European heart doctors released updated guidelines in 2025 for managing cholesterol and fat levels in the blood. These new recommendations use better tools to figure out who’s at risk for heart problems, especially older adults. The guidelines emphasize starting strong cholesterol-lowering medicines quickly when needed, and they introduce new risk factors like family history and a protein called Lp(a). Importantly, the guidelines say vitamins and supplements won’t prevent heart disease. The focus is on personalized treatment based on individual risk, with practical advice doctors can use in their offices.

The Quick Take

  • What they studied: Updated recommendations for how doctors should assess and treat people with high cholesterol and abnormal blood fats to prevent heart disease
  • Who participated: These are guidelines created by European heart and cholesterol experts based on reviewing current scientific evidence—they apply to patients of all ages, with special attention to older adults and people with specific health conditions
  • Key finding: The new guidelines use improved risk assessment tools (SCORE2 and SCORE2-OP) that better identify who needs treatment, recommend starting strong cholesterol medicines immediately after a heart attack, and highlight that certain blood markers like Lp(a) and family history are important risk factors
  • What it means for you: If you have high cholesterol or are at risk for heart disease, your doctor may use new assessment tools to better understand your personal risk. Treatment recommendations may change based on your individual situation, family history, and specific blood markers. Importantly, taking vitamins or supplements won’t prevent heart disease—medicine and lifestyle changes are what matter.

The Research Details

This is a clinical guideline document—not a traditional research study with patients. Instead, it’s a comprehensive review created by leading European heart and cholesterol experts who examined all the latest scientific evidence published since the last guidelines. They looked at hundreds of research studies to determine what works best for preventing and treating cholesterol problems.

The experts organized their recommendations into different risk categories, meaning they created a system to help doctors figure out which patients need treatment and how aggressive that treatment should be. They also identified special situations where different rules apply, like for people with HIV or those receiving certain cancer treatments.

This type of guideline is important because it gives doctors clear, evidence-based instructions they can follow in their daily practice. Rather than each doctor deciding treatment on their own, guidelines ensure that patients everywhere receive consistent, scientifically-supported care.

Guidelines matter because they translate complex research into practical recommendations that doctors can use immediately. When heart experts review all available evidence and create guidelines, it helps ensure that patients get the best possible care based on current science. These 2025 updates are particularly important because they introduce new tools for assessing risk and highlight emerging risk factors that weren’t emphasized before.

These guidelines come from the European Society of Cardiology and European Atherosclerosis Society, which are highly respected organizations of heart and cholesterol specialists. The recommendations are based on systematic reviews of published research, meaning experts carefully examined existing studies rather than conducting new experiments. The guidelines are updated regularly (this is the 2025 version) to incorporate new scientific discoveries. However, guidelines represent expert consensus rather than absolute proof, and individual patient situations may require adjustments to these recommendations.

What the Results Show

The 2025 guidelines introduce SCORE2 and SCORE2-OP as improved tools for assessing heart disease risk. These tools work better than previous versions, especially for older adults. The guidelines now consider additional risk factors beyond just cholesterol levels, including family history of heart disease, ethnic background, other health conditions, and two specific blood markers: hs-CRP (a sign of inflammation) and Lp(a) (a type of cholesterol particle).

For people who have had a heart attack or acute coronary syndrome, the guidelines strongly recommend starting high-intensity statin therapy (powerful cholesterol-lowering medicine) immediately, usually combined with another medicine called ezetimibe. This aggressive early treatment is based on evidence showing it prevents future heart problems.

The guidelines identify special populations needing attention: people with HIV should receive statin therapy starting at age 40 regardless of their cholesterol levels, and high-risk patients receiving certain cancer drugs (anthracyclines) also need cholesterol treatment. These recommendations recognize that these groups face higher heart disease risk.

Target cholesterol levels remain the same as before, but the approach is now more personalized—different people get different targets based on their individual risk profile rather than a one-size-fits-all approach.

