Advances in lipidology

Abstract

Lipid metabolism disorders represent one of the most significant risk factors for cardiovascular diseases. In 2025, the European Society of Cardiology released an update to the 2019 European Guidelines for the Management of Dyslipidemias, incorporating recent clinical trial data and recommending several key modifications. Among the most important changes is the replacement of the previously used SCORE risk estimation system with SCORE2 for individuals under 70 years of age and SCORE2-OP for those between 70 and 89 years. The updated guidelines also introduce the consideration of subclinical atherosclerosis – as evidenced by markers such as elevated coronary artery calcium score – as a risk-modifying factor. Another important addition is the recommendation of bempedoic acid, which is not yet available in Hungary, as a lipid-lowering therapy for patients with statin intolerance, as well as in combination with maximally tolerated statin and/or ezetimibe in high- and very high-risk patients. A significant modification in the management of acute coronary syndromes is the recommendation for early intensification of LDL-C lowering therapy, with the goal of achieving aggressive lipid reduction during the index hospitalization. The update also emphasizes that lipoprotein(a) levels above 50 mg/dL are considered an independent cardiovascular risk factor in all adults, and it is therefore recommended that lipoprotein(a) be measured at least once during a patient’s lifetime. Furthermore, the guidelines highlight that high dose icosapentethyl therapy should be considered in hypertriglyceridemic patients at high or very high cardiovascular risk, particularly when statin therapy alone is insufficient to achieve desired lipid goals. Importantly, the LDL-C target values and cardiovascular risk categories remain fundamentally unchanged compared to the 2019 guidelines. The intensity of LDL-C lowering should still be guided by the individual’s overall cardiovascular risk level. However, the update also acknowledges the role of emerging therapeutic options in certain specific patient populations. These include volanesorsen for familial chylomicronemia syndrome, evinacumab for homozygous familial hypercholesterolemia, and evidence supporting the efficacy of statin therapy in primary prevention among HIV-infected individuals and in cancer patients undergoing chemotherapy. In conclusion, therapeutic options for the management of dyslipidemia are expanding significantly, but their proper implementation in everyday clinical practice remains crucial.