Heart Health Horoscope: Genes, Biomarkers and Lifestyle Explained

The European Society of Cardiology (ESC) Congress 2026 placed new clinical guidelines and earlier Cardiovascular Prevention at the centre of scientific discussion, according to cardiologist and senior researcher Maria Rubini of the National Centre for Cardiovascular Research (CNIC), Madrid. In an interview following the meeting, Rubini highlighted changes to heart failure classification, new guidance on cardiovascular disease and chronic kidney disease, cardiac rehabilitation, the Fifth Universal Definition of Myocardial Infarction and findings from the REACT trial.

Rubini, who also served as a task force member for the Fifth Universal Definition of Myocardial Infarction, described the guideline updates as the major scientific highlight of the congress. She also pointed to the REACT trial as a study that could influence how clinicians think about primary prevention and the detection of silent atherosclerosis.

New ESC Guidelines Take Centre Stage at Congress 2026

According to Rubini, the new ESC guidelines were among the most important scientific developments presented at the 2026 congress. Several guideline updates addressed areas with major implications for cardiovascular care, including heart failure, chronic kidney disease and cardiac rehabilitation.

One notable change concerns the classification of heart failure. Rubini explained that the new heart failure guidelines remove the category of heart failure with mildly reduced ejection fraction, leaving two categories in the updated framework.

She believes the change could simplify clinical practice by reducing the number of categories clinicians need to navigate when assessing and managing heart failure.

Heart failure classification has traditionally incorporated left ventricular ejection fraction alongside clinical assessment and other characteristics. Changes to how patients are categorised can influence communication, treatment pathways and how clinical evidence is applied.

Heart Failure Classification Enters a New Phase

The revised approach highlighted by Rubini reflects the continuing evolution of heart failure terminology and classification. Ejection fraction remains an important measurement, but heart failure is a complex clinical syndrome that cannot be fully understood through a single number.

For clinicians, clearer categories can potentially make guidelines easier to apply at the point of care. At the same time, changes in terminology require careful implementation so that patients are appropriately assessed and treatment decisions remain grounded in the evidence behind each recommendation.

Rubini’s comments suggest that simplification was an important objective of the new framework, particularly as heart failure care continues to involve increasingly complex treatment options and patient profiles.

First ESC Guidelines on Cardiovascular Disease and Chronic Kidney Disease

Another major development highlighted by Rubini was the introduction of ESC guidelines specifically addressing the relationship between cardiovascular disease and chronic kidney disease.

The two conditions frequently intersect in clinical practice. Kidney disease and cardiovascular disease can influence each other, while patients living with one condition may require closer monitoring for the other.

The creation of dedicated guidance reflects the importance of approaching cardiovascular health in the context of a patient’s broader medical condition rather than treating individual organ systems in isolation.

For healthcare professionals, integrated guidance can provide a framework for considering cardiovascular and kidney-related risks together when making clinical decisions.

ESC Introduces Guidelines on Cardiac Rehabilitation

Rubini also identified the first ESC guidelines on cardiac rehabilitation as an important milestone from the congress.

Cardiac rehabilitation generally involves a structured approach to recovery and long-term cardiovascular health following certain cardiac conditions or procedures. Depending on the patient and programme, it can incorporate physical activity, risk-factor management, education and broader support for returning to healthier daily routines.

The inclusion of dedicated ESC guidance reinforces the role of rehabilitation as part of comprehensive cardiovascular care rather than viewing treatment as ending once an acute cardiac event has been managed.

Fifth Universal Definition of Myocardial Infarction

Another major scientific development discussed in the interview was the Fifth Universal Definition of Myocardial Infarction. Rubini was a member of the task force involved in developing the updated definition.

She described the document as offering a new perspective on how myocardial infarction is defined and said that it should help simplify clinical practice.

A clear and consistent definition of myocardial infarction is important because it affects how clinicians interpret patient presentations, classify cardiac events and communicate diagnoses. Definitions also provide a common framework for clinical research and the comparison of evidence across studies.

The updated definition therefore has implications beyond terminology, particularly when clinicians need to distinguish different types of myocardial injury and infarction in complex clinical situations.

REACT Trial Draws Attention to Silent Atherosclerosis

Among the late-breaking trials presented at ESC Congress 2026, Rubini singled out the REACT trial as particularly notable.

According to her account, the study found evidence of silent atherosclerosis in almost 60% of apparently healthy participants, including people at a very early age.

The finding is potentially important because atherosclerosis can develop before a person experiences obvious cardiovascular symptoms. A person who feels healthy may therefore still have underlying changes in their blood vessels.

Rubini believes the results could influence how clinicians think about primary prevention, particularly by encouraging greater attention to cardiovascular risk earlier in life.

Could Cardiovascular Screening Change?

One of the most interesting implications raised by Rubini concerns how atherosclerosis might be detected.

Traditional cardiovascular risk assessment commonly includes measures such as blood pressure, cholesterol and other blood tests, together with information about factors such as age, smoking, diabetes and family history. Rubini suggested that findings from the REACT trial could encourage greater consideration of imaging approaches, including ultrasound, in the assessment of atherosclerosis.

