A new ESC/EAS-focused guideline update on optimal control of patients' lipid levels to reduce cardiovascular risk [2] recommends the use of new algorithms for predicting cardiovascular risk. The update was published today at the ESC Congress 2025.
The algorithms named SCORE2 and SCORE2-OP, already recommended in the ESC prevention guidelines, will help doctors treat patients with the right medications. They predict the 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 offers a risk prediction tool tailored to the risk of people between 70 and 89 years of age.
The Focused Update was created by an international panel of experts, including co-chairs Prof. François Mach, Professor of Cardiology at the University Hospital Geneva, Switzerland, Prof. Jeanine Roeters van Lennep, Professor of Cardiovascular Prevention at Erasmus MC University Medical Center, Rotterdam, Netherlands, and Dr. Konstantinos Koskinas from the University Hospital Bern, Switzerland.
"By combining our expanded medical knowledge of treatments with the improved risk prediction model, we hope that more patients who benefit from these treatments will receive them earlier. This approach could save many lives in Europe and elsewhere," said Prof. François Mach.
The guidelines also recommend the use of statins to prevent cardiovascular disease in HIV patients aged 40 and over, regardless of their cardiovascular risk. This follows a large multicenter, randomized double-blind study called REPRIEVE, which showed a significant reduction in cardiovascular disease in patients randomized to receive a statin after five years. In
people with HIV, the risk of atherosclerotic cardiovascular disease (ASCVD) is twice as high compared to the general population. ASCVD is caused by a narrowing of the arteries, which reduces blood flow and increases the risk of heart attack and stroke.
The new ESC/EAS* guideline also recommends considering statin therapy in cancer patients at high risk of chemotherapy-induced cardiovascular toxicity.
Anthracycline-based chemotherapy is a common part of cancer treatment for patients, including those with breast cancer and lymphomas. Depending on the dose, its use has been linked to the development of heart failure in up to 20% of patients within five years. The guideline cites data from four randomized trials suggesting that statins could be beneficial for patients at high or very high risk of developing cardiovascular complications as a result of their cancer treatment.
“Statins are safe, effective, and inexpensive drugs for the prevention of cardiovascular disease. They have been around since the 1990s, so it’s amazing that we are still finding new uses for them. After reviewing the evidence, we are recommending them to more patients with specific cardiovascular risks, such as those with HIV and those who have received cardiotoxic cancer treatment,” said Prof. Jeanine Roeters van Lennep.
“We are fortunate to have so many safe and effective treatments available to lower the risk of cardiovascular disease, such as statins. We can use these drugs in combination to achieve even better outcomes for patients,” said Dr. Konstantinos Koskinas.
The Focused Update also reviewed the evidence available since 2019 on the use of dietary supplements and vitamins for lowering LDL cholesterol. No dietary supplement or vitamin was found to be both safe and effective. Therefore, the Focused Update does not recommend the use of dietary supplements or vitamins for lowering LDL cholesterol levels with the aim of reducing cardiovascular risk.
“We know that some patients have concerns about taking statins, often due to misinformation they have read online. Some people therefore seek alternative remedies such as dietary supplements and vitamins,” said Prof. Jeanine Roeters van Lennep.
