2025 was a landmark year for cardiology, marked by significant shifts in how we treat and assess cardiovascular health. The biggest news? Long-held beliefs about common treatments were turned upside down.
Interventional cardiology saw major changes in research and clinical practice. One of the most significant developments revolved around aspirin, with new studies challenging its long-standing role.
Research indicated that routine aspirin use might not offer the heart benefits previously assumed, while significantly increasing risks. Superior antiplatelet therapies like clopidogrel are likely to replace aspirin. In fact, one clinical trial had to be stopped early due to excess deaths. This led clinicians to adjust their prescribing habits. It was found that aspirin, when used with anticoagulation therapy, didn't reduce the risk of stent thrombosis and increased the risk of all-cause mortality by a staggering 72%.
We also saw a push for single-pill combinations (SPCs) or fixed-dose combinations (FDCs) as the first line of treatment for hypertension. There were urgent calls for changes to the PBS (Pharmaceutical Benefits Scheme). However, the PBS restrictions weren't lifted, and updates to the Australian Hypertension Guidelines, expected by the end of 2025, were not released.
Australian researchers also made a breakthrough in CRISPR research, with the first human trial successfully using gene-editing to manage cholesterol. A single injection of gene-editing tools led to significant reductions in both cholesterol and triglycerides. This is the first therapy to do both simultaneously and could be a major advancement for mixed lipid disorder management.
In lipid management, the European Society of Cardiology and the European Atherosclerosis Society released new international recommendations for dyslipidaemia management. These guidelines proposed a more aggressive approach to lipid-lowering regimens, moving away from the previously used 'low and slow' approach. They also highlighted the importance of using Lp(a) for heart disease prevention, a previously overlooked cardiovascular risk factor. Routine screening could prevent a significant number of heart attacks, strokes, and early deaths.
At the American Heart Association scientific sessions, PCSK9 inhibitors in cholesterol management were a major focus. Studies showed that combining PCSK9 inhibitors with statins offered additional protection, reducing the risk of cardiovascular death, heart attack, or ischemic stroke by more than a quarter.
But here's where it gets controversial... A viewpoint published in the European Heart Journal highlighted how pivotal clinical trials reshaped daily practice, sharpened procedural strategies, and clarified long-term expectations for percutaneous therapies. The publications refined antiplatelet management after PCI, clarified the optimal timing of multivessel revascularization in ST-elevation myocardial infarction, reinforced the value of imaging and physiology in complex PCI, and extended our understanding of transcatheter aortic valve implantation (TAVI) durability in low-risk patients.
And this is the part most people miss... The impact of these findings extends beyond the clinic, influencing patient care and potentially reshaping healthcare policies. What do you think about these changes? Do you agree with the shift away from aspirin? Share your thoughts in the comments below!
