Bridging the Atlantic: converging paths, diverging approaches: a comparative review of the 2025 European Society of Cardiology/European Atherosclerosis Society focused update and the 2026 American College of Cardiology/American Heart Association guid

PURPOSE OF REVIEW: The global burden of atherosclerotic cardiovascular disease (ASCVD) drives lipid-lowering strategies, now undergoing their biggest transformation since statins. In 2025 and 2026, the two most influential guideline bodies, the European Society of Cardiology/European Atherosclerosis Society (ESC/EAS) and the American College of Cardiology/American Heart Association (ACC/AHA), both released updated guidance that reflects evolving clinical evidence. This review provides a detailed, head-to-head examination of their recommendations, highlighting areas of convergence, divergence, and the clinical implications for practitioners on both sides of the Atlantic. RECENT FINDINGS: The 2025 Focused Update of the 2019 ESC/EAS Guidelines for the Management of Dyslipidaemias builds incrementally on an established framework, incorporating new trial data within its existing risk-stratified, target-driven model. In contrast, the 2026 ACC/AHA Guideline on the Management of Dyslipidaemia represents a comprehensive rewrite, introducing a novel risk calculator, reinstating explicit LDL-C targets for all risk categories, and endorsing a more flexible, individualized selection of nonstatin therapies. SUMMARY: Both documents embrace the 'lower is better' and 'strike early and strong' paradigms, yet they differ profoundly in how they apply these principles. The review distinguishes the ESC/EAS's structured, stepwise approach from the ACC/AHA's flexible, individualized paradigm (Graphical abstract).