Purpose of review The global burden of atherosclerotic cardiovascular disease (ASCVD) drives lipid-lowering strategies, now undergoing their biggest transformation since statins. In 2025 and 2026, the two most influential guideline bodies, the European Society of Cardiology/European Atherosclerosis Society (ESC/EAS) and the American College of Cardiology/American Heart Association (ACC/AHA), both released updated guidance that reflects evolving clinical evidence. This review provides a detailed, head-to-head examination of their recommendations, highlighting areas of convergence, divergence, and the clinical implications for practitioners on both sides of the Atlantic. Recent findings The 2025 Focused Update of the 2019 ESC/EAS Guidelines for the Management of Dyslipidaemias builds incrementally on an established framework, incorporating new trial data within its existing risk-stratified, target-driven model. In contrast, the 2026 ACC/AHA Guideline on the Management of Dyslipidaemia represents a comprehensive rewrite, introducing a novel risk calculator, reinstating explicit LDL-C targets for all risk categories, and endorsing a more flexible, individualized selection of nonstatin therapies. Summary Both documents embrace the ‘lower is better’ and ‘strike early and strong’ paradigms, yet they differ profoundly in how they apply these principles. The review distinguishes the ESC/EAS's structured, stepwise approach from the ACC/AHA's flexible, individualized paradigm (Graphical abstract).
No takes yet. Share an insight, caveat, or question.
Miteva et al. (2026) studied this question.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: