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In 2025, cardiovascular investigators worldwide reported findings that could help fill important gaps in preventing and managing conditions including high blood pressure, stroke, heart failure, dangerous blood clots and aortic stenosis.

Scientists looked at how to repair failing hearts at the cellular level and conducted studies to better understand the effects of smoking on young people and sleep on people of all ages. Researchers uncovered new insights into the most powerful modifiable cardiovascular disease risk factors and how key lifestyle changes impact life and death.

Each year the Ãå±±ÊÓƵ, a leading funder of heart- and brain-related research, compiles a review of significant scientific advances in the fight against conditions related to cardiovascular disease, which claims nearly 950,000 lives in the U.S. annually and is the leading cause of death worldwide.

Ten overarching themes stood out among this year’s remarkable research strides.

Further benefit from blood pressure management, and treating hard-to-control hypertension

Nearly half of all U.S. adults have high blood pressure, also known as hypertension, the most common and most modifiable risk factor for cardiovascular disease, according to the Ãå±±ÊÓƵ’s .

Successfully treating high blood pressure not only may improve heart health but also can reduce risk of dementia from any cause, in a study published in Nature Medicine.

The research involved nearly 34,000 adults 40 and older with uncontrolled high blood pressure living in rural China. Half of participants’ home villages received a primary care physician-supervised intervention carried out by non-physician community health professionals to achieve systolic blood pressure lower than 130 mm Hg and diastolic pressure below 80 mm Hg.

Over 48 months, compared with the usual care group, systolic pressures in the intervention group were on average 22.0 mm Hg lower, and diastolic pressures 9.3 mm Hg lower. Those in the intervention group were notably less likely to develop dementia.

Another research team, meanwhile, found that to treatment regimens can help rein in hard-to-control hypertension. Baxdrostat inhibits aldosterone synthase, the enzyme that produces aldosterone, a hormone released by the adrenal glands that helps regulate blood pressure by managing salt and potassium levels in the blood.

In the research published in The New England Journal of Medicine, the scientists studied nearly 800 adults whose blood pressure remained high despite treatment. While participants continued to take their regularly prescribed antihypertensive medications, one group added a 1-milligram daily dose of baxdrostat, another received 2 mg of baxdrostat daily, and a third took a placebo.

At 12 weeks, systolic blood pressure fell an average of 15.7 mm Hg in the group receiving the 2-mg baxdrostat dose, 14.5 mm Hg in the 1-mg group, and 5.8 mm Hg among those taking the placebo. Hyperkalemia occurred more often in the baxdrostat groups than in the placebo group, but the need to discontinue the medication because of elevated potassium was low, researchers reported.

Growing awareness of the enormity of cardiovascular risk factors globally and their contribution to cardiovascular-kidney-metabolic disease

Five modifiable risk factors account for about half the global burden of cardiovascular disease, research has shown: abnormal body mass index, high systolic blood pressure, excess levels of non-high-density lipoprotein cholesterol (non-HDL cholesterol), smoking and diabetes. These risk factors also contribute to kidney disease and diabetes and increase the risk of cardiovascular-kidney-metabolic (CKM) syndrome, a newly defined health condition affecting nearly 90% of adults that includes heart disease, kidney disease, diabetes and obesity.

This past year, a study published in The New England Journal of Medicine analyzed how these classic risk factors affect from any cause. The study, of more than 2 million people around the world, found:

• Men and women with none of the five risk factors at age 50 lived more than a decade longer than those with all the risk factors.


• Specifically, women with none of the risk factors lived 14.5 years longer (and had over 13 additional years free of cardiovascular disease) than women with all the risk factors.


• Men without the risk factors lived nearly 12 years longer and had almost 11 additional years free of cardiovascular disease.


• Quitting smoking in one’s mid-50s to age 60 was the intervention that had the most impact on delaying death, while controlling hypertension was the most powerful way to live without cardiovascular disease longer.

of more than 50,000 U.S. adults 20 years and older examined the link between different stages of CKM syndrome and cardiovascular death.

