What changed recently

The 2025 focused update leaves the 2019 LDL-cholesterol targets intact but changes how they are reached, pushing earlier and more aggressive combination therapy (high-intensity statin plus ezetimibe, including during the index acute coronary syndrome admission) and adding recommendations covering bempedoic acid, inclisiran and evinacumab. Risk stratification is refined with SCORE2/SCORE2-OP, lipoprotein(a) and coronary artery calcium scoring.

The 2022 Council Recommendation widened the EU screening framework beyond the breast, cervical and colorectal cancers covered in 2003, adding lung, prostate and gastric cancer for feasibility assessment. It also extended the breast screening age band to roughly 45-74 and made HPV testing the preferred cervical screening method for women aged 30-65.

The 2022 statement explicitly replaces the 2016 USPSTF statin recommendation and, after re-reviewing the trial evidence, retained the same structure: a B grade for adults aged 40-75 with at least one risk factor and 10-year cardiovascular risk of 10% or more, a C grade at 7.5% to under 10%, and an I statement for adults 76 and older.

NG209 consolidated eight separate NICE tobacco publications into one guideline covering prevention of uptake, quitting and treatment of dependence in everyone aged 12 and over, with reworked recommendations on harm reduction, smoking in pregnancy, school-based prevention and retailer compliance. The February 2025 revision added cytisinicline (cytisine) as a stop-smoking pharmacotherapy option.

The 2021 ESC prevention guideline replaced the SCORE fatal-event chart used since 2016 with SCORE2 and SCORE2-OP, which estimate combined fatal and non-fatal cardiovascular risk, are calibrated to four European risk regions and for the first time cover adults over 69. It also introduced age-specific risk thresholds and a stepwise, shared-decision approach to intensifying lipid, blood pressure and glucose treatment.

The 2021 statement replaces the 2015 USPSTF recommendation and keeps the A grades for behavioural counselling and pharmacotherapy in non-pregnant adults and for behavioural interventions in pregnancy, but newly issues an I statement on electronic cigarettes as a cessation aid because the evidence on their effectiveness and harms was judged insufficient.