Key result
ESC dyslipidaemia guideline authors show persistent conflicts of interest, rising to ~90% in 2025.
Why the study?
The National Academy of Medicine recommends that clinical practice guideline development group chairs have no conflicts of interest and that members with conflicts represent at most a minority. This study assessed whether these standards influenced the development of the ESC dyslipidaemia guidelines published between 2016 and 2025.
Observational (n=325)
A vast majority (84% to 95%) of authors and reviewers of the ESC dyslipidaemia guidelines between 2016 and 2025 reported conflicts of interest, including widespread direct personal payments, contradicting National Academy of Medicine standards for trustworthy guideline development.
Background In 2009, the National Academy of Medicine (NAM) in the United States published standards for developing trustworthy clinical practice guidelines recommending that “Whenever possible guideline development group members should not have conflicts of interest (COIs)… Members with COIs should represent not more than a minority of the guideline development group members. The chair or cochair should not be a person with COIs.” Aim of this study was to assess if the standards of the NAM have influenced the development of the guidelines for the management of dyslipidaemias of the European Society of Cardiology (ESC) published between 2016 and 2025. Methods From the ESC homepage, the declarations of COIs of task force members (TFM) and reviewers of the guidelines for the management of dyslipidaemias from 2016, 2019 and 2025 were retrieved. The number of COIs was assessed for each version of the guideline. Results Regarding the 2016 guidelines, 16/19 TFM (84%) indicated any COI (range 1-21). Overall, 141 COIs were reported (8.8 per member). 15/19 TFM (79%) received direct personal payments (6.9 COIs per member, range 1-20). The two chairpersons declared 16 and 4 COIs. Among the reviewers, 56/74 (76%) indicated any COI (6.4 COIs per reviewer, range 1-20). In 2019, 20/21 TFM (95%) indicated any COI (range 1-49). Overall, 188 COIs were reported (9.4 per member). 16/21 TFM (76%) received direct personal payments (7.3 COIs per member, range 1-20). The three chairpersons declared 6, 3 and 18 COIs. Among the reviewers, 69/88 (81%) indicated any COI (6.1 COIs per reviewer, range 1-23). In 2025, 18/20 TFM (90%) indicated any COI (range 1-30). Overall, 177 COIs were reported (9.8 per member). 14/20 TFM (78%) received direct personal payments (8.6 COIs per member, range 1-22). The three chairpersons declared 9, 4 and 11 COIs. Among the reviewers, 73/103 (71%) indicated any COI (6.0 per reviewer, range 1-20). Companies marketing Lipid-lowering drugs were those most frequently reported in the COI declarations of the TFM in 2025. Conclusion Despite the recommendations of the NAM, the proportion of TFM and reviewers of the ESC guidelines for the management of dyslipidaemias with COIs remains unchanged and 90% in 2025. The number COIs per TFM has increased continuously since 2016. 2025 received 78% of TFM personal payments. Since COIs can influence healthcare decision makers and may consciously or unconsciously influence choices made throughout the guideline development process, the ESC should follow the standards of the NAM.
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Stoellberger et al. (2026) conducted an observational in Dyslipidaemias (n=325). National Academy of Medicine (NAM) conflict of interest standards across 2016, 2019, and 2025 ESC dyslipidaemia guidelines vs. 2016 ESC dyslipidaemia guideline task force members and reviewers was evaluated on Proportion of task force members and reviewers declaring conflicts of interest (COIs) and number of COIs per member. ESC dyslipidaemia guideline task force members had high COI rates from 2016 to 2025 (84% vs 90%), with mean COIs per member rising from 8.8 to 9.8.
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