European Lipid and Prevention Guidelines

• Both are worthy and detailed but may be far too complex for general use.

• Why were the simple communication tools for young people of relative risk and risk age dropped from the prevention guidelines?

• SCORE2 and SCORE2-OP are to be applauded but are derived from different cohorts and there are some inconsistencies as presented, risk can sometimes fall with increasing age.

• Three different risk categories by age in the prevention guidelines may help to avoid over-treatment in older persons, but you can go to a lower risk category merely by aging.

• Are there now incompatibilities with other ESC guidelines such as lipids? YES

• The approach taken to lifetime risk in the prevention guidelines has been criticized. The concept of using benefits as “extra years of life free from CVD gained with treatment” has never been evaluated as a way to guide treatment decisions. It may be that an early review of the prevention guidelines will be appropriate.

• At present, the 2019 ESC/EAS lipid guidelines present an approach to lipid management that is simpler, and more evidence-based than the 2021 prevention guidelines.