The European Society of Cardiology (ESC) Annual Meeting 2025, held from August 29 to September 1 in Madrid, Spain, showcased a sweeping array of advancements in the cardiovascular and metabolic disorders (CVMD) space, with 7,804 total presentations. This leading global forum delivered critical updates on emerging therapies, pivotal clinical trial outcomes, and evolving standards of care across a variety of indications.

Expanding role of GLP-1s

Several key trends emerged around glucagon-like peptide-1 (GLP-1) agonists, reflecting their expanding role beyond traditional diabetes and weight management. Heart failure (HF) with preserved ejection fraction (HFpEF) emerged as a major focus, with symposiums highlighting GLP-1 receptor agonists as ushering in “a new era in treatment” for obesity-related HFpEF.

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The congress also featured head-to-head comparisons, with SURMOUNT-5 data confirming Eli Lilly’s (Lilly) tirzepatide’s superior weight loss compared to Novo Nordisk’s (Novo) semaglutide, alongside greater predicted ten-year cardiovascular risk reduction. This year’s congress demonstrated that GLP-1 agonists have evolved from diabetes medications into multi-system therapeutic platforms with applications spanning CVMD, HF, and neurodegeneration, setting the stage for unprecedented growth and therapeutic expansion in the coming years.

Real-world studies are transforming CV care through evidence-based medicine

The congress showcased compelling real-world evidence that bridges the gap between controlled clinical trials and everyday clinical practice, with several major pharmaceutical companies presenting groundbreaking data that could reshape treatment paradigms. AstraZeneca’s dapagliflozin showed promise in the DAPA ACT HF-TIMI 68 trial for in-hospital initiation in acute HF, and while it missed its primary endpoint, a prespecified meta-analysis of 3,527 patients demonstrated that early sodium-glucose co-transporter-2 inhibitor treatment reduced cardiovascular death or worsening HF by 29% and all-cause mortality by 43%. Additionally, groundbreaking data on GLP-1 receptor agonists emerged, with real-world evidence showing ±·´Ç±¹´Ç’s semaglutide and Lilly’s tirzepatide reduced HF hospitalization or all-cause mortality by more than 40% in cardiometabolic HFpEF patients compared to sitagliptin. 

Breakthrough trial in hypertension

Late-breaking trials dominated the hypertension discussion. The BaxHTN trial demonstrated that AstraZeneca’s baxdrostat achieved statistically significant reductions in systolic blood pressure of -8.7mmHg and -9.8mmHg for the 1mg and 2mg doses respectively in 796 patients with uncontrolled or resistant hypertension. This selective aldosterone synthase inhibitor represents a novel mechanism targeting aldosterone dysregulation, addressing a critical unmet need in cardiovascular medicine.

The ESC Congress 2025 highlighted the evolving landscape toward integrated CVMD care, with combination therapies showing superior outcomes but facing implementation barriers related to cost, accessibility, and the need for consensus guidelines to support broader clinical adoption.