Purpose: To compare the 2025 ESC/EAS Focused Update and the 2026 ACC/AHA Dyslipidemia Guideline, with emphasis on convergences, divergences, and their practical implications for lipid management. Methods: Narrative comparative review of the two original guideline documents, organized around risk estimation, treatment goals, biomarkers, coronary artery calcium, non-statin therapy, secondary prevention, and clinical implementation. Results: The two documents share a common direction of travel: earlier recognition of risk, broader use of non-statin therapies, and more sustained lowering of atherogenic burden. The ESC/EAS update preserves a target-based framework and emphasizes faster intensification, especially after acute coronary syndromes (ACS). The ACC/AHA guideline broadens the field from cholesterol management to dyslipidemia, gives greater operational weight to apoB, non-HDL-C, and coronary artery calcium (CAC), and embeds treatment decisions within a more differentiated phenotypic framework. Conclusion: The documents often support similar therapeutic decisions, but they differ in how risk is refined, how residual atherogenic burden is interpreted, and how treatment is intensified. The ESC/EAS text places greater emphasis on earlier treatment intensification within an established framework, whereas the ACC/AHA guideline provides a broader and more differentiated management framework.
Comparing the 2025 ESC/EAS Focused Update and the 2026 ACC/AHA Dyslipidemia Guideline: Convergences, Divergences, and Practical Implications
Bonanni L.;Ferri N.
2026
Abstract
Purpose: To compare the 2025 ESC/EAS Focused Update and the 2026 ACC/AHA Dyslipidemia Guideline, with emphasis on convergences, divergences, and their practical implications for lipid management. Methods: Narrative comparative review of the two original guideline documents, organized around risk estimation, treatment goals, biomarkers, coronary artery calcium, non-statin therapy, secondary prevention, and clinical implementation. Results: The two documents share a common direction of travel: earlier recognition of risk, broader use of non-statin therapies, and more sustained lowering of atherogenic burden. The ESC/EAS update preserves a target-based framework and emphasizes faster intensification, especially after acute coronary syndromes (ACS). The ACC/AHA guideline broadens the field from cholesterol management to dyslipidemia, gives greater operational weight to apoB, non-HDL-C, and coronary artery calcium (CAC), and embeds treatment decisions within a more differentiated phenotypic framework. Conclusion: The documents often support similar therapeutic decisions, but they differ in how risk is refined, how residual atherogenic burden is interpreted, and how treatment is intensified. The ESC/EAS text places greater emphasis on earlier treatment intensification within an established framework, whereas the ACC/AHA guideline provides a broader and more differentiated management framework.
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