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REFLECTIONS
Dyslipidaemia
Dyslipidaemia Global Newsletter #10 2025

Association between Lp(a) levels and lifetime risk of major CV events Dyslipidaemia

CI, confidence interval; Lp(a), lipoprotein (a). The risk of major CV
events starts to slightly increase in individuals with Lp(a) levels
>62 nmol/L (30 mg/dL), and the increase in risk becomes more
pronounced in individuals with Lp(a) levels ≥105 nmol/L (50 mg/
dL). The grey lines indicate the smoothed adjusted hazard ratio and
95% CI (left y-axis) for lifetime risk for major CV events for a given
Lp(a) concentration relative to the median Lp(a) in the population
(data from the United Kingdom Biobank, subanalysis including
415,274 white individuals). The blue line shows the frequency
a
distribution of Lp(a) levels, with respective percentages indicated in
the right y-axis (data from the United Kingdom Biobank, including
443,180 individuals without prior atherosclerotic CVD).

For special populations, the update mentions statin therapy for individuals with HIV, recommending its use in primary prevention
for those aged ≥40 years, based on the REPRIEVE (pitavastatin in HIV) trial which demonstrated a 35% lower incidence of
MACE with pitavastatin. For patients undergoing cancer therapy, statins should be considered in adults at high or very high risk of
developing chemotherapy-related CV toxicity. For patients with elevated Lp(a) levels (>50 mg/dL or >105 nmol/L), measurement
is recommended as a CV risk-enhancing factor. While high-dose icosapent ethyl is still considered for high-risk patients with
hypertriglyceridaemia, the use of volanesorsen (300 mg/week) is advised to lower triglyceride levels and reduce the risk of
pancreatitis in cases of severe hypertriglyceridaemia due to familial chylomicronaemia syndrome (FCS). Finally, the use of dietary
supplements or vitamins without documented safety and significant LDL-C-lowering efficacy is not advised, as they are not
recommended to lower the risk of atherosclerotic CVD (ASCVD).

The 2025 Focused Update of the 2019 ESC/EAS Guidelines
provides an evidence-based framework for clinicians to
manage dyslipidaemias effectively. By incorporating advanced
risk prediction tools and emphasising early, intensive LLTs –
including starting with statin and ezetimibe in patients after
ACS, the guidelines aim to reduce the global burden of ASCVD.
Clinicians are encouraged to adopt these updated strategies
to enhance patient outcomes and align with the latest scientific
understanding in lipid management.

CLICK HERE
WATCH PROF. FRANCOIS MACH (FIRST
AUTHOR OF THE UPDATE) DISCUSS
THE 2025 FOCUSED UPDATE OF THE
2019 ESC/EAS GUIDELINES FOR THE
CLICK HERE MANAGEMENT OF DYSLIPIDAEMIAS AT
FOR THE LINK TO FULL ARTICLE ESC 2025 CONGRESS.

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