The European Society of Cardiology (ESC) and the European Atherosclerosis Society (EAS) have released updated guidance on lipid management, introducing new tools and treatment recommendations aimed at reducing cardiovascular disease. The Focused Update was unveiled today at ESC Congress 2025.
At the core of the update are the SCORE2 and SCORE2-OP algorithms, which predict the 10-year risk of both fatal and non-fatal cardiovascular events. SCORE2 applies to adults up to 69 years, while SCORE2-OP is tailored to individuals aged 70 to 89. These models, already integrated into ESC prevention guidelines, are designed to help clinicians prescribe appropriate therapies earlier and more effectively.
“By combining advanced risk prediction with proven treatments, we can reach more patients in time to prevent serious outcomes,” said Prof. François Mach, cardiologist at Geneva University Hospital and co-chair of the update committee.
New Recommendations for High-Risk Groups
The guidance introduces specific recommendations for groups facing elevated cardiovascular risk:
People living with HIV: Statins are now recommended for all patients over 40, regardless of risk level. This follows results from the REPRIEVE trial, which showed statins reduced cardiovascular disease in HIV-positive individuals, who face roughly double the risk of atherosclerotic cardiovascular disease compared with the general population.
Cancer patients: Statin therapy should be considered for patients receiving anthracycline-based chemotherapy, commonly used in breast cancer and lymphoma. Evidence from four randomized trials suggests statins reduce the likelihood of chemotherapy-related heart failure, which can affect up to 20% of patients within five years.
“Statins are safe, cost-effective, and continue to show new benefits decades after their introduction,” noted Prof. Jeanine Roeters van Lennep of Erasmus MC, Rotterdam. “We now recommend them for additional patients with specific risk profiles, including those with HIV and cancer-related heart risks.”
Supplements and Lifestyle Measures
The update firmly advises against using supplements or vitamins to lower LDL cholesterol. A review of evidence since 2019 found no products both safe and effective in improving cardiovascular outcomes. In fact, red rice yeast supplements, once promoted for cholesterol lowering, were banned by the EU after being linked to fatalities.
“We urge patients to seek medical advice rather than relying on unproven alternatives,” Prof. Roeters van Lennep said.
However, the panel reaffirmed the role of healthy eating in prevention, recommending diets low in saturated fat and rich in whole grains, fruits, vegetables, and fish.
Expanding Treatment Options
Beyond statins, the update highlights newer therapies, including bempedoic acid, as alternatives for patients unable to tolerate statins. Lipid-lowering drugs also remain central to improving outcomes in patients with acute coronary syndromes.
“We are fortunate to have a broad set of tools to fight cardiovascular disease,” said Dr. Konstantinos Koskinas of Bern University Hospital. “When used together, these therapies can deliver even stronger protection for patients.”
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