two weeks (Q2W), followed by alirocumab 150 mg Q2W were modeled to be the most efficacious non-statin regimens, with 80% and 70% of effectively treated patients, respectively. The results for inclisiran and the other studied doses of alirocumab were modeled to be more modest (20% to 33%). The mean annual cost per patient effectively treated with evolocumab 140 mg Q2W was 6,200.1€, compared with 7,126.5€ for alirocumab 150 mg Q2W, 15,159.1€ with alirocumab 75 mg Q2W and 19,254.9€ with alirocumab 300 mg every month. Inclisiran resulted in higher costs both during the first year (31,329.1€) and the subsequent time scenarios (26,107.6€ and 22,974.7€ during average first two and five years, respectively). Limitations No head-to-head clinical trials comparing non-statin LLTs are available. We only considered the published direct pharmacological costs in the Spanish setting. Conclusions In our simulation study, evolocumab 140 mg Q2W resulted in similar (versus alirocumab 150 mg Q2W) or better cost-effectiveness in achieving 2019/2025 ESC/EAS LDL-C targets for secondary prevention patients compared to other LLTs.

The fast-changing world of obesity, diabetes, and systemic metabolic disorders.

Lipoprotein(a) [Lp(a)] is a primarily genetically determined, causal and independent risk factor for atherosclerotic cardiovascular disease (ASCVD). Lp(a) levels are stable, unaffected by lifestyle, and best measured using isoform-insensitive, molar-based assays. Current guidelines from the European Atherosclerosis Society and U.S. National Lipid Association recommend a one-time Lp(a) measurement in all adults. Cascade testing is advised in affected families. Elevated Lp(a) levels are associated with increased risk of coronary artery disease, myocardial infarction incidence and recurrence, and aortic stenosis onset and progression. In cerebrovascular disease, high Lp(a) is linked to large artery ischemic stroke incidence and recurrence, as well as poor functional outcomes. Associations with venous thromboembolism are limited to prothrombotic states and extreme Lp(a) concentrations. Elevated levels (≥50 mg/dL or ≥125 nmol/L) should prompt intensified risk factor modification. There are no currently approved lipid-lowering therapies that substantially reduce Lp(a) levels. Novel agents to lower Lp(a) include antisense oligonucleotides, small interfering ribonucleic acid and small molecules, all of which have shown promising results in phase 2 trials. Ongoing phase 3 trials will evaluate the causal relationship between Lp(a) and ASCVD, and whether lowering Lp(a) reduces cardiovascular outcomes.

Background. Atherosclerosis-associated cardiovascular diseases exhibit significant ethnic and regional variability in risk factors. Kazakhstan’s high cardiovascular disease mortality rates necessitate population-specific profiling, particularly given urban-rural disparities and lifestyle differences unique to Central Asia. Methods. This cross-sectional study (2023–2024) analyzed 368 Kazakhstani adults stratified by European Atherosclerosis Society risk tiers: low (n=67), high (n=127), and very high risk (very high-risk group, n=174). Assessments included lipid profiles (low density lipoprotein, high density lipoprotein, and apolipoprotein B to apolipoprotein A ratio), lifestyle factors (smoking, diet, physical activity), and residence (urban/rural). Statistical analyses employed multiclass logistic regression (MNLogit) with FDR-adjusted p-values. Results. Age (OR=8.01, 95% CI:4.40–14.58, p&lt;0.001), male sex (OR=3.27, CI:1.82– 5.88), and smoking (OR=7.19, CI:1.52–34.15) were strongly associated with very highrisk group. Rural residents faced 2.6-fold higher very high-risk group odds (CI:1.52– 5.68, p=0.002) versus urban counterparts. Protective effects emerged for physical activity (OR=0.03, CI:0.004–0.32) and female sex (High-Density Lipoprotein: +8.1 mg/dL vs. males, p&lt;0.001). No alcohol association was observed (p=0.836). Conclusion. A thorough study of the gender aspect of the development of atherosclerotic pathology is required. Physical activity has a strong protective effect. It is interesting that, according to the comparative analysis of binary variables, rural residents have a higher risk of developing atherosclerosis.

Atherosclerotic cardiovascular disease is a leading cause of death and hypercholesterolemia is one relevant risk factor. There are two established guidelines for the management of high cholesterol in general practice in Germany, one of these is from the European Society of Cardiology (ESC). This analysis examines whether treatment modalities and clinical outcomes in German primary care have changed after the publication of the 2019 ESC (European Society of Cardiology)/EAS (European Atherosclerosis Society) guidelines on dyslipidaemia. A retrospective cohort study (2001-2023) with data extracted from electronic health record systems of 17 primary care practices. The Data was used to compare drug treatment and outcomes before and after 2019, the year of the ESC guideline publication. Multilevel regression analysis was used to assess the effects of the new guidelines, accounting for time trends and patient- and practice-level factors. Statin prescriptions for 23,322 patients with hypercholesterolemia increased from 6% in 2001 to 27% in 2023, with an increase in treatment intensity after 2012. Despite general reductions in total and LDL cholesterol, cardiovascular events remained unchanged, while reported complaints associated with side effects increased. Multilevel regression showed more prescriptions after the new ESC/EAS guidelines, with no effect on treatment intensity or outcomes. Following the publication of the new ESC/EAS guideline, a modest rise in statin prescriptions has been documented. However, despite improved lipid profiles, clinically relevant events did not decrease yet, and side effects increased, questioning the benefit of tailoring statin therapy to lower lipid thresholds in real world data so far. German Clinical Trials Register: DRKS00032936. Registration Date: October 30, 2023.

