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REFLECTIONS
Dyslipidaemia
Dyslipidaemia Global Newsletter #8 2024

The guidelines also address special considerations for patients with specific comorbidities, such as diabetes, hypertension,
hyperlipidaemia, or heart failure. For example, in patients with established CCS and hyperlipidaemia, the guidelines recommend an
ultimate LDL-C goal of <1.4 mmol/L (55 mg/dL) and a ≥50% reduction in LDL-C vs. baseline.
Dyslipidaemia

Recommendations for lipid-lowering drugs in patients with CCS

Recommendations Class a Level b
Lipid-lowering treatment with an LDL-C goal of <1.4 mmol/L (55 mg/dL) and a ≥50% reduction in LDL-C I A
vs. baseline is recommended.

A high-intensity statin up to the highest tolerated dose to reach the LDL-C goals is recommended for all I A
patients with CCS.

If a patient’s goal is not achieved with the maximum tolerated dose of statin, combination with ezetimibe
is recommended. I B

For patients who are statin-intolerant and do not achieve their goal on ezetimibe, combination with
bempedoic acid is recommended. I B

For patients who do not achieve their goal on a maximum tolerated dose of statin and ezetimibe, I A
combination with a PCSK9 inhibitor is recommended.
For patients who do not achieve their goal on a maximum tolerated dose of statin and ezetimibe, IIa C
combination with bempedoic acid should be considered.
For patients with a recurrent atherothrombotic event (not necessarily of the same type as the first event)
while taking maximally tolerated statin therapy, an LDL-C goal of <1.0 mmol/L (<40 mg/dL) may be IIb B
considered.
a Class of recommendation. Level of evidence.
b

The authors discuss that many patients require combination
therapy to adequately control symptoms and that there is no CLICK HERE
clear evidence for first- and second-line antianginal therapy. FOR THE LINK TO FULL ARTICLE
Therefore, different classes of antianginal drugs may be
preferable depending on the origin of the ischaemia, whether
obstructive, vasospastic, or microvascular. They introduce a
combination scheme that considers patients’ comorbidities
when selecting potential drug combinations, representing a
clearer evolution towards combination therapy compared to the
previous stepwise approach.

The guidelines conclude with recommendations for long-
term follow-up and care, including guidance on addressing
adherence issues. In particular, they recommend simplification
of medication regimens (e.g., using fixed-dose drug
combination) to increase patient adherence. CLICK HERE
TO VIEW A COMMENTARY FROM
The comprehensive 2024 ESC guidelines for CCS include many GLOBAL EXPERTS ON THE 2024 ESC
algorithmic or visually easy-to-understand figures to help guide CCS GUIDELINES.
physicians in the optimal diagnosis and management of CCS.

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