However, an important distinction remains between identifying disease in a research setting and recommending a screening test for the general population. A finding that a condition is common among apparently healthy people does not automatically establish that widespread imaging screening improves outcomes.

Before any major change to population screening practices, clinicians and health systems would need to consider factors such as test accuracy, cost, accessibility, potential false-positive findings, downstream testing and—most importantly—whether earlier detection leads to better health outcomes.

Earlier Prevention Could Become a Bigger Focus

Rubini’s interpretation of the REACT findings also raises a broader question about when cardiovascular prevention should begin.

Many cardiovascular prevention strategies already focus on identifying and managing risk factors before the first heart attack or stroke. The possibility of detecting atherosclerosis at an earlier stage could potentially expand that conversation.

Rather than waiting for symptoms or a cardiovascular event, prevention could increasingly focus on identifying risk earlier and supporting appropriate interventions over a longer period.

That does not mean that every young person requires advanced cardiovascular imaging. Instead, the findings highlighted by Rubini may contribute to ongoing research into how clinicians can identify people at elevated risk while avoiding unnecessary testing in people unlikely to benefit.

What the ESC 2026 Discussions Could Mean for Patients

The developments discussed by Rubini span several stages of cardiovascular care—from prevention and diagnosis to treatment, rehabilitation and long-term management.

• Heart failure: Updated classification may simplify how clinicians describe and approach heart failure.
• Cardiovascular and kidney health: New guidance recognises the close clinical relationship between cardiovascular disease and chronic kidney disease.
• Cardiac rehabilitation: Dedicated ESC guidance reinforces rehabilitation as an important component of cardiovascular care.
• Myocardial infarction: The Fifth Universal Definition aims to provide an updated framework for defining myocardial infarction.
• Primary prevention: REACT findings highlighted by Rubini may encourage further investigation of cardiovascular disease before symptoms develop.
• Atherosclerosis detection: Imaging may receive greater research attention as a potential tool for identifying silent disease, although broader screening implications require further evidence.

The Growing Importance of Preventive Cardiology

The themes highlighted by Rubini reflect a broader shift in cardiovascular medicine towards prevention and earlier identification of disease.

Heart attacks and strokes can sometimes appear to be sudden events, but the underlying vascular disease may develop over many years. Risk factors such as high blood pressure, abnormal cholesterol, diabetes, smoking and other health conditions can contribute to cardiovascular disease long before symptoms appear.

Understanding how to identify people at meaningful risk—and how best to intervene—is therefore a central challenge for preventive cardiology.

The REACT findings described by Rubini could add another dimension to this discussion by drawing attention to the possibility of detectable but clinically silent atherosclerosis. The key question for future research will be how such information can be used effectively without creating unnecessary testing or treatment.

Why the 2026 ESC Guidelines Matter

For clinicians, guidelines provide a structured way to translate evolving scientific evidence into clinical practice. Their importance lies not only in introducing new recommendations but also in clarifying terminology, integrating evidence and helping healthcare professionals make consistent decisions.

Rubini’s comments indicate that ESC Congress 2026 was notable for guideline developments across several connected areas of cardiovascular medicine. Heart failure, chronic kidney disease, cardiac rehabilitation and myocardial infarction each represent different aspects of cardiovascular care, yet they frequently intersect in real-world patients.

The combination of updated guidance and new trial evidence could therefore shape ongoing discussions about how cardiovascular disease is identified, classified, treated and prevented.

Conclusion

The ESC Congress 2026 highlighted significant developments across cardiovascular medicine, with new guidelines emerging as one of the meeting’s major scientific themes, according to Maria Rubini.

Changes to heart failure classification, the first ESC guidance on cardiovascular disease and chronic kidney disease, new cardiac rehabilitation guidelines and the Fifth Universal Definition of Myocardial Infarction all point towards efforts to refine and simplify cardiovascular care.

Meanwhile, the REACT trial drew attention to the prevalence of apparently silent atherosclerosis and raised questions about whether cardiovascular prevention and disease detection should begin earlier in life. While the findings may stimulate further research into imaging-based assessment, they do not by themselves establish a need for routine screening of the general population.

Overall, the discussions described by Rubini underline an increasingly prevention-focused approach to cardiology—one that aims not only to treat cardiovascular disease after it develops but also to identify risk and disease earlier where evidence supports doing so.

Source: Interview with Maria Rubini, Cardiologist and Senior Researcher, National Centre for Cardiovascular Research (CNIC), Madrid, Spain, published in EMJ Cardiology, 30 September 2026. DOI: 10.33590/emjcardiol/8A486P8Y.

Medical Disclaimer

This article is for general health and educational purposes only and does not constitute medical advice. Research findings and guideline changes should be interpreted in their full clinical context. Patients should speak with a qualified healthcare professional about cardiovascular screening, diagnosis and treatment based on their individual risk factors and medical history.

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