The study, published in the Journal of the American Society of Nephrology, found that people with the highest stage of CKM disease, which includes the presence of clinical cardiovascular disease, were 9.6% more likely to die from cardiovascular disease over a period of 15 years than were people without CKM syndrome.

The association between CKM stage and cardiovascular disease death was stronger than with death from cancer or other non-cardiovascular causes, underscoring the importance of CKM staging when predicting health-related outcomes for people with cardiovascular disease, the researchers wrote.

Ongoing debate about the chronic use of anti-platelet and anticoagulation therapy: Perhaps less is more?

Safety concerns prompted researchers to stop a (an antiplatelet therapy) to anticoagulation (blood-thinning) therapy in people at high risk for dangerous blood clots.

The study, published in The New England Journal of Medicine, examined health results in nearly 900 people 18 and older who had chronic coronary syndrome and had been implanted with stents six months before enrollment in the study. The researchers compared a group who took 100 mg of aspirin daily along with prescribed anticoagulants to a group taking a placebo in the place of aspirin.

Adding aspirin led to a higher risk of cardiovascular death, heart attack, stroke, systemic embolism (a blood clot that travels to another area of the body), acute limb ischemia or the need for a coronary revascularization procedure to restore blood flow to the heart. Those in the aspirin group were also more likely to experience major bleeding and to die from any cause.

Building on medical management in carotid stenosis without symptoms

In encompassing 2,485 people from around the world, researchers explored whether adding revascularization to intensive medical management would improve outcomes in high-grade but asymptomatic carotid artery stenosis.

In carotid stenosis, the carotid arteries in the neck become obstructed by a buildup of fatty deposits, or plaque. The resulting blood flow restriction may lead to stroke. In the study, high-grade meant stenosis, or narrowing of the artery, of at least 70%.

Reporting in The New England Journal of Medicine, the research team found that carotid artery stenting and medicines helped to prevent stroke and death in the study’s patients more than medicines alone. But medicines combined with carotid endarterectomy — surgery to remove blood clots or fatty plaque from the carotid arteries — did not result in the same health benefits when compared with medicines alone.

These findings suggest that while stenting may offer additional benefit beyond medicine alone, endarterectomy did not provide the same level of improvement in this asymptomatic population.

Further impact of GLP-1s on cardiovascular disease

Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are injectable medications that lower blood sugar to treat diabetes but also reduce appetite and can be used for weight loss. There is a growing body of research showing the positive impact of the medications on heart health, including several new studies in 2025.

According to an international study published in The New England Journal of Medicine, the .

Investigators studied injectable tirzepatide in people with obesity who had heart failure with preserved ejection fraction, or HFpEF. Tirzepatide is a GLP-1RA and a long-acting agonist of glucose-dependent insulinotropic polypeptide (GIP).

The study randomly assigned more than 730 adults with HFpEF and a BMI of at least 30 to receive subcutaneous (under-the-skin injections) of tirzepatide or placebo for at least 52 weeks. The research team followed participants for a median 104 weeks and found that compared with placebo, tirzepatide treatment was associated with a lower overall risk of a heart failure event or death from cardiovascular causes. Nearly 10% of those in the tirzepatide group and more than 15% in the placebo group had at least one of those outcomes — death or worsening heart failure.

While there were more side effects, including gastrointestinal bleeding, in the GLP-1RA group, those receiving the medications reported better quality of life.

Another study published in The New England Journal of Medicine looked at the , another long-acting GLP-1RA, in people with Type 2 diabetes and at high risk for cardiovascular disease. The study of more than 9,600 people 50 and older included one group who took a once-daily semaglutide pill and another who took a placebo pill in addition to their usual care. Participants were followed for an average of about 48 months.

The oral semaglutide was associated with a notably lower risk of nonfatal heart attack or stroke or death from cardiovascular causes, the research team found.

