The 2019 recommendations for the management of dyslipidaemia by the ESC/EAS modified slightly criteria for CV risk level and lowered significantly the intervention thresholds (lifestyle and/or drugs intervention).

To evaluate, at a population level, the impact of the 2019 lowering intervention thresholds on prevalence and treatment of LDL hypercholesterolemia in France.

Data from Esteban, a cross sectional study conducted on a representative sample of the French population between 2014 and 2016 were used. Data were collected with questionnaires and a clinical exam. An individual evaluation of cardiovascular risk using calculated SCORE for 10 year risk of fatal CVD and criteria defined in the 2019 ESC/EAS recommendations. People were considered having LDL hypercholesterolemia if their LDL level were higher than the threshold specified in the 2019 recommendations: 0.55mg/dl for very high risk and secondary prevention; 0.7 for high risk; 1.0 for moderate risk and 1.16 for low risk.

An estimate of the prevalence of hypercholesterolemia, based on those new 2019 recommendations with expanded definition of hypercholesterolemia due to lowered thresholds, yields a prevalence rate of 72.1% in France. Results by risk group shown that the prevalence was 57.3% in the low risk group, 89.7% in the moderate risk group and was ≥90% in the high, very high and secondary prevention group. Expanded definition of disease by lowering thresholds in 2019 recommendations led to 3/4 of the French population needing a lifestyle and/or drugs interventions. These elements raise the question of a hierarchical organisation of prevention strategies, particularly in low-risk groups or in younger populations.

These results highlight the impact, in terms of quantifying the burden of the 2019 ESC/EAS recommendations, but also the impact on care, with 3 of 4 patients needed to be treated using health-diet and/or medication measures.