Category: 8. Health

• Campaign will target 13 million girls aged 9–14 across Punjab, Sindh, Islamabad, and AJK
• Single-dose vaccine offers protection against cervical cancer, 2^nd most common cancer among Pakistani women
• Initiative makes Pakistan 150th country to introduce HPV vaccine, govt aims to vaccinate 18m girls in three years

ISLAMABAD: Pakistan is set to launch its first-ever national HPV vaccination campaign from September 15 to 27, 2025, marking a major public health milestone in the fight against cervical cancer, according to the Associated Press of Pakistan on Saturday.

The drive aims to vaccinate 13 million girls aged 9 to 14 across Punjab, Sindh, Islamabad, and Azad Jammu & Kashmir with a single-dose vaccine offering protection against the disease, APP reported, citing a press release here on Saturday.

To build momentum, the DOPASI Foundation, in partnership with FDI and supported by Gavi, The Vaccine Alliance, organized a strategic workshop on creating awareness for a cervical cancer-free Pakistan. The event brought together health experts, government officials, and development partners to highlight the vital role of private hospitals, doctors, and civil society in ensuring the campaign’s success.

Dr. Farhaj Uddin, Program Manager for the HPV campaign at DOPASI Foundation, said the Foundation is committed to raising awareness and supporting national efforts to vaccinate 13 million girls, stressing the importance of advocacy, communication, and community mobilization to address misconceptions, APP said.

Dr. Khurram Shahzad, Director Technical at FDI, emphasized that doctors’ voices remain most influential in countering myths and building trust, while DG Health Services CDA, Dr. Irshad Ali Jokhio, announced that HPV vaccine would be added to Pakistan’s basic immunization program, APP added.

WHO’s Dr. Rozeena Khalid noted that cervical cancer is the second most common cancer among women in Pakistan, with a mortality rate higher than breast cancer, underscoring that vaccinating adolescent girls is critical to reducing future cases. Dr. Saima Khursheed Zubair added that while the disease affects adult women, protection must begin with vaccination before age 15, APP stated.

Speakers underlined that Pakistan aims to vaccinate 18 million girls over the next three years, a target achievable only with the active participation of healthcare providers and civil society. Participants also acknowledged DOPASI Foundation’s leadership in mobilizing communities.

In closing remarks, Dr. Bilal Arshad, CEO Ali Medical Hospital, stressed that the role of doctors will be decisive in the campaign’s success. With this initiative, Pakistan will become the 150th country to introduce the HPV vaccine—an historic step to protect adolescent girls, prevent cervical cancer, and secure a healthier future.

Key take-aways 

• Novel biomarker-based risk scores, such as the ABC-AF scores, have been developed to estimate stroke and bleeding risk in patients with atrial fibrillation (AF). 
• The ABC-AF trial evaluated whether tailoring of treatment recommendations based on patients’ ABC-AF risk scores could improve clinical outcomes as compared with usual guideline-based care. 
• The individually tailored risk-based treatment strategy was not associated with reduced death, stroke or major bleeding compared with usual care. 
• These findings emphasise the need for prospective testing of the utility of risk stratification tools in different clinical settings before implementation in routine care. 

Madrid, Spain – 30 August 2025: An individually tailored multidimensional risk-based treatment strategy was not associated with improvements in clinical outcomes compared with usual guideline-based care in patients with atrial fibrillation (AF), according to late-breaking research presented in a Hot Line session today at ESC Congress 2025.¹ 

Patients with AF are at increased risk of stroke and are often treated with oral anticoagulant (OAC) therapy, mainly direct OACs or warfarin. While OACs substantially reduce the risk of stroke, they may also increase the risk of bleeding events. ESC Guidelines recommend that a risk-based approach is used to make decisions on OACs and other treatments for stroke prevention in patients with AF.²  

Several biomarker-based risk scores for stroke and bleeding have been developed. These include the biomarker-based ABC-AF-stroke score (Age, Biomarkers [NT-proBNP and hs-troponin T] and Clinical history of stroke/transient ischaemic attack) and the ABC-AF-bleeding score (Age, Biomarkers [growth differentiation factor 15, haemoglobin and hs-troponin T] and Clinical history of bleeding).  

Principal Investigator, Professor Jonas Oldgren from Uppsala University, Uppsala, Sweden, explained why and how implementation of these risk scores was assessed in the ABC-AF trial: “While novel biomarker-based risk scores have been validated in different populations, the clinical utility of risk scores to guide treatment decisions and improve clinical outcomes has rarely been prospectively evaluated. We performed a pragmatic registry-based trial to evaluate whether the tailoring of treatment recommendations based on patients’ ABC-AF risk scores improves clinical outcomes as compared with usual guideline-based care in patients with AF.” 