Groundbreaking approaches to treating heart failure

Scientists are working on ways to repair and “re-muscularize” failing hearts at the cellular level. In a study published in Nature, researchers showed that they could .

The research team conducted an animal study using epicardial engineered heart muscle (EHM) grafts derived from pluripotent stem cells, which can develop into many different cells, and stromal cells, which are connective tissue cells that build the infrastructure of the body’s organs. When used in rhesus monkeys with heart failure, the EHM structurally and functionally re-muscularized chronically failing hearts, the researchers found. The results of the procedure lasted up to six months, and the animals’ hearts behaved like healthy hearts, without side effects such as arrhythmias or tumor growth.

The scientists also confirmed remuscularization in a human heart removed during transplant from a patient with advanced heart failure who had previously received EHM treatment. These promising results are guiding future human research.

Another study, published in Nature Cardiovascular Research, could contribute to .

Scientists have known that downregulation and inactivation of a protein known as SERCA2a reduce the ability of failing hearts to contract and are major mechanisms of heart failure. But supplementing SERCA2a did not pan out in previous studies.

The new study found that a protein in the body called p22phox, which protects SERCA2a from oxidation, prevents SERCA2a’s downregulation and stabilizes it in the heart. The investigators also identified a major site where oxidation occurs in SERCA2a in the absence of p22phox.

Their analysis showed that while p22phox can interact with many proteins, it does so most commonly with SERCA2a. And SERCA2a appears to help mediate the function of p22phox in the heart when it is stressed.

In other SERCA2a-related research, published in Circulation Research, a journal of the Ãå±±ÊÓƵ, investigators found that a newly identified cardiac microprotein called DWORF , a process that drives the heart’s contraction and relaxation.

In mice, DWORF gene therapy preserved cardiac function when their hearts were stressed, the scientists reported.

The findings support DWORF as a promising therapeutic target for heart failure and reflect a broader interest in targeting SERCA2a to treat heart failure, researchers wrote.

The tragedy of childhood tobacco use

Research using data from the Avon Longitudinal Study of Parents and Children birth cohort followed more than 1,900 children in England from ages 10 through 24 years. The analysis found that persistent smoking from childhood was linked to a 33% to 52% greater chance of premature structural and functional cardiac injury, after controlling for other risk factors. The study, described in the Journal of the American College of Cardiology, as well as its early consequences in youth.

Tobacco smoking from childhood through young adulthood was linked to increased cardiac mass from age 17 through 24 years. Changes in the heart’s size or weight are often associated with conditions that negatively impact the heart’s function, the scientists noted.

They also reported that, among those who smoked, the prevalence of left ventricular hypertrophy — thickening of the heart’s left pumping chamber — increased from 2.8% at age 17 to 7.5% at age 24. Left ventricular diastolic dysfunction prevalence increased from 10.4% at 17 years to 16.9% at age 24.

Smoking prevalence became more common with age, starting with 0.3% at age 10, 1.6% at age 13, 13.6% at age 15, 24% at age 17 and 26.4% by age 24. Sixty percent of those who started smoking at age 10 through 17 continued smoking at age 24.

Aortic stenosis: Early treatment better than surveillance alone

About 12% of Americans 75 and older have aortic stenosis, a narrowing of the aortic valve. When left untreated, it can lead to heart failure and death.

If the aortic valve becomes too obstructed or symptoms become severe, people will generally undergo a procedure to replace the narrowed valve. One option is open-heart surgery, known as surgical aortic valve replacement, or SAVR. Another, less invasive option is transcatheter aortic valve replacement, known as TAVR, during which a catheter is threaded through an artery into the heart, and a new valve is placed and then expanded inside the old valve.

Current guidelines recommend routine surveillance every six to 12 months for people who have asymptomatic severe aortic stenosis and preserved left ventricular ejection fraction. But a study published in The New England Journal of Medicine suggests might be a better option for many of these patients.

