Dyslipidemia increases the risk of atherosclerotic cardiovascular disease (ASCVD). Management aims to lower this risk with healthy lifestyle changes, appropriate management of other conditions like diabetes, and lipid lowering drugs.
In this side-by-side comparison, we compare the algorithm for the management of adults with dyslipidemia from the American Association of Clinical Endocrinology (AACE) to the latest clinical practice guideline update for the management of dyslipidemia from the European Society of Cardiology (ESC) and the European Atherosclerosis Society (EAS). We focus on pharmacologic treatments that target low-density lipoprotein cholesterol (LDL-C), but encourage you to review the full text guidelines available at the provided links for more information on this topic.
Quick Rundown for Comparison
| Item | American Association of Clinical Endocrinology Consensus Statement: Algorithm for Management of Adults with Dyslipidemia – 2025 Update | 2025 Focused Update of the 2019 ESC/EAS Guidelines for the management of dyslipidaemias: Developed by the task force for the management of dyslipidaemias of the European Society of Cardiology (ESC) and the European Atherosclerosis Society (EAS) |
|---|---|---|
| Authoring Organization | American Association of Clinical Endocrinology (AACE) | European Society of Cardiology (ESC) and European Atherosclerosis Society (EAS) |
| Publication Date | September 2025 | August 2025 |
| Graded Recommendations | No | Yes |
| Links | Summary / Full Text | Summary / Full Text |
Key Takeaways
The AACE algorithm for the management of adults with dyslipidemia includes sections on pharmacologic treatment of LDL-C as well as sections not covered in this article on the evaluation of atherosclerotic cardiovascular disease risk, lifestyle modification, statin associated muscle symptoms, treatment of hypertriglyceridemia, and management of dyslipidemia in pregnant and lactating women.
The ESC/EAS focused update addresses changes in treatment of dyslipidemia based on evidence since their last guideline in 2019. Areas that were updated and addressed in this guideline include: cardiovascular risk estimation, LDL-C lowering therapies, lipid-lowering during index hospitalization for acute coronary syndrome, recommendations on lipoprotein(a), treatment of hypertriglyceridemia, statin therapy for people with HIV and people with cancer at high or very high risk for chemotherapy-related CV toxicity, and dietary supplements for dyslipidemia.
Now we will review the differences and similarities in the pharmacologic LDL-C lowering recommendations between the two guidelines:
- Statins
- Statin therapy is the initial treatment recommended by both guidelines.
- ESC/EAS takes a more aggressive approach to statin therapy compared to the AACE, recommending high-intensity statins up to the highest tolerated dose to reach patient specific goals based on risk. While the AACE recommends high-intensity statin therapy for those with high ASCVD risk and moderate-intensity statin therapy for those with intermediate ASCVD risk.
- Ezetimibe
- The AACE algorithm further guides clinical decision making recommending adding ezetimibe to maximally tolerated statin therapy as the next step in treatment.
- The ESC/EAS guideline suggests that non-statin therapies, including ezetimibe and bempedoic acid be recommended alone or in combination to patients unable to take statins to lower their LDL-C.
- Bempedoic acid
- The AACE algorithm recommends add-on therapy with bembedoic acid for patients on maximally tolerated statin therapy and ezetimibe who are still not at goal LDL-C.
- ESC/EAS recommends bempedoic acid for patients who cannot take statins or in addition to statin therapy with or without ezetimibe.
- Evinacumab
- ESC/EAS recommends evinacumab for patients five years of age or older who have homozygous familial hypercholesterolaemia not at goal LDL-C despite maximally tolerated lipid lowering therapy.
- AACE does not address treatment of homozygous familial hypercholesterolaemia or the use of evinacumab.
Comparison of Recommendations
| Pharmacotherapy | AACE | ESC/EAS |
|---|---|---|
| Statin Therapy | Consider moderate intensity statin therapy for patients with intermediate ASCVD risk. High intensity statin therapy recommended for patients with high ASCVD risk. | From the 2019 guideline: It is recommended that a high-intensity statin is prescribed up to the highest tolerated dose to reach the goals set for the specific level of risk. |
| Ezetimibe | Patients on moderate and high intensity maximally tolerated statin therapy with LDL-C above goal should add ezetimibe. | Non-statin therapies with proven cardiovascular benefit (ezetimibe, a proprotein convertase subtilisin/kexin type 9 monoclonal antibody, or bempedoic acid), taken alone or in combination, are recommended for patients who are unable to take statin therapy to lower LDL-C levels and reduce the risk of CV events. The choice should be based on the magnitude of additional LDL-C lowering needed. |
| Bempedoic Acid | Patients on maximally tolerated statin therapy and ezetimibe with LDL-C above goal consider add-on therapy: bempedoic acid, proprotein convertase subtilisin/kexin type 9 (PCSK9)-based therapy, or bile acid resins. | Bempedoic acid is recommended in patients who are unable to take statin therapy to achieve the LDL-C goal. The addition of bempedoic acid to the maximally tolerated dose of statin with or without ezetimibe should be considered in patients at high or very high risk in order to achieve the LDL-C goal. |
| Evinacumab | Not addressed. | Evinacumab should be considered in patients with homozygous familial hypercholesterolaemia aged 5 years or older who are not at LDL-C goal despite receiving maximum doses of lipid-lowering therapy to lower LDL-C levels. |
That concludes our side-by-side look at pharmacological treatment of dyslipidemia targeting LDL-C. Be sure to sign up for alerts to stay informed on the latest published clinical guidelines and guideline updates.
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