Late last month, the European Society of Cardiology (ESC) released a new guidelines and a consensus statement on a broad range of cardiovascular-related topics. The guidelines focus on the management of dyslipidaemias, the management of valvular heart disease, the management of myocarditis and pericarditis, ad the management of cardiovascular disease during pregnancy. The consensus statement focuses on the correlation between cardiovascular disease and mental health.
Below, we feature a rundown of each guideline and the consensus statement, including a brief summary of the updates included.
Management of Dyslipidaemias, August 29, 2025
This focused update builds upon the 2019 guideline recommendations, providing new and revised recommendations. The update is based on evidence published through March 31, 2025.
The 2025 focused update sees changes to the following sections:
- Estimation of Total Cardiovascular Risk and Implications for Dyslipidaemia Management
- New Low-Density Lipoprotein Cholesterol-lowering Therapies
- Combination of Lipid-lowering Therapies During Index Hospitalization for Acute Coronary Syndromes
- Lipoprotein(a)
- Hypertriglyceridaemia
- Primary Prevention in People with Human Immunodeficiency Virus Infection
- Patients with Cancer at High or Very High Chemotherapy-related Cardiovascular Toxicity Risk
- Dietary Supplements
Management of Valvular Heart Disease, August 29, 2025
This guideline replaces the 2021 guideline on the management of valvular heart disease. The 2025 update sees recommendation revisions and additions to the following sections:
- The importance of shared and patient-centred decision-making by multidisciplinary expert Heart Teams working within a regional network has been reinforced. Patients with complex conditions or requiring complex procedures should be referred to high-volume centres, where corresponding expertise is concentrated to ensure high-quality treatment.
- Advanced imaging modalities—such as three-dimensional (3D) echocardiography, cardiac computed tomography (CCT), and cardiac magnetic resonance (CMR) imaging—have gained importance and become a central aspect in the screening and evaluation of patients with valvular heart disease (VHD).
- Emphasis is put on the importance of correctly assessing the cause(s) and mechanism(s) of all valve diseases. In particular, the distinction between atrial and ventricular secondary mitral regurgitation (SMR) has clear implications in terms of prognosis and management.
- New evidence has been published regarding the benefits of intervention for the treatment of severe aortic stenosis (AS) irrespective of symptoms, left ventricular ejection fraction (LVEF), and flow reserve.
- The criteria used for decision-making concerning the optimal modality of AS treatment [transcatheter aortic valve (AV) implantation (TAVI) or surgical AV replacement (SAVR)] based on a Heart Team approach have been refined, including the combination of key aspects such as age, procedural risk, and anatomical suitability, incorporating estimated life expectancy and lifetime management considerations.
- Further randomized evidence confirming the mid-term safety and efficacy of TAVI in low-risk patients has been published.
- The indications for TAVI in patients with bicuspid AV (BAV) stenosis or severe aortic regurgitation (AR) at high surgical risk, based on anatomical suitability and a comprehensive Heart Team evaluation, are discussed.
- Several advancements have been made regarding the treatment of patients with primary mitral regurgitation (PMR): refinement of the criteria for intervention in asymptomatic patients; demonstration of the value of minimally invasive mitral valve (MV) surgery to reduce the length of hospital stay and accelerate recovery; and large-scale data confirming the role of transcatheter edge-to-edge repair (TEER) in high-risk patients.
- Longer-term follow-up data and two new randomized controlled trials (RCTs) concerning the management of patients with ventricular SMR have been published.
- The evidence for the treatment of tricuspid valve (TV) disease is growing—including new randomized data supporting concomitant TV repair during left-sided valve surgery, and transcatheter options (repair and replacement) that reduce tricuspid regurgitation (TR), promote reverse right ventricular (RV) remodelling, and improve quality of life compared with medical treatment.
- Efforts have been made to provide improved guidance regarding the diagnostic steps and management of patients with multiple and mixed VHD.