Researchers studied more than 900 adults (average age 75.8 years) treated in the U.S. and Canada for asymptomatic severe aortic stenosis and preserved left ventricular ejection fraction. Half of those studied underwent early TAVR, and half had clinical surveillance. About 27% (122 patients) in the TAVR group experienced death, stroke or unplanned hospitalization for cardiovascular causes, compared with more than 45% (202 patients) in the clinical surveillance group.

Among the patients assigned to TAVR, 8.4% died, compared with 9.2% of the patients in clinical surveillance. Stroke occurred in 4.2% versus 6.7%, respectively, and unplanned hospitalization for cardiovascular causes occurred in 20.9% versus 41.7%.

During a follow-up of about 3.8 years, 87% of patients in the clinical surveillance group underwent aortic valve replacement.

New refinements in the use of thrombolytics for stroke

Two studies shed light on the roles of clot-busting medications in helping people with blood clots in a large brain artery (called large-vessel occlusions, or LVOs) achieve maximal independence.

One study found that , a tissue plasminogen activator (tPA) — given before a minimally invasive procedure known as endovascular thrombectomy to remove the clot — improved patients’ odds of achieving functional independence.

The study, published in The New England Journal of Medicine, involved 550 people in China who obtained care within 4.5 hours after onset of an LVO stroke. Roughly half were treated with tenecteplase before thrombectomy. Nearly 53% (147 patients) in the tenecteplase group were functionally independent 90 days after treatment, compared with 44% (120 patients) who had thrombectomy without tenecteplase.

A second study, published in the Journal of the American Medical Association, found that could further enhance clot dissolution and recovery. In this trial of 324 patients with anterior-circulation LVO stroke, about half received intra-arterial alteplase following the procedure, while the remainder received standard post-thrombectomy care. The findings showed that intra-arterial alteplase improved functional outcomes, suggesting that targeted delivery of tPA after clot retrieval may offer additional benefit in selected patients.

Sleep: How it’s key to heart health

Getting a good night’s sleep every night is one component of the Ãå±±ÊÓƵ’s Life’s Essential 8™ checklist for improving and maintaining cardiovascular health.

Catching up on sleep during the weekend may help the heart, while “social jet lag” — the misalignment of one’s daily schedule to one’s circadian sleep clock — was weakly associated with incident coronary artery calcium (CAC), in a new study in the journal Sleep.

The research looked at the effect that those sleep scenarios may have on CAC, which can be a sign of accumulation of plaques in the body’s arteries even before symptoms appear. Scores reflecting CAC are typically derived from scans that show detailed images of the arteries that supply blood to the heart. Higher scores reflect higher amounts of calcium and suggest more severe buildup in the arteries.

Among more than 1,800 middle-aged adults, extending sleep time during the weekend was associated with lower five-year CAC scores, the researchers found. That suggests it benefits heart health, the scientists said.

Among participants who had 90 minutes or less of weekend catch-up sleep, nearly 32% had higher CAC scores over five years, compared with only about 19% of those getting more than 90 minutes of weekend catch-up sleep. No notable link was found between CAC scores and social jet lag.

In another study in Sleep, involving 360 adolescents (median age 16), scientists looked at . They found that irregular sleep days and resulting delayed sleep on following days were associated with unhealthy changes in heart rate variability (HRV).

This circadian misalignment of the sleep-wake cycle was notably linked with lower overall HRV, indicating worse heart health, in adolescents. Adolescents with delayed sleep on weekends while on school breaks and high sleep irregularity during weekdays while in school had variable HRV, particularly at night.

Circadian misalignment should be monitored and targeted early in life to prevent the development of future cardiometabolic disease, the authors wrote.

NOTE: Investigators who at some point in their careers have received research funding from the Ãå±±ÊÓƵ were among the authors of 12 of the 15 highlighted studies, a testament to the Association’s impact as the largest nongovernmental, nonprofit funder of cardiovascular and cerebral vascular research globally.