Dyslipidemia

Also known as: high cholesterol · HLD · hypercholesterolemia · hyperlipidemia · lipid management

Also relevant to Endocrine & MetabolicAlso relevant to Preventive Medicine & Primary Care

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United StatesACC/AHA

Current

2018 AHA/ACC Guideline on the Management of Blood Cholesterol

AHA/ACC (multisociety) · 2018

The current US cholesterol guideline. It emphasizes lifetime ASCVD-risk reduction and more intensive LDL-C lowering than the 2013 guideline it replaced.

Uses the Pooled Cohort Equations to estimate 10-year ASCVD risk in primary prevention. source
Recommends high-intensity or maximally tolerated statins to lower LDL-C by ≥50% in clinical ASCVD. source
Adds selective use of nonstatin agents (ezetimibe, PCSK9 inhibitors) for very-high-risk patients. source

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EuropeESC

Current

2025 Focused Update of the 2019 ESC/EAS Guidelines for the management of dyslipidaemias

ESC/EAS · 2025 · 2025 Focused Update

Supersedes the 2019 ESC/EAS version

The current European dyslipidaemia guidance — a 2025 focused update of the 2019 ESC/EAS guideline, incorporating newer trial evidence on lipid lowering.

Retains risk-based LDL-C goals, with the lowest targets for very-high-risk patients. source
Uses the SCORE2 / SCORE2-OP algorithms to estimate cardiovascular risk in apparently healthy people. source

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US vs EU key differences

Version currency differs sharply: the US guideline dates to 2018, while the European guidance was refreshed by a 2025 focused update. source
Risk-estimation tools differ: the US uses the Pooled Cohort Equations, the ESC uses SCORE2 / SCORE2-OP. source
Both prioritize statins first-line and add nonstatin agents (ezetimibe, PCSK9 inhibitors) for higher-risk patients, but the ESC frames treatment around explicit numeric LDL-C targets. source

What changed recently

EU2019 → 2025 Focused Update2025-06-15
2025 focused update of the 2019 ESC/EAS guideline, incorporating newer lipid-lowering trial evidence while retaining risk-based LDL-C goals.
source ↗
US2013 → 20182018-11-10
Replacing the 2013 ACC/AHA cholesterol guideline, the 2018 version reintroduces LDL cholesterol thresholds to trigger treatment intensification - roughly 70 mg/dL in very high-risk secondary prevention - and endorses adding ezetimibe first and then a PCSK9 inhibitor to maximally tolerated statin. It also adds risk-enhancing factors and coronary artery calcium scoring to refine statin decisions in intermediate-risk primary prevention.
source ↗curation confidence 90%

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