ESC 2025: The largest cardiology congress was groundbreaking this year

Main global cardiology event

„The combination of breakthrough data from clinical trials, newly issued clinical practice guidelines, and strong global representation makes the ESC 2025 Congress a significant event that is shaping the future of cardiovascular medicine. We have never before seen such a large number of the latest studies from all areas of cardiology that were presented and simultaneously published in leading journals, informed clinical decision-making, and improved patient care,“ said Prof. Mahfoud.

The ESC 2025 Congress was not only highly successful but also ceremonial –⁠ the ESC celebrated its 75th anniversary in the presence of Spain’s King Felipe VI. On top of that, it had record attendance: 33 thousand healthcare professionals from 169 countries. Scientific contributions arrived from 115 countries. Some of the presented findings are summarized below.

The link between mental health and CV disease

On September 1, the first ESC consensus statement on the relationship between mental health across its spectrum and cardiovascular (CV) disease was presented at the ESC Congress. Its purpose is to inform healthcare professionals that mental disorders affect CV health and vice versa, and it outlines how to prevent the negative impacts of this connection or at least minimize them. According to the authors, clinicians do not have sufficient awareness of this topic. The consensus therefore offers a comprehensive overview of the evidence on this association.

The document emphasizes that assessment and management of mental health should be part of routine CV care, while at the same time noting that further research is needed. According to the authors, care for people with CV disease should be approached holistically; they recommend new models of care and the operation of psycho-cardiology teams in CV departments in collaboration with mental health specialists and primary and social care.

The authors propose the ACTIVE principles for routine care –⁠ acknowledge, check, tools (use validated tools), implement, venture, and evaluate.

Furthermore, the authors pointed to systemic barriers in the prevention, screening, diagnosis, and treatment of CV disease in people with severe mental disorders, which lead to differences between CV care for these patients and that for the general population. To eliminate these, it is necessary to remove stigma, stereotypes, biases, and diagnostic overshadowing (misattributing somatic symptoms to pre-existing mental illness).

Can VZV vaccination reduce the risks of MI and stroke?

It is known that the herpesvirus varicella-zoster (VZV, HHV-3) first causes chickenpox, then “sleeps” in the nervous system and, after “awakening,” can trigger shingles (herpes zoster). In addition, it also induces inflammation and vascular remodeling.

Research has shown that VZV reactivation can even cause myocardial infarction (MI) or stroke. Using a global systematic review and meta-analysis (the first on this topic), the possible association between vaccination against VZV and the risk of major CV events (MI, stroke) was evaluated.

The authors searched three scientific literature databases and included 19 studies in the review, of which 9 (8 observational and 1 randomized controlled phase III) met the criteria for meta-analysis. In those 9 studies, 53.3% of participants were men, and in 7 of them the median age of participants was 53.6–74 years.

It was found that patients who received vaccination against herpes zoster, whether recombinant (RZV) or live (ZVL), had a statistically significantly lower risk of MI and stroke than the unvaccinated, in both age groups studied –⁠ in the population ≥ 18 years by 18% and ≥ 50 years by 16%. The absolute risk of a CV event decreased by 1.2–2.2 per 1000 person-years.

Patients underestimate myocardial infarction

How accurate are patients’ self-reported data on family history (FH) of myocardial infarction (MI) when compared with national registry data? Researchers from the Karolinska Institutet in Stockholm sought the answer to this question.

They included 25,302 subjects from the Swedish SCAPIS study for whom data on both parents were available in the Swedish Multigeneration Register. Participants’ reports of parental and sibling FH of MI were obtained from the SCAPIS questionnaire, and the actual data on MI occurrence in parents and siblings were taken from the Swedish National Patient Register and the Cause of Death Register. 

The median age of respondents was 57.4 years. Self-reported FH of MI, compared with national registries, markedly underestimated prevalence (Cohen’s kappa, i.e. the statistical measure of agreement between raters, 0.491 [95% CI 0.480–0.503]). This was especially true for early-onset MI, which is clinically most relevant (Cohen’s kappa 0.396, 95% CI 0.367–0.426).

Men generally reported less accurate FH of MI than women. Individuals with a university education and high disposable income reported parental history more accurately, but only in the case of MI without age restriction.

Protection against ventricular arrhythmias

Hypokalemia, and even lower-normal plasma potassium levels in patients with CV disease, increase the risk of ventricular arrhythmias. The Danish randomized open-label POTCAST study therefore tested whether it is clinically worthwhile to raise these values.

A total of 1,200 patients at high risk of ventricular arrhythmia (individuals with an implantable cardioverter-defibrillator [ICD]) and a baseline plasma potassium level ≤ 4.3 mmol/L received either usual care (n = 600) or had their potassium concentration increased (n = 600) to 4.5–5.0 mmol/L by adding mineralocorticoid receptor antagonists and/or potassium supplements with dietary counselling. Use of potassium-wasting diuretics was reduced or stopped where applicable.

The mean age of participants at baseline was 62.7 years, women accounted for 19.8%, most patients (64.6%) had a history of heart failure, half had ischemic heart disease, and half had cardiomyopathy or primary arrhythmia.

Potassium augmentation proved beneficial. During a median follow-up of 39.6 (26.4–49.3) months, fewer events of the composite endpoint (sustained ventricular tachycardia or appropriate ICD therapy, unplanned hospitalization due to arrhythmia or heart failure, or death from any cause) occurred in the group with increased potassium levels than in the standard-care group: 22.7% (136) vs. 29.2% (175) of individuals, which corresponds to 7.3 vs. 9.6 events/100 person-years (HR 0.76; 95% CI 0.61–0.95; p = 0.01). The incidence of hospitalizations due to hyper -⁠ or hypokalemia was similar in both groups.

Editorial Team, Medscope.pro

Photo: ESC

Sources:

1. Bueno H. et al. 2025 ESC Clinical Consensus Statement on mental health and cardiovascular disease. Eur Heart J 2025, doi:10.1093/eurheartj/ehaf191.

2. Williams C., Bhatt D. L., Aguiar C. et al. Herpes zoster vaccine effectiveness against cardiovascular events –⁠ a systematic literature review and meta-analysis. ESC Congress, Madrid, 29. 8.–1. 9. 2025.

3. Wahrenberg A., Leander K., Habel H. et al. Validation of self-reported family history of myocardial infarction using nationwide health care data. ESC Congress, Madrid, 29. 8.–1. 9. 2025. Available at: www.esc365.escardio.org/esc-congress/speakers/520960

4. Jøns C., Zheng C., Winsløw U. C. G. et al. Increasing potassium levels improve outcomes in patients at high risk of ventricular arrhythmia. ESC Congress, Madrid, 29. 8.–1. 9. 2025, doi: 10.1056/NEJMoa2509542.