New and revised clinical guidance spanning dyslipidemia, cardiovascular disease in pregnancy, valvular heart disease, myocarditis and pericarditis, and mental health was released as part of ESC Congress 2025 in Madrid. These updates reflect the latest evidence and expert consensus, offering timely direction for improving patient outcomes across diverse and complex cardiac conditions.

A new 2025 Focused Update of the 2019 ESC/EAS Guidelines for the Management of Dyslipidaemias focuses on how best to manage lipid levels to reduce cardiovascular risk in patients, including those with acute coronary syndrome, cancer and HIV. It also recommends the use of new SCORE2 and SCORE2-OP algorithms to better predict the 10-year risk of fatal and nonfatal cardiovascular events in patients.

Additionally, the updated guideline endorses previous recommendations for a healthy diet to lower LDL cholesterol levels and provides guidance on the use of new LDL-lowering drugs such as bempedoic acid for patients unable to take statins. 

The new 2025 ESC Guidelines for the Management of Cardiovascular Disease and Pregnancy move away from advising women considered at high risk to avoid pregnancy. Instead, the guidelines recommend a personalized, multidisciplinary team approach involving transparent dialogue, counseling and shared decision-making that takes into account genetic background, family history, current medical history, social drivers of health and previous vascular events.

The new guidelines also address the use of Pregnancy Heart Teams to support women's mental and physical health; use of medications to manage cholesterol, blood pressure and cardiogenetic disorders during pregnancy; and when caesarean sections are appropriate in women with cardiovascular risk. They also recommend postponing pregnancy for at least one year after heart transplantation, taking individual risk factors into account.

Updated 2025 ESC/EACTS Guidelines for the Management of Valvular Heart Disease respond to new evidence suggesting that some newer and less invasive treatments like TAVR or minimal invasive mitral surgery should be used more widely and consistently to treat patients. They also stress the importance of shared- and patient-centered decision-making by multidisciplinary expert Heart Teams; expand guidance on sex-specific considerations for treating patients; and outline the correct diagnostic steps and management of patients with multiple and combined valvular heart disease.

Additionally, the new guidelines recognize the increasingly important role that advanced imaging techniques, such as 3D echocardiography, cardiac CT, and cardiac magnetic resonance imaging, have in screening and evaluating patients with valvular heart. They also provide guidance on when to refer patients to high-volume centers for treatment.

The 2025 ESC Guidelines for the Management of Myocarditis and Pericarditis are the first to offer guidance on both issues at the same time, providing algorithms and easy-to-use flow charts to support clinicians in better recognizing, diagnosing and treating the two diseases. They also introduce the term "inflammatory myopericardial syndrome" as an umbrella diagnosis to account for potential overlap between myocarditis and pericarditis until a more specific diagnosis is made.

The guidelines also give personalized recommendations for return to work and exercise; offer a list of red flags for clinicians, including clinical signs and/or biomarkers, that may be clues for the detection of myocarditis and pericarditis improving the time to diagnosis; and provide guidance for a complete clinical evaluation and when to consider genetic testing.

Greater awareness of the multidirectional relationship between mental health conditions and cardiovascular disease is the focus of ESC's first-ever Clinical Consensus Statement on mental health and cardiovascular disease.

The statement recommends systematic screening for mental health as part of regular cardiovascular care and, conversely, that cardiovascular risk be routinely assessed for those being treated for mental health conditions. It also urges solutions to some of the biggest problems facing mental health and cardiovascular care, including lack of awareness by health care professionals of the impact and prevalence of mental health conditions in people with cardiovascular disease, as well as the lack of evidence-based protocols to support screening and treatment.