ESC 2025: Cardiovascular outcomes in diabetes: new evidence and collaborative action

September 24, 2025 — 08:30 🕑 6 minutes

ESC 2025: Cardiovascular outcomes in diabetes: new evidence and collaborative action

The impact of diabetes on cardiovascular health remains one of the most urgent clinical challenges, influencing outcomes for millions worldwide. At the 2025 Congress of the European Society of Cardiology (ESC) in Madrid, the ESC and EASD held a joint session dedicated to cardiovascular outcomes in diabetes. Co-chaired by EASD Honorary Secretary Professor Tina Vilsbøll, Steno Diabetes Center Copenhagen, Denmark, and Professor Katherine R. Tuttle, Providence Health Services Washington, USA, the session brought together leading experts to share new data and strategies for advancing care.

Tina Vilsbøll presented the session highlights directly after the session from Madrid:

Video transcript

My name is Tina Vilsbøll. I am a professor at Steno Diabetes Center in Copenhagen, but I’m also the Honorary Secretary for the EASD. Right now, I’m in Madrid for the ESC 2025, and I just came out from a joint symposium which were created in collaboration with the ESC and the EASD. I actually went to my first ESC 15 years ago. Back then, the cardiologist was so focused on PCI, which stent to use, when to do bypass, and they didn’t really care about diabetes. They didn’t really bother about overweight. They did care about lipids. But now it’s a completely different situation. They are now very familiar with our new classes of diabetes treatment, SGLT2is and GLP-1 receptor agonists. And in the session that I had the honour to chair today, we had focus on cardiovascular outcome trials in diabetes. We had gathered a really bright group of speakers. Naveed Sattar, he started the scene talking about the impact of pre-diabetes and cardiovascular disease. Then Ulf Landmesser from Berlin, an invasive cardiologist, he talked about treating dyslipidaemia in diabetes. And then finally Kathy Tuttle, who has been very central in all the chronic kidney disease trials with SGLT2is and GLP-1 receptor agonists and was also central in the KDIGO guidelines. She talked about the recent evidence, and where we are, and where we are moving into the future. It was a really interesting session, where we had different types of doctors together, different scientists talking about how to have the individual in the centre, and how to treat them with many different kind of drugs. It was a wonderful session. We didn’t have all the solutions, but it was interactive. And I’m looking very much forward to seeing many of the cardiologists and nephrologists also at the EASD, where we will actually have another joint symposium with the ESC and the EASD. See you there.

Prediabetes and cardiovascular risk

Naveed Sattar, Professor of Metabolic Medicine at the Glasgow Royal Infirmary, UK, explored the cardiovascular risk profile of individuals destined to develop diabetes. Data show increased risk even before the onset of clinical diabetes, driven largely by adiposity, hypertension, and dyslipidaemia rather than glucose elevation alone. Triglycerides emerged as an especially relevant marker, with evidence indicating that remnant particles may be significantly more atherogenic than LDL at higher levels. Sattar emphasised personalised risk assessment—considering age, LDL, smoking status, and ethnicity—and recommended targeted interventions including statins, antihypertensives, and lifestyle modification, given their substantial impact on lifetime cardiovascular risk. Early-onset diabetes, particularly in young adults, poses the greatest risk for years of life lost. Preventive strategies must thus focus on high-risk individuals with prediabetes, especially the young. As GLP-1 receptor agonists have proven to reduce cardiovascular risk factors, independent of weight loss effects, Sattar hopes that in the future, these drugs will play an essential role in the prevention of diabetes.

Management of dyslipidaemia in diabetes

Professor Ulf Landmesser from the Charité Berlin, Germany, addressed the management of dyslipidaemia, a major driver of cardiovascular risk in diabetes. The 2019 ESC guidelines set aggressive targets for LDL cholesterol, with < 55 mg/dL for very high-risk patients, including those with diabetes and established cardiovascular disease or organ damage. In the 2025 Focused Update of the 2019 ESC/EAS Guidelines for the management of dyslipidaemias, published at the ESC Congress, bempedoic acid was highlighted as a valuable alternative for patients intolerant to statins to reach these goals, while ezetimibe and PCSK9 inhibitors provide further options. High-dose icosapent ethyl can be beneficial for patients with high triglycerides and low HDL-C, though availability varies across Europe. Precision medicine approaches are increasingly important, with therapies tailored to individual risk profiles—particularly for those with concomitant obesity, diabetes, and elevated Lp(a).

Improving kidney outcomes in diabetes

Professor Katherine Tuttle outlined new insights into chronic kidney disease (CKD) management in people living with diabetes. With diabetes responsible for half of all CKD worldwide, KDIGO guidelines recommend combining RAS inhibitors (ACE inhibitors, ARBs), SGLT2 inhibitors, statins, and metformin for optimal first-line therapy. Evidence from major trials (CREDENCE, DAPA-CKD, EMPA-KIDNEY) confirms substantial benefits for both heart and kidney outcomes, even in patients with advanced CKD. Finerenone, a non-steroidal mineralocorticoid receptor antagonist, further reduces cardiovascular and renal risks when added to standard regimens.

And of course, GLP-1 receptor agonists will play a major role for the management of patients with diabetes and kidney disease. “They came as a gift from the cardiovascular outcome trials”, said Tuttle. “One of the very distinctive features about them is, that they can be used in advanced CKD, even dialysis and transplantation. The FLOW trial proved that with GLP-1 RA, we can tackle formerly unmet needs!” The session underscored the need for ongoing, risk-based reassessment and multimodal therapy to address the high burden of complications in diabetes.

ESC/EASD Joint Session
Chairs: Tina Vilsbøll (Denmark), Katherine R. Tuttle (USA)
Naveed Sattar (UK): Cardiovascular risk reduction: should we target prediabetes?
Ulf Landmesser (Germany): Management of dyslipidaemia in diabetes
Katherine Tuttle (USA): Improving chronic kidney disease outcomes in diabetes

To learn more about the ESC, go to: https://www.escardio.org/