Review

. 2024 Feb 17:55:74-92.

doi: 10.1016/j.athplu.2024.01.004. eCollection 2024 Mar.

Executive summary of the Hellenic Atherosclerosis Society guidelines for the diagnosis and treatment of dyslipidemias - 2023

N Katsiki^{1

2}, Td Filippatos³, C Vlachopoulos⁴, D Panagiotakos⁵, H Milionis⁶, A Tselepis⁷, A Garoufi⁸, L Rallidis⁹, D Richter¹⁰, T Nomikos⁵, G Kolovou¹¹, K Kypreos^{2

12}, C Chrysohoou¹³, K Tziomalos¹⁴, I Skoumas¹⁵, I Koutagiar¹⁶, A Attilakos¹⁷, M Papagianni¹⁸, C Boutari¹⁹, V Kotsis²⁰, C Pitsavos²¹, M Elisaf²², K Tsioufis²³, E Liberopoulos²⁴

Affiliations

¹ Department of Nutritional Sciences and Dietetics, International Hellenic University, Thessaloniki, Greece.
² School of Medicine, European University Cyprus, Nicosia, Cyprus.
³ Department of Internal Medicine, School of Medicine, University of Crete, Crete, Greece.
⁴ Cardiology Department, First Cardiology Clinic, Athens Medical School, Hippokration Hospital, Athens, Greece.
⁵ Department of Nutrition and Dietetics, School of Health Sciences & Education, Harokopio University, Athens, Greece.
⁶ Department of Internal Medicine, School of Health Sciences, Faculty of Medicine, University of Ioannina, Ioannina, Greece.
⁷ Atherothrombosis Research Centre, University of Ioannina, Ioannina, Greece.
⁸ 2nd Department of Pediatrics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
⁹ 2nd Department of Cardiology, Medical School, National and Kapodistrian University of Athens, University General Hospital ATTIKON, Athens, Greece.
¹⁰ Head of Cardiac Department, Euroclinic Hospital, Athens, Greece.
¹¹ Metropolitan Hospital, Cardiometabolic Center, Lipoprotein Apheresis and Lipid Disorders Clinic, Athens, Greece.
¹² University of Patras, School of Health Science, Department of Medicine, Pharmacology Laboratory, Patras, 26500, Greece.
¹³ 1st Cardiology Clinic National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece.
¹⁴ First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece.
¹⁵ 1st Department of Cardiology, National & Kapodistrian University of Athens, Athens, Greece.
¹⁶ 1st Cardiology Department, Hygeia Hospital, Athens, Greece.
¹⁷ 3rd Department of Pediatrics, School of Medicine, National and Kapodistrian University of Athens, Attikon General Hospital, Athens, Greece.
¹⁸ Third Department of Pediatrics, Aristotle University of Thessaloniki, School of Medicine, "Hippokrateion" General Hospital of Thessaloniki, Thessaloniki, Greece.
¹⁹ Second Propedeutic Department of Internal Medicine, Hippocration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
²⁰ 3rd Department of Internal Medicine, Papageorgiou Hospital, Aristotle University Thessaloniki, Greece.
²¹ First Cardiology Clinic, School of Medicine, University of Athens, Greece.
²² Department of Internal Medicine, Faculty of Medicine, University Hospital of Ioannina, 45110, Ioannina, Greece.
²³ 1st Department of Cardiology, National and Kapodistrian University of Athens, Hippocration Hospital, Greece.
²⁴ 1st Department of Propedeutic Medicine, School of Medicine, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece.

PMID: 38425675
PMCID: PMC10901915
DOI: 10.1016/j.athplu.2024.01.004

Review

Executive summary of the Hellenic Atherosclerosis Society guidelines for the diagnosis and treatment of dyslipidemias - 2023

N Katsiki et al. Atheroscler Plus. 2024.

. 2024 Feb 17:55:74-92.

doi: 10.1016/j.athplu.2024.01.004. eCollection 2024 Mar.

