This year’s British Cardiovascular Society (BCS) Annual Conference – held in Manchester 2nd–4th June 2025 – focused on the risks in cardiology that affect patients, professionals, and society. Leading experts from around the world shared their insights into this important topic. George Cocks and Sarah Birkhoelzer report the conference highlights.
Introduction
The 2025 conference was opened by Professor Andre Ng (BCS President, and Professor of Cardiac Electrophysiology, University of Leicester) who celebrated its continued growth. He paid tribute to the late Professor Douglas Chamberlain CBE OStJ KSG, a former BCS President, and a former Consultant Cardiologist at Royal Sussex County Hospital, who was one of the ‘greats’ of cardiology. He leaves a legacy in resuscitation medicine and his pioneering work includes establishing Europe’s first paramedic unit.
Advancing preconception care in women with cardiovascular disease
Professor Deborah Lawlor (Professor of Epidemiology, University of Bristol) gave a compelling lecture on the growing risk faced by pregnant women with cardiovascular disease (CVD). She highlighted the rising prevalence of CVD in pregnancy, particularly in those with congenital1 or acquired disease, showing increased risk of preterm birth, small for gestational age infants, and low APGAR scores, especially among women with hypertensive conditions.2 She proposed that angiotensin-converting enzyme (ACE) inhibitors and beta blockers may reduce risks, such as gestational hypertension and pre-eclampsia, though findings for calcium channel blockers and thiazides remain inconclusive. Professor Lawlor called for proactive, multidisciplinary preconception care and emphasised the urgent need for better data on the safety and efficacy of cardiovascular treatments in pregnancy.
This lecture highlighted the need to understand the link between CVD and pregnancy outcomes, and that we need to obtain better evidence of the effects of medications in pregnancy – involving women and their partners in shared decision-making as much as possible.
Echocardiography in female athletes: a call for sex-specific data
Echocardiography is central to diagnosing and stratifying cardiovascular risk, yet much of the evidence base excludes women. Professor David Oxborough (Professor of Echocardiography and Cardiovascular Physiology, Liverpool John Moores University) highlighted sex disparities in sports-related sudden cardiac death (SCD), with women showing a 10–13 times lower risk than men,3 and SCD in women being more often associated with low-intensity sports and non-shockable rhythms.
The underlying mechanisms may involve hormonal, autonomic, and genetic factors. While arrhythmogenic cardiomyopathy is more common in male athletes, women had a 14% higher risk of sudden arrhythmic death syndrome (SADS).4 Elite female endurance athletes also face increased risk of atrial fibrillation (AF) compared to the general population in a matched cohort study.5 The new 2025 British Society of Echocardiography guidelines aim to address these disparities by refining cardiac assessment in young athletes, considering sex-specific remodelling patterns and body size metrics.6
Sex-specific gaps in valve disease diagnosis and management
Dr Alison Duncan (Associate Specialist, Royal Brompton Hospital, London) emphasised that women remain underdiagnosed and undertreated in CVD and under-represented in cardiovascular clinical trials. Sex-specific factors include later heart failure (HF) presentation, lower referral for advanced HF therapies, higher tricuspid regurgitation rates, higher rates of delayed/missed diagnoses, and worse clinical outcomes in acute coronary syndrome (ACS).7
She also highlighted the challenges of echocardiographic assessment in women due to their smaller heart size, which underestimates valve disease severity. Women also have higher ‘normal’ left ventricular ejection fraction (LVEF) ranges, yet elevated risk persists at 60–65%, compared to men at 50–55%. Women with aortic stenosis (AS) experience higher mortality, likely due to later diagnosis and delayed referral.8 Additionally, mitral regurgitation severity is underestimated in smaller female hearts, contributing to worse surgical outcomes. Dr Duncan made a call for increased awareness, sex-specific research, and tailored echo interpretation, highlighting that in valve disease, one size does not fit all.
