Assess CV Risk
SCORE2 or SCORE2-OP
All Pathways
CardiologyManagement
Dyslipidemia Management (ESC/EAS 2019)
Dyslipidemia Management (ESC/EAS 2019): Assess CV Risk → CV Risk Category → Very High Risk → Recurrent Event <2y → Step 1: High-Intensity Statin.
Pathway Overview
12 steps
Algorithm Steps
12 total
01Start 02Decision CV Risk Category
Determines LDL target
03Action Very High Risk
LDL <55 mg/dL + ≥50% reduction
- ASCVD documented
- DM + target organ damage
- Severe CKD (eGFR <30)
- SCORE2 ≥7.5% (≥50yo)
04Warning Recurrent Event <2y
LDL <40 mg/dL
05Action Step 1: High-Intensity Statin
First-line therapy
- Atorvastatin 40-80mg
- Rosuvastatin 20-40mg
- Recheck in 4-6 weeks
06Action Step 2: Add Ezetimibe
If not at target
- Ezetimibe 10mg daily
- +15-20% LDL reduction
07Action Step 3: Add PCSK9 Inhibitor
If still not at target
- Evolocumab or Alirocumab
- +50-60% LDL reduction
- Consider in-hospital initiation post-ACS
08Outcome Monitor & Maintain
Annual lipid panel, adherence check
09Warning Statin Intolerant
Alternative strategies
- Alternate statin/lower dose
- Bempedoic acid
- Inclisiran (siRNA)
- PCSK9i monotherapy
- Path rejoins step 08Shared downstream outcome
- Path rejoins step 05Shared downstream outcome
10Action High Risk
LDL <70 mg/dL + ≥50% reduction
- Single major RF markedly elevated
- FH without ASCVD
- DM ≥10y or with RF
- SCORE2 2.5-7.5%
- Path rejoins step 05Shared downstream outcome
11Action Moderate Risk
LDL <100 mg/dL
- Young DM (<35yo T1, <50yo T2)
- DM <10y without RF
- SCORE2 1-2.5%
- Path rejoins step 05Shared downstream outcome
12Action Low Risk
LDL <116 mg/dL
- SCORE2 <1%
- Path rejoins step 05Shared downstream outcome
Guideline Source
2019 ESC/EAS Guidelines for the Management of Dyslipidaemias
Clinical Safety Information
Clinical Decision Support — Not a Substitute for Clinical Judgment
Individual patient factors may require deviation from these recommendations.
Known Limitations
- Statin dosing not detailed
- Drug interactions not included
- Does not address familial hypercholesterolemia workup
Contraindicated Populations
pediatric
Applicable Regions
EUUS
EU: ESC/EAS LDL <55 for very high risk
US: ACC/AHA LDL <70 for ASCVD may differ
Version 1Next review: 2027-01-01
Next steps
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Related Resources
Frequently Asked Questions
What is the Dyslipidemia Management (ESC/EAS 2019)?
The Dyslipidemia Management (ESC/EAS 2019) is a management clinical algorithm for Cardiology. It provides a structured decision tree to guide clinical decision-making, based on 2019 ESC/EAS Guidelines for the Management of Dyslipidaemias.
What guideline is the Dyslipidemia Management (ESC/EAS 2019) based on?
This algorithm is based on 2019 ESC/EAS Guidelines for the Management of Dyslipidaemias (DOI: 10.1093/eurheartj/ehz455).
What are the limitations of the Dyslipidemia Management (ESC/EAS 2019)?
Known limitations include: Statin dosing not detailed; Drug interactions not included; Does not address familial hypercholesterolemia workup. Individual patient factors may require deviation from these recommendations.
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