Dyslipidaemia is a key modifiable risk factor for atherosclerotic cardiovascular disease. However, achieving recommended low-density lipoprotein cholesterol (LDL-C) target levels is challenging owing to dose-dependent adverse effects and limited tolerability of high-dose statins. This study evaluated the real-world efficacy and safety of combining very-low-dose rosuvastatin (2.5 mg) with ezetimibe (10 mg) in adult patients with dyslipidaemia across different cardiovascular risk strata. This multicentre prospective study in South Korea enrolled 2,388 patients. Participants were stratified into low-, moderate-, or high-risk groups on the basis of the 2019 European Society of Cardiology and European Atherosclerosis Society guidelines. Lipid profiles and safety outcomes were assessed at baseline and after 12 weeks. The primary and secondary outcomes were LDL-C and non-high-density lipoprotein cholesterol (non-HDL-C) target level achievements, respectively, and adverse events were monitored. After 12 weeks, LDL-C target levels were achieved by 82.6% of low-risk (< 116 mg/dL), 73.9% of moderate-risk (< 100 mg/dL), and 50.4% of high-risk (< 70 mg/dL) patients. Non-HDL-C target level achievement followed a similar trend. Combination therapy with ezetimibe and low-dose statin resulted in significant LDL-C reductions, compared with statins alone. Adverse events were infrequent (0.6%), and only 0.2% of patients discontinued treatment owing to medication-related concerns. Very-low-dose rosuvastatin-ezetimibe combination therapy significantly lowered LDL-C levels and improved lipid profiles across various risk groups, demonstrating a favourable safety profile. These findings support its use as an effective, well-tolerated option for managing dyslipidaemia. Longer-term studies are warranted to evaluate sustained lipid control and cardiovascular outcomes.

Objective The objective of this study is to compare guideline adherence between artificial intelligence (AI) models (Claude-3 (Anthropic, San Francisco, CA), DeepSeek-V2 (DeepSeek, Hangzhou, China), GPT-4 (OpenAI, San Francisco, CA)) and human experts in dyslipidemia management using standardized clinical scenarios based on 2019 European Society of Cardiology (ESC)/European Atherosclerosis Society (EAS) and 2021 ESC prevention guidelines. The study employed a comprehensive evaluation framework to capture the holistic nature of dyslipidemia management across multiple interconnected domains. Methods Thirty fictitious but clinically representative cases were developed by lipid specialists across five domains: cardiovascular risk assessment, lipid management, lifestyle modifications, pharmacotherapy, and special populations. This broad scope was deliberately chosen to evaluate the full complexity of integrated cardiovascular risk management as it occurs in clinical practice. Cases included all variables required for objective guideline application. AI models and clinicians (professors, specialists, residents) provided management recommendations. A blinded assessment paradigm was employed to minimize potential evaluation bias, with evaluators scoring responses using alphanumeric coding to prevent source identification bias. Responses were assessed using standardized rubrics (0-3 scales) for four equally-weighted parameters: accuracy (guideline concordance), comprehensiveness (clinical coverage), applicability (implementation feasibility), and efficacy (simulated low-density lipoprotein cholesterol (LDL-C) target attainment). Composite scores were calculated by summing all parameters (maximum 12 points). Results Correct response rates were 91% for AI, 72% for professors, 50% for specialists, and 21-32% for residents. Composite scores (mean ± SD/12) were 10.3 ± 1.0 for AI, 8.1-9.2 for professors, 7.4 ± 1.5 for specialists, and 5.2-6.2 for residents. AI excelled in literal guideline application while professors considered contextual factors (frailty, life expectancy). Professors primarily erred in LDL-C targets (using <100 vs. <55 mg/dL), while AI in nuanced risk stratification. Simulated outcomes showed LDL-C target attainment of 83% with AI, 64% with professors, and 92% with a combined approach. Conclusion AI demonstrated superior guideline adherence in standardized scenarios but may miss contextual clinical factors. The hybrid AI-human approach optimized outcomes, suggesting that augmented intelligence represents the most promising implementation strategy. Limitations include simulated cases (n = 30), potential performance bias favoring literal interpretation, and lack of real-world complexity. Prospective clinical validation is warranted.

To quantify international variations in lipid-lowering therapies (LLT) use among patients with coronary heart disease (CHD) and attainment of European guideline-recommended lipid goals. INTERASPIRE is an observational study (2020-23) covering 14 countries from all WHO regions. Patients (18-79 years) hospitalized in the preceding 6-36 months with CHD were invited for standardized interviews and examination, with central laboratory analyses for low-density lipoprotein cholesterol (LDL-C), non-HDL-C, and apolipoprotein B (apoB). Valid lipid data meeting quality control standards were available from 13 countries. Lipid goals followed the 2019 guidelines of the European Atherosclerosis Society and the European Society of Cardiology: LDL-C < 1.4 mmol/L, non-HDL-C < 2.2 mmol/L, and apoB <65 mg/dL.Among 4061 patients (78.8% male, mean age 60.3 years), between index event and interview, 66.3% had no change in treatment intensity. LLT use at interview was largely statin monotherapy: 49.6% high-intensity (inter-country range 5.3%-77.3%) and 24.1% low/moderate-intensity (inter-country range 5.1%-70.1%). Otherwise, 12.2% (inter-country range 0.2%-41.1%) were on combination therapy, and 12.7% on no LLT (inter-country range 3.5%-36.7%). Goal attainment for LDL-C was 17.5%. Corresponding non-HDL-C and apoB goals were achieved by 29.9% and 29.2%, respectively. Higher-income countries (defined by the World Bank's 2024-25 classification of income levels) did better in goal attainment than lower-middle-income countries. In this international study, contemporary lipid goals were not achieved in most CHD patients, with lower-middle-income countries having the worst goal attainment. Contributory factors include absence of any LLT use, low use of combinations and a failure to up-titrate LLT to achieve guideline targets.