Big data for better HF prevention
HF carries high morbidity and mortality, with a complex interplay of risk factors, complicating individual risk assessment. Professor Amitava Banerjee (Professor of Clinical Data Science, UCL, London) showcased how large-scale data can be used at a population level to guide effective primary prevention strategies for diseases such as HF. Using health records from over 170,000 patients, his team analysed 92 risk factors and found that one in six people with HF had either no recorded risk factors or ones not studied in trials,9 stressing the need for future trials to target clusters of risk rather than single variables. Professor Banerjee illustrated how big data can support this shift across research and population healthcare.
Risk stratification in stable angina
Dr Fizzah Choudry (Consultant Interventional Cardiologist, Barking Havering and Redbridge University Hospitals NHS Foundation Trust and Barts Health NHS Trust) presented the 2024 European Society of Cardiology (ESC) guidelines on chronic coronary syndromes, highlighting the risk factor-weighted clinical likelihood model which focuses on the number of risk factors and symptom scoring.
This approach reclassifies more patients into lower-risk categories, reducing the need for unnecessary testing. Diagnosis begins with clinical and echocardiographic assessment, followed by tailored testing, based on clinical likelihood, availability (noting significant geographical disparities in the UK), local expertise and patient characteristics/preference. CT coronary angiogram is preferred for low to moderate likelihood (5–50%), functional imaging for moderate to high (15–85%), and invasive angiography for very high (>85%) likelihood. However, uncertainty remains about the value and cost-effectiveness of screening for coronary artery disease in the general population.10,11
Recognising ANOCA: beyond the angiogram
Angina with no obstructive coronary arteries (ANOCA), also referred to as ischaemia with no obstructive coronary arteries (INOCA), describes angina-like symptoms and normal epicardial coronary artery blood flow (<50% stenosis) when investigated with coronary angiography. Dr Klio Konstantinou (Consultant Cardiologist, The Essex Cardiothoracic Centre) explored a diagnostic algorithm for ANOCA endotypes including endothelial-dependent and non-endothelial dependent coronary microvascular dysfunction, and epicardial vasospastic angina.
The CorMicA (Coronary Microvascular Angina) trial found that:
- up to 50% of patients with angina have non-obstructive disease
- targeted medical therapy based on pathophysiological endotype led to significantly improved angina scores and quality of life at six months.12
As ignoring ANOCA leads to repeated investigations, reduced quality of life, and adverse outcomes.13 Dr Constantinou called for routine use of functional coronary testing to diagnose ANOCA endotypes and to enable tailored treatment to significantly improve angina symptoms and quality of life.
Refractory angina: personalised approaches and emerging therapies
Refractory angina – persistent symptoms despite optimal therapy and revascularisation – is a growing clinical challenge. Dr Kevin Cheng (BHF Clinical Research Fellow, Imperial College London) reviewed key evidence showing that while mortality remains stable, these patients face reduced quality of life and greater healthcare utilisation.14 Research into innovative solutions is accelerating, with ongoing trials studying coronary sinus reducer therapy (e.g. ORBITA-COSMIC15) and trials are also assessing biologic therapy such as intracoronary administration for autologous bone marrow-derived cells in patients with refractory angina (e.g. REGENERATE-COBRA16).
NSTEMI in older adults: take home messages from the SENIOR-RITA trial
Professor Vijay Kunadian (Professor of Interventional Cardiology, Newcastle University) highlighted age-related disparities in non–ST-segment elevation myocardial infarction (NSTEMI) care. Although 50% of NSTEMIs occur in patients ≥70 years, only 14% of those ≥85 years undergo invasive coronary angiography, reflecting an age bias in guideline-recommended treatments for ACS.17 Randomised controlled trials (RCTs) often exclude older adults, lacking data on frailty, comorbidities, and cognition, leaving clinicians without guidance for this high-risk group. The SENIOR-RITA (Invasive Treatment Strategy for Older Patients with Myocardial Infarction) trial18 randomised 1,518 patients ≥75 years with NSTEMI to either invasive strategies or conservative management. While the invasive approach did not significantly reduce cardiovascular death or myocardial infarction (MI), it lowered nonfatal MI and revascularisation rates, with proven safety. This supports shared, personalised decision-making in older adults.
