2025 Focused Update of the 2019 ESC/EAS Guidelines on Dyslipidaemia Management
We are pleased to share important news from the European Society of Cardiology (ESC) and the European Atherosclerosis Society (EAS). At the ESC Congress 2025 in Madrid, the societies jointly announced the publication of the 2025 Focused Update of the 2019 ESC/EAS Guidelines for the management of dyslipidaemias.
This update reflects the latest scientific evidence up to March 2025 and brings new recommendations that will directly impact the care and treatment of people living with lipid disorders – including those affected by familial hypercholesterolaemia (HeFH and HoFH), elevated lipoprotein(a) [Lp(a)], and familial chylomicronaemia syndrome (FCS).
Since the last full guidelines in 2019, many new clinical trials have been completed. Some of these trials have shown important benefits from newer treatments or clarified how existing therapies should be used. Because of this, the ESC and EAS decided not to wait until the next full guideline revision, but instead to publish a Focused Update, ensuring patients and doctors can benefit from the most up-to-date care recommendations right away.
🔹 New SCORE2 & SCORE2-OP risk algorithms for more accurate prediction of heart attack and stroke risk (What is SCORE*)
🔹 Introduction of bempedoic acid and evinacumab for LDL-C lowering
🔹 Early, intensive lipid-lowering therapy now recommended in heart attack (ACS) during hospital admission
🔹 Lp(a) >50 mg/dL (≥105 nmol/L) officially recognized as a cardiovascular risk modifier
🔹 Updated recommendations on hypertriglyceridaemia, including novel RNA-based therapies
🔹 Strong evidence for statins in people with HIV (REPRIEVE trial)
🔹 Guidance for cancer patients at high cardiovascular risk during chemotherapy
🔹 Clear statement: dietary supplements show no proven benefit for preventing heart disease
A step forward towards more personalised and aggressive prevention in high-risk patients.
Key Updates for Patients
Familial Hypercholesterolaemia (HeFH & HoFH)
For those living with inherited high cholesterol, the update introduces new therapies. Alongside statins, ezetimibe, and PCSK9 inhibitors, additional medicines such as bempedoic acid and, for HoFH, the antibody evinacumab, are now recommended as effective options. These treatments can provide stronger LDL-cholesterol lowering, where older drugs may not have been enough.
Elevated lipoprotein(a) [Lp(a)]
High levels of Lp(a) are now more clearly recognised as an important risk factor for heart disease and aortic valve disease. The guidelines recommend that everyone should have their Lp(a) checked at least once in their lifetime. For those with very high levels, the update advises early and intensive cholesterol-lowering treatment, even while we await the arrival of specific Lp(a)-lowering medicines currently in clinical trials.
Familial Chylomicronaemia Syndrome (FCS)
For the first time, the update makes a strong recommendation for volanesorsen, a treatment shown to lower triglycerides by up to 77% and reduce the risk of pancreatitis in people with FCS. This represents a major step forward for a condition that has long had very limited treatment options.
These updates are part of a continuing shift towards earlier, stronger, and more personalised lipid management. The message is clear: lowering LDL-cholesterol and addressing risk factors like Lp(a) and triglycerides saves lives.
The full guideline update has been published in both the European Heart Journal and Atherosclerosis.
And don’t forget: FHEF will host upcoming patient-friendly webinars to explain these changes further.
✨ Together, we are moving closer to a future where patients with inherited lipid disorders can live longer and healthier lives.
The European Commission has officially launched a public consultation on the EU Cardiovascular Health Plan—a long-anticipated and vital step forward in shaping the future of cardiovascular disease (CVD) prevention and care across the EU.
This is a historic opportunity for our community to ensure that inherited lipid disorders—including familial hypercholesterolaemia (FH), homozygous FH, elevated lipoprotein(a) [Lp(a)], and familial chylomicronaemia syndrome (FCS)—are fully recognised as major risk factors for cardiovascular disease in EU-level health policy.
The consultation is more than a formality—it’s a chance to influence the EU’s strategic direction on cardiovascular health. We must advocate for:
Over the years, FH Europe Foundation, in collaboration with our network of patients, clinicians, researchers, and policy advocates, has laid the groundwork for this moment. Key milestones include:
These achievements have helped build the momentum we now see reflected in this EU-level initiative.
The consultation is open until 15 September 2025 and is hosted on the European Commission’s platform (registration required). We encourage all stakeholders—patients, clinicians, researchers, and advocates—to participate and make their voices heard.
FH Europe Foundation is coordinating a comprehensive response, drawing on insights from our Network Leaders, Patient Ambassadors, Scientific Experts, and industry partners. Our submission will combine robust scientific evidence with the lived experiences of those affected by lipid conditions.
