2025 was a big year for cardiology, with several paradigm shifts in treatment and risk assessment and the release of practice-changing research and guidelines.
Cardiovascular health research and updates to clinical practice shifted interventional cardiology last year.
Top of the list was aspirin, with many long-held assumptions challenged by new research released in 2025.
The Medical Republic reported on several of these large studies, including findings that routine use of aspirin does not provide benefits which outweigh the substantially increased risks.
Researchers found that recommending lifelong aspirin use was a practice based on outdated evidence and that superior antiplatelet therapies such as clopidogrel will likely replace aspirin as the preferred agent.
One aspirin clinical trial actually had to be ceased early due to excess deaths, prompting clinicians to alter their prescribing practices.
The researchers found that aspirin alongside anticoagulation therapy did not reduce the risk of stent thrombosis – the primary clinical reason to leave patients on aspirin following stent implantation – and increased all-cause mortality risk by 72%.
We also saw a big push for single pill combinations (SPCs) or fixed dose combinations (FDCs) as first-line hypertension treatment in 2025, with urgent calls for changes to the PBS.
Since the article publication in August, the PBS restrictions have not been lifted and updates to the Australian Hypertension Guidelines (which were expected at the end of 2025) have not been released.
Australian researchers also reached a new frontier in CRISPR research last year, with the first in-human trial which successfully used gene-editing to manage cholesterol.
The single injection of editing tools led to significant reductions in both cholesterol and triglycerides. It’s the first therapy to do both simultaneously and was described as a potential breakthrough for mixed lipid disorder management.
Speaking of lipids, the European Society of Cardiology and the European Atherosclerosis Society released new international recommendations for dyslipidaemia management.
Alongside changes to pharmacological interventions and the use of risk prediction tools, the guidelines also proposed a monumental paradigm shift to a more aggressive approach to lipid-lowering regimens, moving away from the long-used low and slow tactic.
The guideline highlighted the necessity of utilising Lp(a) for heart disease prevention, a long-overlooked cardiovascular risk factor which routine screening of could prevent 60 heart attacks, 13 strokes and 26 early deaths per 10,000 people, according to research released in 2025.
There were many things presented at the annual American Heart Association scientific sessions, but a highlight was the multiple studies of PCSK9 inhibitors in cholesterol management, including a large trial of an oral version of the injectable medication.
One of the studies presented found that pairing PCSK9 inhibitors with statins provided additional protection, cutting risk of cardiovascular death, heart attack or ischemic stroke by more than a quarter.
In a viewpoint published in the European Heart Journal, cardiologists from Italy, Germany and the US said “interventional cardiology in 2025 has been characterised by several pivotal randomised clinical trials that have reshaped daily practice, sharpened procedural strategies, and clarified long-term expectations for percutaneous therapies.”
They cited publications which “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.”