Obesity therapies in HF: learning from the ACC President
Dr Christopher Kramer (President, American College of Cardiology [ACC]) gave a contemporaneous session on emerging obesity therapies in CVD, particularly in the context of HF with preserved ejection fraction (HFpEF).19 While lifestyle interventions remain the first-line approach to weight loss, their long-term effectiveness in HF patients is limited. New pharmacotherapies, especially glucagon-like peptide-1 (GLP-1) receptor agonists and dual glucose-dependent insulinotropic polypeptide (GIP) and GLP-1 receptor agonists, have demonstrated significant benefits. He highlighted the SURMOUNT-120 and SURMOUNT-521 trials, where tirzepatide outperformed semaglutide in adults with obesity without diabetes, achieving >20% weight loss and reductions in waist circumference.
In addition to weight loss, Dr Kramer provided a summary of RCTs and the benefits of GLP-1 receptor agonists (table 1). While US practice increasingly embraces these agents, their use in the UK remains limited, constrained by cost, availability, and licensing. With oral agents like semaglutide on the horizon and broader therapeutic benefits established, the NHS risks falling behind unless adoption and infrastructure catch up with emerging global standards to address the growing burden of obesity and its associated comorbidities on a broader scale.
Table 1. Summary of clinical trials with GLP-1 receptor agonists
| Condition improved | Semaglutide | Tirzepatide |
| Type 2 diabetes mellitus | ✓ SUSTAIN trials22–28 | ✓ SURPASS trials29–32 |
| Prediabetes | ✓ STEP-1033 | ✓ SURMOUNT-120 |
| Cardiovascular disease | ✓ SUSTAIN-6,27 PIONEER-6,34 SELECT,35 SOUL,36 FLOW37 | SURPASS-CVOT (ongoing),38 SURMOUNT-MMO (ongoing)39 |
| HFpEF | ✓ STEP-HFpEF,40 FLOW37 | ✓ SUMMIT41 |
| MASLD/NAFLD | ESSENCE (ongoing)42 | ✓ SYNERGY-NASH43 |
| CKD | ✓ FLOW37 | TREASURE-CKD (ongoing)44 |
| OSA | Ongoing | ✓ SURMOUNT-OSA45 |
| Osteoarthritis | ✓ STEP-946 | STOP KNEE-OA (ongoing)47 |
| Key: ✓ = completed trials; CKD = chronic kidney disease; GLP-1 = glucagon-like peptide 1; HFpEF = heart failure with preserved ejection fraction; MASLD = metabolic dysfunction-associated steatotic liver disease; NAFLD = non-alcoholic fatty liver disease; OSA=obstructive sleep apnoea | ||
CVD and health inequality
The National Health Service (NHS) was founded on providing equitable care for all so it is vital that we work to identify any inequalities present with respect to care delivery and outcomes and also to aortic implement appropriate strategies to mitigate these differences. Dr Ramesh Nadarajah (Senior Research Fellow and Honorary Consultant Cardiologist, University of Leeds and Leeds Teaching Hospitals NHS Trust) presented National Cardiac Audit data showing the care variation of MI, HF, AF and AS.48
Key disparities include reduced access to invasive coronary angiography in older adults and women post-MI, longer diagnostic delays in HF, and less evidence-based treatment in AF. While patients from South Asian ethnicity receive similar MI care to patients of Caucasian background, data for HF and AF remain limited. Geographical-, age-, gender- and ethnicity-based inequalities in cardiovascular care persist across the NHS. Dr Nadarajah et al. suggest enhancing national cardiovascular care registries by using data to identify inequalities in care of patients with HF and AF to ensure ethnicity-specific reporting across all six National Cardiac Audits. They also propose establishing hospital networks based on local need, redistributing workforce roles, upskilling non-medical staff, and developing integrated teams across primary and secondary care.
BCS Lecture: the maths of life and death
Professor Kit Yates (Professor of Mathematical Biology and Public Engagement, University of Bath) delivered this year’s BCS Lecture focusing on how maths shapes healthcare decisions. He explained the impact of false positives, repeat testing, and risk framing. With audience participation, Professor Yates reflected on the good, as well as the harm, that national screening programmes do, and highlighted the need for clear communication and statistical understanding in patient care.