- Definitions of structural valve deterioration (SVD) have been updated and unified.
- The recommendations concerning the use of direct oral anticoagulants (DOACs) in patients with VHD have been updated, and the importance of education and (self-)monitoring is emphasized.
- Sex-specific considerations in patients with VHD have been extended and regrouped into a new dedicated section.
Management of Myocarditis and Pericarditis, August 29, 2025
This 2025 ESC Guideline updates and replaces its pericarditis guideline from 2015. The 2025 guideline now also includes myocarditis alongside pericarditis, making this guideline the first ESC clinical practice guideline covering the entire spectrum of the diseases.
The 2025 guideline features recommendations for the following sections:
- Clinical Evaluation of Myocarditis and Pericarditis
- Genetic Testing
- The Use of Cardiovascular Magnetic Resonance Imaging
- Computed Tomography
- Nuclear Medicine
- Endomyocardial Biopsy
- Autopsy
- Electro-anatomical Mapping
- Medical Therapy in Myocarditis
- Medical Therapy in Pericarditis
- Interventional Techniques Including Circulatory Support in Myocarditis
- Interventional Techniques in Pericarditis
- Surgical Therapy
- Management of Arrhythmias and Prevention of Sudden Cardiac Death in Myocarditis
- Risk Stratification, Complications, and Outcomes of Inflammatory Myopericardial Syndrome
- Giant-cell Myocarditis
- Myocarditis in Carcoidosis
- Immune Checkpoint Inhibitor-associated Myocarditis
- Inflammatory Cardiomyopathy
- Tuberculous Pericarditis
- Neoplastic Pericardial Involvement
- Post-cardiac Injury Syndrome
- Purulent Pericardarditis
- Constrictive Pericarditis
- Pregnancy, Lactation, and Reproductive Issues
- Physical Activity and Myocarditis/Pericarditis
- Multidisciplinary Teams in Myopericardial Syndromes
Management of Cardiovascular Disease and Pregnancy, August 29, 2025
The 2025 version of the ESC Guidelines for the Management of Cardiovascular Disease and Pregnancy are an update to the 2018 version. The updated version features a structural revision and takes into consideration a more modernized clinical focus reinforced by the latest evidence.
The ESC outlined some of the most relevant updates within Table 3 of the guidelines along with a brief note regarding the updated information. Those updates include:
- The Pregnancy Heart Team; Broader acceptance, dedicated section.
- Risk Stratification; mWHO 2.0 classification, refined and expanded clinical categories
- Clinical Data and Research; ROPAC and PPCM Registries Cardiomyopathies Primary Arrhythmia Syndromes
- Clinical Scenarios; Algorithms for management of clinical situations in pregnant women
- Genetic Testing and Counseling; Advancements in testing and pre-implantation procedures
- Revision of Contraindications (COR III) for Pregnancy in Women Classified as mWHO Class IV; Emphasis on the critical role of comprehensive counseling by the Pregnancy Heart Team (COR I)
- Adverse Pregnancy Outcomes; Increased focus on long-term outcomes.
Mental Health and Cardiovascular Disease, August 29, 2025
This clinical consensus statement on mental health and cardiovascular disease enlightens the reader to the magnitude and extent of cardiovascular disease burden on a patient’s mental health, and vice versa.
The ESC states that the high burden of concomitant CVD and mental health conditions necessitates a novel integrated approach to care. Cardiovascular health and mental health professionals need to collaborate to provide proper guidance and care for patients and their caregivers.
The consensus statement covers a broad range of topics, including:
- The Impact of Mental Health on the Risk of Developing Cardiovascular Disease
- Mental Health and Mental Health Conditions in People with Cardiovascular Disease
- Identification, Prevention, and Management of Mental Health Issues in People with Cardiovascular Disease
- Severe Mental Illness and Cardiovascular Disease
- Mental Health in Specific Populations and Situations
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