This open-label registry-based, randomised controlled study enrolled patients from 39 Swedish sites. Eligible patients were adults with a diagnosis of AF, including newly or previously diagnosed AF, with or without current OAC treatment. Patients were randomised 1:1 to either an ABC-AF risk score-guided treatment strategy or to standard of care. Plasma samples were obtained at randomisation and ABC-AF risk scores were automatically calculated based on the ABC-AF-stroke variables and the ABC-AF-bleeding variables. The investigator received a visual presentation of the ABC-AF risk scores along with specific treatment recommendations tailored to each individual patient. Based on this information, the investigator decided on medical treatments and other interventions. Patients in the control arm were managed in accordance with usual practices at the discretion of the investigator, without measurements of any ABC-AF risk score biomarkers and without individual treatment recommendations. The primary outcome was a composite of stroke or death. Data for study outcomes were retrieved from mandatory national registers with complete coverage of all in-patient care at Swedish hospitals and vital status for all Swedish residents. Enrolment was prematurely terminated owing to safety concerns with a trend towards higher mortality in patients with CHA2DS2-VASc scores of 3 or above.  

The intention-to-treat population comprised 3,933 patients who had a median age of 73.9 years and 33.6% were women. In total, 51.3% had paroxysmal AF, 11.2% had prior stroke or transient ischaemic attack and 85.7% had OAC treatment. 

After randomisation, the proportion of patients receiving any OAC increased to 97.8% in the active arm and 92.6% in the control arm (p<0.0001). In the active group, there were changes in the use of some direct OACs – increased use of apixaban and dabigatran, and reductions in rivaroxaban – and reductions in the use of warfarin. In the control group, there was increased use of apixaban, edoxaban and rivaroxaban, and reductions in the use of warfarin. In both study groups, the proportion of patients on antiplatelet treatment was halved and statin treatment increased. 

Over a median follow-up of 2.6 years, the primary outcome occurred at a similar rate between the groups: 3.18/100 patient-years (100PY) in the active group  and 2.67/100PY in the control group (hazard ratio [HR] 1.19; 95% confidence interval [CI] 0.96 to 1.48; p=0.12). 

There were no significant differences in the active vs. control groups in the rate of stroke (0.87/100PY vs. 0.74/100PY; HR 1.18; 0.78 to 1.79; p=0.44) or death (2.44/100PY vs. 2.02/100PY; HR 1.21; 0.94 to 1.55; p=0.13).  

Major bleeding events occurred at a similar rate in the active vs. control group (2.82/100PY vs. 2.61/100PY; HR 1.08; 95% CI 0.86 to 1.36; p=0.50). 

Professor Oldgren concluded: “We found no benefit of individually tailored, multidimensional treatment recommendations based on ABC-AF-stroke and ABC-AF-bleeding risk scores compared with usual guideline-based care in this study population who had lower-than-expected event rates. Due to premature termination of recruitment, the study was underpowered for its primary objective, but we will continue to follow-up randomised patients to assess any long-term effects. Overall, the results emphasise the need for prospective testing of the utility of risk stratification and precision medicine tools in different clinical settings before being implemented for tailoring of treatment in routine clinical care.” 

ENDS 

Notes to editor

This press release accompanies a presentation at ESC Congress 2025.  

It does not necessarily reflect the opinion of the European Society of Cardiology.  

ESC Press Office
Tel: +33 6 61 40 18 84   
Email: press@escardio.org

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Funding: The study was funded by the Medical Research Agency of Poland. 

Disclosures:  Professor Szczeklik reports no conflicts of interest. 

References and notes: 

1‘PREVENT-MINS trial: Ivabradine for prevention of myocardial injury after noncardiac surgery’ presented during HOT LINE 5 on 30 August 2025 at 17:45 to 17:55 in Madrid (Main Auditorium). 

2Vascular Events in Noncardiac Surgery Patients Cohort Evaluation Study Investigators. Association between complications and death within 30 days after noncardiac surgery. CMAJ. 2019;191:E830–E837. 

3Wijeysundera DN, Duncan D, Nkonde-Price C, et al. Perioperative beta blockade in noncardiac surgery: a systematic review for the 2014 ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines. J Am Coll Cardiol. 2014;64:2406–2425. 

About ESC Congress 2025 

It is the world’s largest gathering of cardiovascular professionals, disseminating ground-breaking science both onsite in Madrid and online – from 29 August to 1 September 2025. Explore the scientific programme. More information is available from the ESC Press Office at press@escardio.org. 

About the European Society of Cardiology

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Key take-aways 

• Many cases of cardiovascular disease are preventable through early detection and intervention.  
• In the DANCAVAS 2 population-based trial, being invited to undergo comprehensive cardiovascular screening did not significantly reduce the incidence of death among men aged 60 to 64 years compared with no invitation. 
• A higher incidence of severe bleeding in those invited for screening suggests aspirin should be used very selectively for primary prevention.  
• Further studies in women and different age groups may help to define if there is a cohort of individuals that derives mortality benefit from population-based cardiovascular screening.  