Young Investigators Award 2025
The popular Young Investigators Award was announced at the conference (table 2).
Table 2. The 2025 British Cardiovascular Society/British Heart Foundation/British Atherosclerosis Society/British Society for Cardiovascular Research Young Investigators Award
| Name | Affiliation | Abstract topic |
| Winner Dr Daniel Taylor |
Clinical Research Fellow (University of Sheffield) | Computed coronary microvascular resistance: optimisation, validation and application in a landmark clinical trial49,50 |
| Runner-up Dr Benn Jessney |
Cardiology SpR (Royal Papworth Hospital) and Clinical Research Associate (Cambridge University) | Artifact-corrected artificial intelligence-led intracoronary OCT analysis identifies plaque progression and vulnerability, drug efficacy and patient events51 |
| Runner-up Miss Maya Noureddine |
PhD Student (University of Birmingham) | Biophysical and functional characterisation of alpha-actinin-2 variants in hypertrophic cardiomyopathy52 |
| Runner-up Dr Henry Procter |
Cardiology Research Fellow (University of Leeds) | Therapeutic potential of the mitochondrial antioxidant mitoquinone (MitoQ) in the treatment of diabetic cardiomyopathy53 |
| Runner-up Dr Rahul Sanwlani |
Cardiovascular Biology Research Fellow (University of Surrey) | Myofibroblast-derived small extracellular vesicles are regulators of electrophysiology and mediators of hypertrophy in human cardiomyocytes54–6 |
Is conduction system pacing the new default?
Attendees enjoyed a debate between Dr Julian Ormerod (Consultant Cardiologist, John Radcliffe Hospital, Oxford) and Dr Badri Chandrasekaran (Consultant Cardiologist, Wiltshire Cardiac Centre, Great Western Hospital, Swindon) regarding conduction system pacing (CSP) and how it may represent the new standard of care for patients with conduction system disease, biventricular pacing indications and some instances of HF.
Dr Ormerod proposed that CSP, particularly left bundle branch pacing (LBBP), offers a more physiological alternative to traditional biventricular cardiac resynchronisation therapy (CRT). He highlighted a randomised study which enrolled 40 patients with non‑ischaemic cardiomyopathy and left bundle branch block, demonstrating that LBBP‑CRT produced greater improvements in LVEF, shorter QRS duration, and better functional class versus biventricular pacing (BiVP) over six months.57
In contrast, Dr Chandrasekaran urged restraint, noting that while it was encouraging, the quoted trial had only 40 participants, was a single‑centre design, and a relatively short (six‑month) follow-up, limiting its generalisability. He pointed out that most CSP data remain from small-scale or non-randomised studies, and that long-term device performance, lead stability, and reproducibility across varied operator experience remain uncertain. He also emphasised that some studies report no significant improvement in mortality and reminded us that current ESC58 and American Heart Association59 guidelines continue to endorse CRT (via BiVP) as the standard of care, given its established benefits on mortality, morbidity, and quality of life.
Both clinicians acknowledge CSP’s clear potential, especially in restoring native conduction and improving electrical synchrony, but agree that broader, multicentre RCTs with longer follow-up and clinical end points (e.g. mortality, hospitalisation) are needed before CSP can supplant CRT in guideline recommendations.
Conclusion
This year’s BCS conference highlighted that:
- we must address long-standing disparities affecting women and ethnic minorities—ensuring equitable access to diagnostics, personalised treatments, and representation in clinical trials
- sex-specific physiology and differential treatment responses demand tailored approaches, especially in valve disease and HF
- we must adopt advances in therapies such as GLP-1 receptor agonists which offer substantial potential in metabolic diseases beyond weight loss
- we must champion proactive care models, data-driven policy, and faster adoption of transformative treatments in NHS practice.
Conflicts of interest
GC: none declared. SB has conducted consultancy work for AstraZeneca.
George Cocks
FY2 Doctor, and Wessex FY2 Trust Representative
University Hospital Southampton NHS Foundation Trust
Sarah Birkholezer
Cardiology Registrar
University Hospitals NHS Dorset Trust
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