In terms of treatment decision-making for dyslipidemia, the new 2021 European recommendations for the prevention of atherosclerotic cardiovascular diseases provide some nuances compared to the previous 2019 recommendations. These nuances notably concern the use of a new primary prevention risk assessment based on more recent epidemiological data and some changes in risk classification: the SCORE2. Changes include the use of non-HDL cholesterol rather than total cholesterol to estimate the risk, as well as a risk expressed as morbi-mortality rather than mortality alone as previously. Changes in risk thresholds to categorize patients as being at “very high”, “high”, or “low-to-moderate” risk also better identify younger patients who may benefit from cardiovascular prevention early enough to avoid cardiovascular problems that may occur in their 50s or 60s. Conversely, in elderly patients, the cardiovascular risk classification has been revised upwards so as not to treat these more drug-sensitive patients aggressively. The recommendations are also timely to better define the use of new molecules that have been introduced in Belgium during the year 2022.
What is already known about this topic?
Cardiovascular diseases are still the leading cause of death in our populations and their prevention is of concern to everyone. However, the individual medical approach consists in identifying the patients most at risk who will require our full attention and, eventually, the prescription of treatments, such as lipid-lowering drugs.
What does this article bring up for us?
- Several important new nuances have been introduced in the updated 2021 European recommendations to facilitate cardiovascular prevention and better integrate it into our daily practice.
- After screening for conditions that categorize patients as (very) high risk (history of cardiovascular diseases, diabetes, renal insufficiency, familial hypercholesterolemia), the use of the new SCORE2 (or SCORE2OP for patients aged 70 years and older) provides a more accurate estimation of the cardiovascular risk of these patients in primary prevention than the older SCORE or SCORE-Belgium table.
- The new recommendations also bring more common sense to the application of drug therapy, especially in elderly patients, and emphasize the importance of earlier detection and prevention in younger patients at risk of developing cardiovascular problems in their 60s.
- The new lipid-lowering treatments marketed in Belgium also find a place in these updated recommendations.
Key Words
Cholesterol, cardiovascular prevention, cardiovascular disease, guidelines, statins