The evolution of European guidelines: Changing the management of cholesterol levels

  • Leif R. Erhardt
    Corresponding author. Tel.: +46 40 331941; fax: +46 40 337329.
    Department of Cardiology, Cardiology Research Unit, University of Lund, Malmö University Hospital, SE-205 02 Malmö, Sweden
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  • Author Footnotes
    1 Tel.: +1 212 746 0194; fax: +1 212 746 8200.
    A. Gotto Jr.
    1 Tel.: +1 212 746 0194; fax: +1 212 746 8200.
    Weill Medical College of Cornell University, Olin Hall, Room 205, 445 East 69th Street, New York, NY 10021, USA
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  • Author Footnotes
    1 Tel.: +1 212 746 0194; fax: +1 212 746 8200.


      Cardiovascular disease (CVD) is the leading cause of death in Europe and the US. This paper reviews the evolution of the Joint European Societies’ guidelines with respect to their lipid recommendations. We stress the importance of lowering lipid levels to, or below, the currently recommended goals and argue that patients’ global risk for CVD, rather than baseline lipid levels, should direct the intensity of lipid-lowering treatment. However, the emphasis on near-term (i.e., in the next 10 years) global risk estimation may under-emphasize the importance of considering lifetime cardiovascular risk in treatment decisions. Although various guidelines’ thresholds for treatment initiation and recommended goals differ, they are similar in the theme of treating global risk. Most clinical trials have not identified a threshold of cholesterol level beyond which lowering cholesterol levels no longer provides cardiovascular benefit. An urgent call for action is needed to improve goal attainment in patients with or at risk for CVD. Improving access to risk-reducing treatments should be a priority.


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