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A new update on the management of dyslipidemias has recently been released by the American College of Cardiology and the American Heart Association (ACC/AHA), providing a comprehensive revision of the previous 2018 cholesterol guideline (1).This document should be interpreted alongside the2025 focused update of the European Society of Cardiology and European Atherosclerosis Society (ESC/EAS) guidelines, which introduced relevant innovations in lipid-lowering strategies and cardiovascular risk assessment (2).In the last few years, the field of lipid management has undergone major developments, particularly with the introduction of new pharmacological agents and a growing emphasis on individualized cardiovascular risk.In this context, previous work has highlighted the importance of integrating emerging therapeutic strategies with patient-specific risk profiles, reinforcing the need for a more tailored and dynamic approach to dyslipidemia management (3).As a consequence, both European and American societies have updated their recommendations, although with partially different conceptual approaches.One of the main differences between the two guidelines lies in the general treatment philosophy.The European document maintains a target-driven strategy, emphasizing specific low-density lipoprotein cholesterol (LDL-C) goals according to cardiovascular risk categories.In contrast, the American guideline, while reintroducing LDL-C thresholds, still places significant emphasis on risk estimation and percentage reduction of LDL-C, reflecting a hybrid approach between target-based and intensity-based strategies.This divergence is particularly evident in cardiovascular risk assessment.The ESC/EAS guideline continues to rely on the SCORE2 and SCORE2-OP systems for risk stratification, maintaining a population-based European model.Conversely, the ACC/AHA guideline introduces the PREVENT ASCVD equations, replacing previous models and expanding risk prediction to both 10-and 30-year horizons.
Vito et al. (Sun,) studied this question.