Atherosclerotic cardiovascular disease (ASCVD) and consequent acute coronary syndromes (ACS) are substantial contributors to morbidity and mortality across Europe. Fortunately, as much as two thirds of this disease's burden is modifiable, in particular by lipid-lowering therapy (LLT). Current guidelines are based on the sound premise that, with respect to low-density lipoprotein cholesterol (LDL-C), "lower is better for longer", and recent data have strongly emphasised the need for also "the earlier the better". In addition to statins, which have been available for several decades, ezetimibe, bempedoic acid (also as fixed dose combinations), and modulators of proprotein convertase subtilisin/kexin type 9 (PCSK9 inhibitors and inclisiran) are additionally very effective approaches to LLT, especially for those at very high and extremely high cardiovascular risk. In real life, however, clinical practice goals are still not met in a substantial proportion of patients (even in 70%). However, with the options we have available, we should render lipid disorders a rare disease. In April 2021, the International Lipid Expert Panel (ILEP) published its first position paper on the optimal use of LLT in post-ACS patients, which complemented the existing guidelines on the management of lipids in patients following ACS, which defined a group of "extremely high-risk" individuals and outlined scenarios where upfront combination therapy should be considered to improve access and adherence to LLT and, consequently, the therapy's effectiveness. These updated recommendations build on the previous work, considering developments in the evidential underpinning of combination LLT, ongoing education on the role of lipid disorder therapy, and changes in the availability of lipid-lowering drugs. Our aim is to provide a guide to address this unmet clinical need, to provide clear practical advice, whilst acknowledging the need for patient-centred care, and accounting for often large differences in the availability of LLTs between countries.

1st Department of Cardiology National and Kapodistrian University of Athens Athens Greece

2nd Department of Cardiology Faculty of Medicine Pavol Jozef Safarik University and East Slovak Institute of Cardiovascular Diseases Kosice Slovakia

3rd Department of Cardiology School of Medical Sciences in Zabrze Medical University of Silesia Katowice Poland

3rd Department of Medicine Department of Endocrinology and Metabolism of the 1st Faculty of Medicine Charles University and General University Hospital Prague Czech Republic

Centre of Cardiology North Estonia Medical Centre Tallinn University of Technology Tallinn Estonia

Clinic for Heart Blood Vessels and Rheumatic Diseases Medical Faculty Sarajevo University Clinical Center Sarajevo Sarajevo Bosnia and Herzegovina

Clinic of Cardiology University Clinical Centre of Kosova Medical Faculty University of Prishtina Prishtina Kosovo

Clinic of Cardiovascular Diseases University Hospital Center Zagreb School of Medicine University of Zagreb Zagreb Croatia

Department of Cardiology 2nd Faculty of Medicine Charles University and Motol University Hospital Prague Czech Republic

Department of Cardiology and Adult Congenital Heart Diseases Polish Mother's Memorial Hospital Research Institute Lodz Poland

Department of Cardiology and Cardiovascular Surgery University and Emergency Hospital Bucharest Romania

Department of Cardiology Center for Translational and Experimental Cardiology University Hospital Zurich Zurich Switzerland

Department of Cardiology South Buda Center Hospital St Imre University Teaching Hospital and Vascular and Heart Center of Semmelweis University Budapest Hungary

Department of Cardiology University Hospital Centre Sestre Milosrdnice Zagreb Croatia

Department of Cardiology University Hospital Institute of Medical Sciences University of Opole Opole Poland

Department of Cardiology University Medical Centre Ljubljana Ljubljana Slovenia

Department of Cardiology University of Medicine and Pharmacy Victor Babes Institute of Cardiovascular Diseases Research Center IBCVTIM Timisoara Romania

Department of Diabetes Nutrition and Metabolic Diseases Carol Davila University of Medicine and Pharmacy Bucharest Romania

Department of Family Medicine and Public Health University of Opole Opole Poland

Department of General Cardiology Middle Slovak Institute of Cardiovascular Diseases Banska Bystrica Slovakia

Department of General Medicine Emergency University Hospital St Anna Medical University of Sofia Sofia Bulgaria

Department of Gerontology and Geriatric PJ Safarik University Kosice Slovakia

Department of Internal Medicine and Clinical Pharmacology Medical University of Silesia Katowice Poland

Department of Internal Medicine and Geriatric Cardiology Medical Centre for Postgraduate Education Warsaw Poland

Department of Internal Medicine School of Medicine University of Banja Luka Banja Luka Republic of Srpska

Department of Internal Medicine School of Medicine University of Zagreb Zagreb Croatia

Department of Medicine Academy of Science and Arts Republic of Srpska Bosnia and Herzegovina Banja Luka Republic of Srpska

Department of Nutritional Sciences and Dietetics International Hellenic University Thessaloniki Greece

Department of Preventive Cardiology and Lipidology Medical University of Lodz Rzgowska 281 289 93 338 Lodz Poland

Division of Cardiology Department of Medicine Ciccarone Center for the Prevention of Cardiovascular Disease Johns Hopkins University School of Medicine Baltimore MD USA

Division of Medicine Department of Vascular Medicine Centre for Preventive Cardiology University Medical Centre Ljubljana Ljubljana Slovenia

Division of Metabolic Disease Department of Internal Medicine Faculty of Medicine University of Debrecen Debrecen Hungary

Division of Metabolic Diseases Department of Internal Medicine University Hospital Centre Zagreb Zagreb Croatia

Dyslipidaemia Department Institute of Cardiology AMS of Ukraine Kiev Ukraine

Faculty of Medicine and University Hospital Center for Endocrinology Diabetes and Preventive Medicine University of Cologne Cologne Germany

Faculty of Medicine Vilnius University Vilnius Lithuania

Institute of Cardiology and Regenerative Medicine University of Latvia and Pauls Stradins Clinical University Hospital Riga Latvia

Integrated Heart Center Shaare Zedek Medical Center Jerusalem Israel

Invasive Department Centre of Postgraduate Medical Education Warsaw Poland

Jagiellonian University Medical College Krakow Poland

Liverpool Centre for Cardiovascular Science Liverpool UK

Medical and Surgical Sciences Department Alma Mater Studiorum University of Bologna Bologna Italy

Medical Faculty University of Ljubljana Ljubljana Slovenia

MEDIPARK University Research Park PJ Safarik University Kosice Slovakia

School of Medicine European University Cyprus Nicosia Cyprus

School of Pharmacy and Biomolecular Sciences Liverpool John Moores University Liverpool UK

The 3rd Department of Internal Medicine Metabolic Care and Gerontology Charles University and University Hospital in Hradec Králové Hradec Králové Czech Republic

University of Medicine and Pharmacy Carol Davila University and Emergency Hospital Bucharest Romania

Vilnius University Hospital Santaros Klinikos Vilnius Lithuania

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Lp(a)-Lowering Agents in Development: A New Era in Tackling the Burden of Cardiovascular Risk?