Comments on the new European Society of Cardiology guidelines (2011) for the management of dyslipidaemias

The present European Society of Cardiology and European Atherosclerosis Society (ESC/EAS) guidelines for the management of dyslipidaemias are more detailed compared to earlier recommendations by the ESC as well as by the German Cardiac Society (DGK). The core issues of the guidelines consist of stringent risk-oriented indications for therapy based on the global risk of the patient which has to be estimated using the ESC SCORE (Systemic Coronary Risk Estimation) system. Furthermore, a stronger reduction of the target parameter low-density lipoprotein- cholesterol (LDL-C) is now recommended for patients with very high risk as well as those with high and moderate risk. For patients with very high risk, which includes all patients with atherosclerotic manifestations, an LDL-C goal of < 70 mg/dl is recommended. This recommendation, however, represents a compromise from observational studies, several clinical intervention trials and an extrapolation based on these data. The new guidelines also clearly recommend a specific LDLC goal of 115 mg/dl in subjects with moderately elevated risk, the group which includes the vast majority of cardiovascular events in the general population. Finally, in its present stringent form risk-guided therapy of dyslipidaemias presents a first step in the direction of personalized medicine.