We will share our final position with the community to ensure transparency and alignment, and to empower others to advocate effectively.
Together, we can shape a Cardiovascular Health Plan that truly reflects the needs of our community.
📅 Deadline: 15 September 2025
PRESS RELEASE
A new study* shows routine testing for a little-known cardiovascular threat could prevent heart attacks, strokes, and save millions in health costs.
Most people have heard of cholesterol. But there’s another dangerous lipid in the blood – lipoprotein(a), or Lp(a), which if high in levels, could be silently putting millions at risk.
An international study led by Professor Zanfina Ademi and her Team at Monash University (Melbourne, Australia) reveals the cost effectiveness of testing high levels of Lp(a), a genetic and lifelong risk factor for heart disease affecting nearly 1 in 5 adults.
“This is one of the biggest blind spots in heart health,” said Professor Zanfina Ademi, a health economist and senior author of the study. “You can have a healthy lifestyle and normal cholesterol, but if your Lp(a) is high, you’re still at serious risk.”
Cardiovascular disease remains the world’s leading cause of death. In Australia, it costs over $14 billion a year; in Europe, that number soars to €282 billion. Yet Lp(a), which cannot be improved by diet or exercise, is not part of routine testing in most healthcare systems.
Published in Atherosclerosis, the study analysed data from over 10,000 adults in the UK. The results were striking: routine Lp(a) testing would have reclassified 20% of participants as high-risk, leading to earlier intervention with blood pressure or cholesterol-lowering medications.
In the same issue, Prof. Jan Boren, Editor-in-Chief of Atherosclerosis, issues a call to action in an editorial**, urging guideline developers and policymakers to act: “When a simple blood test can help prevent life-threatening cardiovascular events and improve quality of life, all in a cost-effective way, implementing such testing isn't just advisable, it's imperative”.
The modelling showed that, testing could prevent 60 heart attacks, 13 strokes and 26 early deaths (per 10,000 people tested). While adding 217 years and 255 years of healthy life – all while saving approximately $85 and £263 per person in Australia and in the UK respectively in medical and productivity costs. Researchers tested this approach in nine high income countries and found the same result everywhere: regularly testing for Lp(a) could save money in all their healthcare systems.
“This is a game-changer,” said Professor Florian Kronenberg of the Medical University of Innsbruck, Chair of the Lp(a) International Taskforce. “A one-time test could prevent countless tragedies and is one of the most cost-effective tools we have.”
The research helped inform the Brussels International Declaration on Lp(a) Testing and Management, a new global policy roadmap calling for Lp(a) to be included in national cardiovascular screening programs.
Magdalena Daccord, CEO of FH Europe and co-author of the study, said: “Most people think they’re safe if their cholesterol is normal. But Lp(a) is often the missing piece. This simple test can save lives. The science is here – now it’s time to act.”
Commissioned by the Lp(a) International Taskforce and hosted by the FH Europe Foundation (FHEF), this patient-driven research initiative was led by the Centre for Medicine Use and Safety at the Monash Institute of Pharmaceutical Sciences, in collaboration with global researchers and the Lp(a) International Taskforce. The study forms part of a broader multistakeholder effort to advance understanding and action on Lp(a).
* Lp(a) testing for the primary prevention of cardiovascular disease in high-income countries: a cost-effectiveness analysis.Jedidiah I Morton, Florian Kronenberg, Magdalena Daccord, Nicola Bedlington, Marius Geantӑ, Tobias Silberzahn, Zhenyue Chen, Jean-Luc Eiselé, Bogi Eliasen, Mariko Harada-Shiba, Marc Rijken, Albert Wiegman, George Thanassoulis, Pia R Kamstrup, Iñaki Gutiérrez-Ibarluzea, Pablo Coral, Raul D Santos, Erik Stroes, Michal Vrablík, Gerald F Watts, Christie M Ballantyne, Samia Mora, Børge G Nordestgaard, Kausik K Ray, Stephen J Nicholls, Zanfina Ademi, On behalf of the Lp(a) International Taskforce (ITF) initiative.
Atherosclerosis. https://doi.org/10.1016/j.atherosclerosis.2025.120447
** The test that pays for itself: Why we can no longer afford to ignore Lp(a). Jan Borén (editor-in-chief of Atherosclerosis)
Atherosclerosis. https://doi.org/10.1016/j.atherosclerosis.2025.120468
Explore the highlights from FH Europe's May and June 2025 Heart Beat newsletter to catch up on the latest news and events in the world of cardiovascular health: