Madrid, Spain – 29 August: New ESC/EAS Focused Update to Guidelines, about how best to manage lipid levels in patients to reduce cardiovascular risk [2], recommends the use of new cardiovascular risk predication algorithms. The update was published today at ESC Congress 2025.
The algorithms, called SCORE2 and SCORE2-OP and already recommended in the ESC Prevention Guidelines, will help clinicians treat patients with the right medications. They predict 10-year risk of fatal and non-fatal cardiovascular events – meaning they measure not only deaths from cardiovascular disease (mortality) but also the risk of living with poor health (morbidity). SCORE2-OP provides a risk prediction tool tailored to risk in people between 70 and 89 years old.
The Focused Update was produced by an international panel of experts that include co-Chairpersons, Prof François Mach, Professor of Cardiology at Geneva University Hospital, Switzerland, Prof Jeanine Roeters van Lennep, Professor Cardiovascular prevention at Erasmus MC University Medical Center, Rotterdam, Netherlands, and Dr Konstantinos Koskinas from Bern University Hospital, Bern, Switzerland.
“Combining our increased medical knowledge about treatments with the improved risk prediction model, we hope that more patients who will benefit from these treatments will get them earlier. This approach could save many lives across Europe and beyond,” Prof François Mach said.
The guidance also recommends the use of statins to prevent cardiovascular disease in patients with HIV aged 40 years and older, irrespective of their cardiovascular risk. This follows a large multicentre, randomised, double-blind trial called REPRIEVE which showed significant reduction in cardiovascular disease of patients who were randomized to a statin after five years.
People with HIV have a two-fold increase in atherosclerotic cardiovascular disease (ASCVD) compared to the general population. ASCVD is caused by arteries becoming narrowed, which reduces blood flow, and increases the risk of heart attack and stroke.
The new ESC/EAS* guidance also recommends considering statin therapy for patients with cancer at high chemotherapy-related cardiovascular toxicity risk.
Anthracycline-based chemotherapy is a common part of treatment for cancer patients, including those with breast cancer and lymphoma. Depending on the dose, its use is associated with the development of heart failure in up to 20% of patients within five years. The guidance cites data from four randomised trials that suggest statins would be beneficial for patients at a high or very high risk of developing cardiovascular complications as a result of their cancer treatment.
“Statins are safe, effective and cost-efficient drugs that prevent cardiovascular disease. They have been around since the 1990s, so it is incredible that we are still finding new uses for them. After reviewing the evidence, we are recommending them to additional patients with specific cardiovascular risks, such as those with HIV and patients who have received cancer treatments that could damage their heart,” Prof Jeanine Roeters van Lennep explained.
“We are lucky that we have so many safe and effective treatments to reduce patients’ risk of cardiovascular disease, such as statins. We can use these drugs in combination to get even better results for patients,” said Dr Konstantinos Koskinas.
The Focused Update also reviewed available evidence since 2019 on the use of supplements and vitamins to reduce LDL cholesterol. No evidence of a supplement or vitamin that is both safe and effective was found, so the Focused Update does not support the use of dietary supplements or vitamins to lower LDL cholesterol levels with the aim of reducing cardiovascular risk.
“We know that some patients worry about taking statins, often due to misinformation that they have read online. This causes some people to seek out alternative remedies such as supplements and vitamins,” Prof Jeanine Roeters van Lennep said.
“We searched the available evidence and did not find any supplements or vitamins that are both safe and effective with a significant beneficial effect on cardiovascular prognosis. In fact one of the supplements, red rice yeast, has been banned by the European Union at dosages that could potentially have an effect on LDL cholesterol after it was linked to deaths. We urge anyone concerned about their cholesterol levels to speak to a medical professional for advice rather than taking any chances with their health,” Prof Jeanine Roeters van Lennep concluded.
The Focused Update endorses previous guidance that a healthy dietary habit, such as consuming low levels of saturated fat, wholegrain products, vegetables, fruit and fish, can lower LDL cholesterol levels.
The Focused Update also gives guidance on:
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The use of new LDL cholesterol lowering drugs such as bempedoic acid, which may be helpful for patients who are not able to take statins.
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The use of lipid-lowering therapies to improve outcomes for patients with acute coronary syndromes.
ENDS
Note to editor
Funding: Not applicable
Disclosures: None
References and notes:
[1] European Society of Cardiology (ESC)/European Atherosclerosis Society (EAS)
[2] The Focused Update provides new and revised recommendations for the ‘2019 ESC/EAS
Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular (CV) risk’ following new data from several randomized controlled trials that might change patient management ahead of the next scheduled full dyslipidaemia guidelines review.
Low-density lipoprotein cholesterol, or LDL cholesterol, are particles made of fats (lipid) andproteins that carry fats through the bloodstream. They perform important biological functions, but excessively high levels put people at a higher risk of cardiovascular events, such as stroke or heart attacks. Many high-quality research trials have shown that reducing LDL cholesterol, using treatments such as statins, reduces heart attacks, strokes and blockages in blood vessels in the limbs.
The Guidelines “Focused update of the 2019 dyslipidaemias” will be discussed during the session “2025 ESC Guidelines and Document overview” Friday 29 August at 8:51 am CEST in room Madrid.
A dedicated ESC Guidelines Press Q&A session, featuring the task force chairs, will take place in the Press Area on Friday, 29 August, at 12:00 CEST.
2025 ESC Guidelines for the “Focused update of the 2019 dyslipidaemias” , European Heart Journal, 2025, https://doi.org/10.1093/eurheartj/ehaf190
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