Comparing Primary Prevention Recommendations

A Focused Look at United States and European Guidelines on Dyslipidemia

Neil J. Stone, MD; Roger S. Blumenthal, MD; Donald Lloyd-Jones, MD, ScM; Scott M. Grundy, MD, PhD


Circulation. 2020;141(14):1117-1120. 

In This Article


There are important similarities between AHA/ACC and ESC/EAS guidelines in primary prevention. Both identify individuals with either severely elevated LDL-C at any age, or diabetes mellitus at 40 to 75 years of age, that merit LDL-C lowering therapy. Both recommend statins as first-line therapy. Both recommend follow-up LDL-C levels for adequacy of effect and as a measure of adherence. However, there are important differences. Although both endorse attainment of specific LDL-C lowering (expressed as a percentage of baseline LDL-C) with statin intensity proportional to individual risk, the ESC/EAS includes specific LDL-C goals or targets at all levels of risk. However, targets can lead to intensified treatment of uncertain net benefit in those who fall just short of arbitrary LDL-C goals and who might benefit instead from a treatment discussion. For example, the net benefit of intensifying LDL-C lowering therapy in a low-risk patient, at 42 years of age with recent diabetes mellitus on a moderate intensity statin and LDL-C just above 100 mg/dl (2.6 mmol/L), to get below goal is not clear. AHA/ACC endorse statins for LDL-C lowering in those primary prevention patients shown to have net benefit with LDL-C lowering therapy proven safe and effective by randomized controlled trials. It puts emphasis on the clinician-patient risk discussion and the option of coronary artery calcium scoring that may focus statin therapy more specifically on those who benefit the most.