Authors

Affiliations

¹ Department of Nutritional Sciences and Dietetics, International Hellenic University, Thessaloniki, Greece.
² School of Medicine, European University Cyprus, Nicosia, Cyprus.
³ Department of Internal Medicine, School of Medicine, University of Crete, Crete, Greece.
⁴ Cardiology Department, First Cardiology Clinic, Athens Medical School, Hippokration Hospital, Athens, Greece.
⁵ Department of Nutrition and Dietetics, School of Health Sciences & Education, Harokopio University, Athens, Greece.
⁶ Department of Internal Medicine, School of Health Sciences, Faculty of Medicine, University of Ioannina, Ioannina, Greece.
⁷ Atherothrombosis Research Centre, University of Ioannina, Ioannina, Greece.
⁸ 2nd Department of Pediatrics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
⁹ 2nd Department of Cardiology, Medical School, National and Kapodistrian University of Athens, University General Hospital ATTIKON, Athens, Greece.
¹⁰ Head of Cardiac Department, Euroclinic Hospital, Athens, Greece.
¹¹ Metropolitan Hospital, Cardiometabolic Center, Lipoprotein Apheresis and Lipid Disorders Clinic, Athens, Greece.
¹² University of Patras, School of Health Science, Department of Medicine, Pharmacology Laboratory, Patras, 26500, Greece.
¹³ 1st Cardiology Clinic National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece.
¹⁴ First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece.
¹⁵ 1st Department of Cardiology, National & Kapodistrian University of Athens, Athens, Greece.
¹⁶ 1st Cardiology Department, Hygeia Hospital, Athens, Greece.
¹⁷ 3rd Department of Pediatrics, School of Medicine, National and Kapodistrian University of Athens, Attikon General Hospital, Athens, Greece.
¹⁸ Third Department of Pediatrics, Aristotle University of Thessaloniki, School of Medicine, "Hippokrateion" General Hospital of Thessaloniki, Thessaloniki, Greece.
¹⁹ Second Propedeutic Department of Internal Medicine, Hippocration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
²⁰ 3rd Department of Internal Medicine, Papageorgiou Hospital, Aristotle University Thessaloniki, Greece.
²¹ First Cardiology Clinic, School of Medicine, University of Athens, Greece.
²² Department of Internal Medicine, Faculty of Medicine, University Hospital of Ioannina, 45110, Ioannina, Greece.
²³ 1st Department of Cardiology, National and Kapodistrian University of Athens, Hippocration Hospital, Greece.
²⁴ 1st Department of Propedeutic Medicine, School of Medicine, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece.

PMID: 38425675
PMCID: PMC10901915
DOI: 10.1016/j.athplu.2024.01.004

Abstract

Atherosclerotic cardiovascular disease (ASCVD) remains the main cause of death worldwide, and thus its prevention, early diagnosis and treatment is of paramount importance. Dyslipidemia represents a major ASCVD risk factor that should be adequately managed at different clinical settings. 2023 guidelines of the Hellenic Atherosclerosis Society focus on the assessment of ASCVD risk, laboratory evaluation of dyslipidemias, new and emerging lipid-lowering drugs, as well as diagnosis and treatment of lipid disorders in women, the elderly and in patients with familial hypercholesterolemia, acute coronary syndromes, heart failure, stroke, chronic kidney disease, diabetes, autoimmune diseases, and non-alcoholic fatty liver disease. Statin intolerance is also discussed.

Keywords: Atherosclerotic cardiovascular disease; Bempedoic acid; Ezetimibe; Familial hypercholesterolemia; Heart failure; PCSK9 inhibitor; Statins; Type 2 diabetes.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

**Fig. 1**
HellenicSCORE II – 10-year risk of fatal ASCVD in Greece. (Reproduced with permission from Panagiotakos et al. [5]). ASCVD: atherosclerotic cardiovascular disease.

**Fig. 2a**
Management of dyslipidemia in statin-naïve patients with acute coronary syndromes (ACS). STEMI: ST-elevation myocardial infarction; NSTEMI: non-ST-elevation myocardial infarction; UA: unstable angina; LDL-C: low-density lipoprotein cholesterol; PCSK9: proprotein convertase subtilisin/kexin type 9.

**Fig. 2b**
Management of dyslipidemia in statin-treated patients with acute coronary syndromes (ACS). STEMI: ST-elevation myocardial infarction; NSTEMI: non-ST-elevation myocardial infarction; UA: unstable angina; LDL-C: low-density lipoprotein cholesterol.

**Fig. 2c**
Management of dyslipidemia in statin-plus-ezetimibe-treated patients with acute coronary syndrome (ACS). STEMI: ST-elevation myocardial infarction; NSTEMI: non-ST-elevation myocardial infarction; UA: unstable angina; LDL-C: low-density lipoprotein cholesterol; PCSK9: proprotein convertase subtilisin/kexin type 9.

**Fig. 3**
Algorithm for the management of patients with statin-associated muscle symptoms. CK: creatine kinase; ULN: upper limit of normal; TSH: thyroid-stimulating hormone; LDL-C: low-density lipoprotein cholesterol; CVD: cardiovascular disease; PCSK9: proprotein convertase subtilisin/kexin type 9.

**Fig. 4**
ASCVD risk groups and LDL-C targets. ASCVD: atherosclerotic cardiovascular disease; LDL-C: low-density lipoprotein cholesterol; CKD: chronic kidney disease; FH: familial hypercholesterolemia.

**Fig. 5**
Proposed treatment algorithm for the management of patients with dyslipidemia - 2023. ASCVD: atherosclerotic cardiovascular disease; LDL-C: low-density lipoprotein cholesterol; CKD: chronic kidney disease; FH: familial hypercholesterolemia.

**Fig. 6**
Eligible patients for PCSK9 inhibitor initiation. PCSK9: proprotein convertase subtilisin/kexin type 9; ASCVD: atherosclerotic cardiovascular disease; LDL-C: low-density lipoprotein cholesterol; CKD: chronic kidney disease; FH: familial hypercholesterolemia.

**Fig. 7**
Laboratory follow-up in patients on hypolipidemic drug treatment.

**Fig. 8**
Proposed reporting of lipid test results in adults.

See this image and copyright information in PMC

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Executive summary of the Hellenic Atherosclerosis Society guidelines for the diagnosis and treatment of dyslipidemias - 2023

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Executive summary of the Hellenic Atherosclerosis Society guidelines for the diagnosis and treatment of dyslipidemias - 2023

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