Chiara Lagorio: the Strategic Role of Lifestyle in the Management of Dyslipidemia

Chiara Lagorio, Research Dietitian at Candiolo Cancer Institute IRCCS, posted on LinkedIn:

“2025 European Society of Cardiology /European Atherosclerosis Society guidelines: the strategic role of lifestyle in the management of dyslipidemia.

The 2025 Focused Update of these LG ESC/EAS strongly confirms that prevenzione cardiovascolare can no longer be seen as a “lifestyle or drug therapy”, but as a real integrazione between risk assessment, nutritional intervention and pharmacological treatment when appropriate.

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1. Risk assessment: the starting point

• New SCORE2 and SCORE2-OP algorithms: estimate the risk of fatal and non-fatal CV events up to 89 years.
• Introduction of risk modifiers (coronary calcium, vascular imaging) in borderline cases.
• The focus shifts from the single lipid value to the global cardiovascular risk profile: essential for deciding how much to focus on lifestyle and when to combine drug therapy.

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2. Lifestyle: not an alternative, but the basis of treatment

• Diet, physical activity, weight control and fumo are at the forefront of all patients, at any risk level.
• Recommended model: DietaMediterranea → high in fiber and unsaturated fats, low in saturated fats and free sugars.
• Supplements not recommended in the absence of clinical evidence on cardiovascular events.
• As dietisti, our role is to ensure adherence, personalization and continuity over time.

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3. Drug therapy: when lifestyle is not enough

• In high- and very high-risk patients, an early and strong strike approach is indicated.
• LDL -cholesterol confirmed as a causal factor of atherosclerosis: if the target is not reached, it is supplemented with statins ± ezetimibe ± PCSK9 or bempedoic acid inhibitors.
• Our contribution is critical to optimizing efficacy, reducing adverse metabolic effects, and improving aderenza.

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4. Practical implications for us nutrition professionals

• Evaluate the patient in terms of overall cardiovascular risk, not just cholesterol values.
• Propose lifestyle as a terapia and not as simple advice.
• Collaborate with the doctor when drug therapy is indicated, with a view to therapeutic sinergia.
• Educare the patient to see prevention as a percorsointegrato, personalized and continuous.

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In summary: effective cardiovascular prevenzione arises from the integration of lifestyle and risk-driven drug treatment. As nutrition professionals, we are an active part of the team in dislipidemie management and aterosclerosi prevention.

Source: Mach F, et al. 2025 Focused Update of the 2019 ESC/EAS Guidelines for the Management of Dyslipidaemias. European Heart Journal. 2025; doi:10.1093/eurheartj/ehaf190.”

Title: 2025 Focused Update of the 2019 ESC/EAS Guidelines for the management of dyslipidaemias: Developed by the task force for the management of dyslipidaemias of the European Society of Cardiology (ESC) and the European Atherosclerosis Society (EAS)

Authors: François Mach, Konstantinos C Koskinas, Jeanine E Roeters van Lennep, Lale Tokgözoğlu, Lina Badimon, Colin Baigent, Marianne Benn, Christoph J Binder, Alberico L Catapano, Guy G De Backer, Victoria Delgado, Natalia Fabin, Brian A Ference, Ian M Graham, Ulf Landmesser, Ulrich Laufs, Borislava Mihaylova, Børge Grønne Nordestgaard, Dimitrios J Richter, Marc S Sabatine, ESC/EAS Scientific Document Group

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