BACKGROUND AND AIMS: This European Atherosclerosis Society (EAS) Task Force provides practical guidance for combination therapy for elevated low-density lipoprotein cholesterol (LDL-C) and/or triglycerides (TG) in high-risk and very-high-risk patients. METHODS: Evidence-based review. RESULTS: Statin-ezetimibe combination treatment is the first choice for managing elevated LDL-C and should be given upfront in very-high-risk patients with high LDL-C unlikely to reach goal with a statin, and in primary prevention familial hypercholesterolaemia patients. A proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitor may be added if LDL-C levels remain high. In high and very-high-risk patients with mild to moderately elevated TG levels (>2.3 and < 5.6 mmol/L [>200 and < 500 mg/dL) on a statin, treatment with either a fibrate or high-dose omega-3 fatty acids (icosapent ethyl) may be considered, weighing the benefit versus risks. Combination with fenofibrate may be considered for both macro- and microvascular benefits in patients with type 2 diabetes mellitus. CONCLUSIONS: This guidance aims to improve real-world use of guideline-recommended combination lipid modifying treatment.

3rd Department of Internal Medicine General University Hospital and 1st Faculty of Medicine Charles University U Nemocnice 1 128 08 Prague 2 Czech Republic

Department of Cardiology Hacettepe University Faculty of Medicine Turkey

Department of Cardiology University Hospital Ramón y Cajal Carretera de Colmenar Madrid Spain

Department of Health Promotion Sciences Maternal and Infantile Care Internal Medicine and Medical Specialities University of Palermo Palermo Italy

Department of Internal Diseases University Hospital Center Zagreb School of Medicine Zagreb University Zagreb Croatia

Department of Medicine DIMED University of Padua Padova and IRCCS MultiMedica Milan Italy

Department of Pharmacological and Biomolecular Sciences Universita' degli Studi di Milano Milan and IRCCS MultiMedica Milan Italy

European Atherosclerosis Society Mässans Gata 10 SE 412 51 Gothenburg Sweden

Lipid Clinic Endocrinology and Nutrition Service Hospital Clínic Institut d'Investigacions Biomèdiques August Pi i Sunyer Instituto de Salud Carlos 3 Madrid 28029 Spain

Luz Saúde Portugal; Sociedade Portuguesa de Aterosclerose Lisbon Portugal

PEC2 EA 7460 University of Bourgogne Franche Comté and Department of Cardiology CHU Dijon Bourgogne Dijon France

Pitié Salpêtrière Hospital and Sorbonne University Cardio Metabolic Institute Paris France

Polish Mother's Memorial Hospital Research Institute in Lodz Lodz Poland

SYNLAB Academy SYNLAB Holding Deutschland GmbH and Medical Clinic 5 Medical Faculty of Mannheim University of Heidelberg Germany; Clinical Institute of Medical and Chemical Laboratory Diagnostics Medical University of Graz Austria

Universitatea de Medicina si Farmacie Victor Babes Institutul de Boli Cardiovasculare Clinica de Recuperare Cardiovasculara Timisoara Romania

Vascular Medicine and Metabolism Unit Research Unit on Lipids and Atherosclerosis Sant Joan University Hospital Universitat Rovira i Virgili IISPV CIBERDEM 43201 Reus Spain

Vorarlberg Institute for Vascular Investigation and Treatment Feldkirch Austria; Private University of the Principality of Liechtenstein Triesen Liechtenstein; Drexel University College of Medicine Philadelphia PA USA

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