ESC Congress 2026: Day 2 Recap—6 Headlines to Know

Day 2 of the European Society of Cardiology (ESC) Congress 2026 in Munich, Germany, brought a run of practice-relevant trial readouts spanning primary prevention, undiagnosed atherosclerosis, novel anti-inflammatory and anticoagulant therapies, and antibiotic stewardship.

STAREE offered the first large trial of statins for primary prevention in older adults, while REACT exposed a substantial burden of silent atherosclerosis missed by standard risk tools. TRANQUILITY brought a new interleukin-6 (IL-6)-targeted antibody into chronic kidney disease (CKD), LIBREXIA ACS closed the book on milvexian for acute coronary syndrome (ACS), POET-II challenged decades-old antibiotic duration norms in endocarditis, and ENRICH-AF delivered a cautionary signal on anticoagulation after intracranial hemorrhage. Here is a rundown of the top 6 stories out of day 2.

1. STAREE: Statins reduce cardiovascular events but not disability in older adults

Atorvastatin reduced major cardiovascular events by 30% relative to placebo in adults 70 years and older without known cardiovascular disease, diabetes, or dementia, but did not significantly improve disability-free survival, according to results from the STAREE trial presented in a Hot Line session at ESC Congress 2026.

Investigators randomly assigned 9971 participants to atorvastatin 40 mg daily or placebo; over a median follow-up of 5.9 years, major cardiovascular events occurred in 6.0% of the atorvastatin group versus 8.3% with placebo (hazard ratio [HR], 0.70; 95% CI, 0.61-0.82; P <.001). The composite disability-free survival endpoint did not differ substantively between groups (HR, 0.94; 95% CI, 0.84-1.05; P = .25).¹

2. REACT: Silent atherosclerosis widespread, missed by standard risk tools

The REACT study found silent atherosclerosis in 57.1% of 16,808 adults 18 to 70 years old without known cardiovascular disease, using 3-dimensional vascular ultrasonography and coronary computed tomographic angiography.

Prevalence rose in an S-shaped curve with age, detectable in roughly 1 in 13 participants 18 to 29 years old and in 9 of 10 participants 60 to 70 years old. The SCORE2 risk tool classified only a small minority of participants with silent atherosclerosis as high risk, with a marked gap among younger participants.²

3. Pacibekitug sustains inflammatory biomarker reduction in CKD in TRANQUILITY trial

The phase 2 TRANQUILITY trial found pacibekitug, an investigational long-acting monoclonal antibody targeting interleukin-6 (IL-6), produced sustained, dose-dependent reductions in high-sensitivity C-reactive protein (hs-CRP) in 143 patients with CKD stage 3-4 and elevated inflammatory risk.

Median time-averaged change from baseline in hs-CRP through day 180 was -89% with pacibekitug 15 mg every 30 days, versus +7% with placebo (P <.0001). Pacibekitug was well tolerated, with few discontinuations and no clear dose-related safety signals.³

4. LIBREXIA ACS: Milvexian fails to reduce MACE after acute coronary syndrome

The factor XIa inhibitor milvexian did not reduce major adverse cardiovascular events (MACE) compared with placebo when added to standard antiplatelet therapy after a recent acute coronary syndrome (ACS), according to results from the phase 3 LIBREXIA ACS trial.

Among 14,194 randomized participants, the primary endpoint of cardiovascular death, myocardial infarction, or ischemic stroke occurred in 5.4% of the milvexian group versus 5.1% with placebo (HR, 1.05; 95% CI, 0.91-1.21; P = .50). Intracranial or fatal bleeding occurred at the same rate in both groups (0.3% vs 0.3%).⁴

5. POET-II: Tailored antibiotics could cut duration in endocarditis

A response-tailored antibiotic strategy reduced treatment duration by approximately one-third compared with standard therapy without compromising safety in 508 patients with left-sided infective endocarditis.

The tailored strategy cut median antibiotic duration to 26 days versus 41 days with standard therapy (P <.001), and the composite safety endpoint of mortality, unplanned valve surgery, or embolic events met prespecified noninferiority criteria (8.2% vs 10.7%). Primary relapse occurred more often with tailored therapy (5.1% vs 1.6%), though most relapses were managed with reinitiation of antibiotics.⁵

6. ENRICH-AF: Edoxaban increases bleeding without reducing stroke

Edoxaban did not significantly reduce stroke or systemic embolism but increased major bleeding in 948 high-risk patients with atrial fibrillation (AF) and a prior intracranial hemorrhage.

Over an average follow-up of 28 months, the primary endpoint occurred in 11.8% of the edoxaban group versus 12.8% with no anticoagulation (HR, 0.88; 95% CI, 0.61-1.26; P = .48), while major bleeding occurred in 11.6% versus 5.2% (HR, 2.23; 95% CI, 1.39-3.59; P <.001). Ischemic stroke and myocardial infarction were reduced with edoxaban, but this was offset by a nearly 3-fold increase in hemorrhagic stroke.⁶

References

1. European Society of Cardiology. Cholesterol-lowering medication reduces major cardiovascular events by 30 per cent in older people without known cardiovascular disease. Published August 29, 2026.

2. Bundgaard H, García-Lunar I, Kofoed KF, et al; REACT Investigators. Prevalence of silent atherosclerosis across adult life. N Engl J Med. 2026. doi:10.1056/NEJMoa2609059

3. European Society of Cardiology. Sustained reductions in inflammatory markers seen with novel antibody drug. Published August 29, 2026.

4. Steg PG, et al. Milvexian after Recent Acute Coronary Syndromes: The LIBREXIA ACS Trial. N Engl J Med. Presented at: ESC Congress 2026; August 29, 2026; Munich, Germany.

5. European Society of Cardiology. Reducing antibiotic courses by two weeks could be possible in patients with infective endocarditis. Published August 28, 2026.

6. European Society of Cardiology. Safer stroke prevention strategies are needed for patients with atrial fibrillation after intracranial haemorrhage. Published August 29, 2026.