Inflammatory and Autoimmune Diseases

This chapter synthesizes evidence from the 2025 ESC/EAS Focused Update of the 2019 ESC/EAS Guidelines for the management of dyslipidemias and other recent guidelines to provide a practical, integrated approach for lipid management and presents a contemporary treatment algorithm for dyslipidemia, centered on a risk-stratified and intensifying approach to LDL-C reduction. The foundational step is a precise cardiovascular risk assessment using the SCORE2/SCORE2-OP algorithms that guide stringent, personalized LDL-C targets, including for the elderly. For very high-risk patients, the goal is https://www.w3.org/1998/Math/MathML” display=“inline”> < 1.4 -mmol / L https://www.w3.org/1999/xlink” xlink:href=“https://s3-euw1-ap-pe-df-pch-content-public-p.s3.eu-west-1.amazonaws.com/9781003642497/b48f1cbb-d223-4a0c-9a75-2620aaf16c68/content/ieq0282.tif”/> (https://www.w3.org/1998/Math/MathML” display=“inline”> < 55 -mg / dL https://www.w3.org/1999/xlink” xlink:href=“https://s3-euw1-ap-pe-df-pch-content-public-p.s3.eu-west-1.amazonaws.com/9781003642497/b48f1cbb-d223-4a0c-9a75-2620aaf16c68/content/ieq0283.tif”/>) , descending to https://www.w3.org/1998/Math/MathML” display=“inline”> < 1.0 -mmol / L https://www.w3.org/1999/xlink” xlink:href=“https://s3-euw1-ap-pe-df-pch-content-public-p.s3.eu-west-1.amazonaws.com/9781003642497/b48f1cbb-d223-4a0c-9a75-2620aaf16c68/content/ieq0284.tif”/> (https://www.w3.org/1998/Math/MathML” display=“inline”> < 40 -mg / dL https://www.w3.org/1999/xlink” xlink:href=“https://s3-euw1-ap-pe-df-pch-content-public-p.s3.eu-west-1.amazonaws.com/9781003642497/b48f1cbb-d223-4a0c-9a75-2620aaf16c68/content/ieq0285.tif”/>) for those with recurrent events. The pharmacological algorithm is a treat-to-target cascade. High-intensity statin therapy remains the cornerstone. A critical paradigm shift is the recommendation for early, intensive combination therapy, particularly initiating statin plus ezetimibe during hospitalization for an acute coronary syndrome (ACS) to accelerate goal attainment. If targets are not met, the algorithm proceeds by escalating to a PCSK9 monoclonal antibody. For specific clinical scenarios, the arsenal now includes bempedoic acid for statin-intolerant patients and evinacumab for homozygous familial hypercholesterolemia. This streamlined, evidence-based algorithm provides a clear pathway for clinicians to implement intensive lipid-lowering strategies effectively, guided by the principle for LDL-C, “the lower, the earlier, the better”.