The guidelines specifically recommend against using dietary supplements and vitamins for heart disease prevention. This is important because many people believe vitamins prevent heart problems, but research shows they don’t. The guidelines emphasize that the stepwise treatment approach remains important—doctors should start with basic treatments and add stronger medicines only if needed. The update also stresses the importance of consistent, long-term cholesterol management rather than sporadic treatment.

These 2025 guidelines build on previous versions but make several important changes. The new risk assessment tools (SCORE2 and SCORE2-OP) are improvements over older versions, particularly for older adults who were sometimes misclassified before. The addition of Lp(a) and hs-CRP as risk modifiers is relatively new—previous guidelines didn’t emphasize these as much. The specific recommendations for people with HIV and those receiving certain cancer treatments represent expanded recognition of special populations. However, the core principle of using LDL cholesterol targets and stepwise treatment remains unchanged, showing continuity with previous evidence.

As a guideline document rather than a research study, it doesn’t have limitations in the traditional sense. However, readers should understand that guidelines represent expert consensus based on available evidence—they’re not absolute rules. Individual patients may need different approaches based on their unique situations. Guidelines also can’t account for every possible scenario or patient preference. Additionally, some recommendations may be based on limited evidence in certain populations, and new research may lead to future updates. Doctors should use these guidelines as a framework while considering each patient’s individual circumstances.

The Bottom Line

If you have high cholesterol or risk factors for heart disease, work with your doctor to assess your personal risk using current tools. If you’ve had a heart attack, expect your doctor to recommend strong cholesterol-lowering medicine started immediately. Ask your doctor about your Lp(a) level and family history, as these are now recognized as important risk factors. Don’t rely on vitamins or supplements for heart disease prevention—focus on prescribed medicines and lifestyle changes. Take cholesterol medicine consistently as prescribed, even if you feel fine. These recommendations have high confidence based on extensive research evidence.

These guidelines apply to anyone with high cholesterol, anyone with a family history of heart disease, people who’ve had a heart attack or stroke, older adults, people with HIV, and those receiving certain cancer treatments. People with diabetes, high blood pressure, or other heart disease risk factors should also pay attention. However, healthy young people without risk factors may not need aggressive cholesterol treatment. Always discuss your individual situation with your doctor rather than assuming these guidelines apply to you.

If you start cholesterol medicine, it typically takes 4-12 weeks to see the full effect on blood cholesterol levels. However, the protective benefits for your heart develop over months and years of consistent treatment. If you’ve had a heart attack, starting medicine immediately provides benefits within days by stabilizing the heart and preventing further damage. Lifestyle changes like diet and exercise can show benefits within weeks to months. Don’t expect overnight results—cholesterol management is a long-term commitment.

Want to Apply This Research?

  • Track your cholesterol medication adherence daily (did you take your medicine?) and log your LDL cholesterol levels at each doctor visit. Also track any family history of heart disease and note your personal risk category as determined by your doctor.
  • Set a daily reminder to take your cholesterol medicine at the same time each day. Use the app to log when you take it and celebrate weekly streaks of consistent use. If your doctor mentions your Lp(a) level or hs-CRP, add these to your tracked biomarkers to monitor over time.
  • Check your cholesterol levels every 4-12 weeks initially after starting or changing medicine, then every 3-6 months once stable. Track your blood pressure and weight monthly. Note any new symptoms or side effects from medicine. Review your overall risk category annually with your doctor and update it in the app. Monitor adherence to medication as the single most important factor in preventing heart disease.

This summary describes clinical guidelines created by European heart experts. These guidelines are recommendations for doctors, not personal medical advice. Your individual cholesterol treatment should be determined by your own doctor based on your specific health situation, risk factors, and medical history. Do not start, stop, or change any cholesterol medicine without consulting your healthcare provider. If you have questions about whether these guidelines apply to you, discuss them with your doctor at your next appointment. This information is current as of 2025 but may be updated as new research emerges.