Management of Dyslipidemias in Europe and the USA: Same Evidence, Different Conclusions? Can We Find Common Ground?

Ian M. Graham, Alberico L. Catapano

An examination of the current ACC/AHA and ESC/EAS Guidelines on the management of dyslipidemias for common ground and differences. There is much common ground. Both note that ASCVD is, in most people, the product of a number of risk factors, notably tobacco exposure, hyperlipidemia, hypertension, inactivity, overweight and diabetes. They stress that risk calculators can help in the assessment of risk in apparently healthy persons. Persons with established ASCVD and many with diabetes or renal impairment are at high to very high risk and warrant intensive risk factor advice. The ACC/AHA Guidelines favor the universal use of statins in all high-risk subjects. In contrast, the ESC/EAS Guidelines favor a goal approach based on total risk and baseline LDL cholesterol level. Perhaps the most important challenges are to stress similarities rather than differences and to simplify communications with both healthcare professionals and the public. Subjects with established vascular disease and renal impairment and many with diabetes are at high to very high risk and need intensive risk factor management. A risk chart or calculator is recommended to assess total risk in apparently healthy persons. The higher the risk, the more intense the risk factor management.