Madrid, Spain – 30 August 2025:  An invitation to attend a comprehensive screening examination for the early signs of cardiovascular disease (CVD) did not reduce all-cause death among men aged 60 to 64 years, according to late-breaking research presented in a Hot Line session today at ESC Congress 2025.¹ 

It has been estimated that 80% of cardiac events and strokes are preventable, around half of these through early detection and intervention.² Population screening is one approach to identify individuals with early signs of CVD, but there is limited evidence that it provides benefits in terms of reducing deaths. 

Principal Investigator of the DANCAVAS 2 trial, Professor Axel Cosmus Pyndt Diederichsen from Odense University Hospital, Odense, Denmark, said: “We have previously shown in the population-based DANCAVAS 1 trial that while inviting men aged 65 to 74 years to undergo cardiovascular screening did not significantly reduce the incidence of death overall, there appeared to be a reduction in a subgroup of men aged 65 to 69 years.3 We designed the DANCAVAS 2 trial to investigate the effects of population-based screening in even younger men – aged between 60 and 64 years – to see if death could be significantly reduced.” 

The population-based, parallel-group, randomised controlled DANCAVAS 2 trial included all men aged 60–64 years living in 18 municipalities in Denmark from August 2017 to November 2018 without any exclusion criteria. They were randomised 1:4 to receive an invitation to attend screening for subclinical CVD (the invited group) or not to receive an invitation for screening (the control group). Participants in the control group were blinded and were not aware of the trial. Intention-to-treat analyses were performed which compared control vs. all invited participants, whether or not they attended screening. 

Screening included non-contrast ECG-gated computed tomography (CT) to determine the coronary-artery calcium score and to detect aneurysms and atrial fibrillation, ankle-brachial blood-pressure measurements to detect peripheral artery disease and hypertension, and a blood sample to detect diabetes mellitus and hypercholesterolaemia. Statins and/or an antithrombotic agent (aspirin or clopidogrel) were prescribed based on the results of the screening tests. The primary outcome was death from any cause. 

In total, 31,268 participants were randomised: 25,322 to the control arm and 5,946 to the invited arm, of whom 3,720 attended and were screened (62.6%). In total, 33.5% of the invited group initiated an antithrombotic agent compared with 15.9% in the control group, while the initiation rate of statins was 44.3% and 30.3%, respectively.  

In intention-to-treat analyses, after a median follow-up of 7.0 years, 9.3% of men in the invited group and 9.9% men in the control group had died (hazard ratio [HR] 0.94; 95% confidence interval [CI] 0.86 to 1.03; p=0.169). 

Major adverse cardiovascular events (CVD-related death, stroke or acute myocardial infarction) occurred in 10.2% of participants in the invited group vs. 10.6% in the control group (HR 0.96; 95% CI 0.88 to 1.04), while 1.8% of participants in both groups experienced major adverse lower limb events (HR 1.01; 95% CI 0.82 to 1.24). CVD-related death occurred in 2.1% of participants in the invited group vs. 2.3% in the control group (HR 0.92; 95% CI 0.76 to 1.11). 

There was a significantly higher incidence in the invited group vs. control group of severe bleeding (6.0% vs. 5.1%; HR 1.18; 95% CI 1.05 to 1.32; p=0.007). This included intracranial bleeding (1.4% vs. 1.1%; HR 1.23; 95% CI 0.96 to 1.58; p=0.097) and gastrointestinal bleeding (4.8% vs. 4.1%; HR 1.18; 95% CI 1.03 to 1.34; p=0.014), respectively. 

In post hoc per-protocol analyses, attending screening reduced mortality by 17% (95% CI 2% to 29%; p=0.029), while there was no significant difference in major adverse cardiovascular events. 

Putting the findings into context, Professor Diederichsen noted: “The non-significant 6% reduction in death in men aged 60–64 years in the DANCAVAS 2 trial was less than the 11% reduction observed in the subgroup of men aged 65–69 years in the DANCAVAS 1 trial.³ The results may have been affected by those who were invited but did not attend screening. We could also speculate that screening slightly older individuals – around 67 years old – may be more beneficial. An important observation was the increase in severe bleeding seen in the invited group, which was likely due to higher aspirin intake and indicates that aspirin should be used very selectively for primary prevention in men aged 60–64 years, even in patients with coronary calcifications.” Regarding next steps, he concluded: “We included only men in DANCAVAS 2 because of a higher prevalence of screening findings in an earlier pilot study, but future population-based studies are warranted in women.” 

ENDS