2023 Hellenic Atherosclerosis Society guidelines for management of patients with dyslipidemia

Atherosclerotic cardiovascular disease (ASCVD) is the prominent cause of mortality globally, and dyslipidemia is considered as a significant risk factor for the development of ASCVD. Hence, prompt diagnosis and appropriate management of dyslipidemia plays a critical role in the prevention and treatment of ASCVD. 

It is important to note that the advantages of lowering LDL-C are not exclusive to statin therapy. Consequently, non-statin treatments should be considered for very high- or high-risk patients who do not reach their LDL-C targets while on statins. As there is no defined threshold for LDL-C at which the benefits stop or adverse effects begin, it is advisable to aim for the lowest possible LDL-C levels, particularly in patients at very high risk for ASCVD.

Treatment targets in dyslipidemia include:

• Lowering LDL-C is the primary treatment goal for nearly all patients. I
• In individuals with triglyceride (TG) levels exceeding 200 mg/dL, non-HDL-C serves as a secondary treatment target, set at LDL-C target + 30 mg/dL. IIa
• For patients with TG levels greater than 500 mg/dL, reducing TGs is a top treatment priority. IIa
• •Conversely, HDL-C is not considered a treatment target.

Following are the LDL-C treatment goals for different ASCVD risk groups; III

• Individuals at very high ASCVD risk:

• LDL-C treatment target is <55 mg/dL AND ≥50% LDL-C reduction from baseline
• Initiation of lipid-lowering drug treatment is immediate along with therapeutic lifestyle changes.

• Individuals at high ASCVD risk:

• LDL-C treatment target is <70 mg/dL AND ≥50% LDL-C reduction from baseline 
• Initiation of lipid-lowering drug treatment is immediate along with therapeutic lifestyle changes.

• Individuals at moderate ASCVD risk:

• LDL-C treatment target is <100 mg/dL
• Initiation of lipid-lowering drug treatment is 3 months following therapeutic lifestyle changes.

• Individuals at low ASCVD risk:

• LDL-C treatment target is <116 mg/dL
• Initiation of lipid-lowering drug treatment is 3–6 months following therapeutic lifestyle changes.

Source: Katsiki N, Filippatos T, Vlachopoulos C, Panagiotakos D, Milionis H, Tselepis A, Garoufi A, Rallidis L, Richter D, Nomikos T, Kolovou G, Kypreos K, Chrysohoou C, Tziomalos K, Skoumas I, Koutagiar I, Attilakos A, Papagianni M, Boutari C, Kotsis V, Pitsavos C, Elisaf M, Tsioufis K, Liberopoulos E. Executive summary of the Hellenic Atherosclerosis Society guidelines for the diagnosis and treatment of dyslipidemias - 2023. Atheroscler Plus. 2024 Feb 17;55:74-92. doi: 10.1016/j.athplu.2024.01.004. PMID: 38425675; PMCID: PMC10901915.