HS and Heart Health: Why the New European Guideline Recommends Cardiovascular Checks

Not: “HS doubles your risk of dying from heart disease.” Instead: people with HS have higher rates of several cardiovascular risk factors and events in observational studies — and the new European guideline therefore recommends a cardiovascular risk assessment at the first visit and then at least annually.

The difference between those two sentences is the entire point of this article. The evidence justifies attention, not alarm — and attention translates into something quite concrete: a recurring, unremarkable check that’s already part of general preventive care.

This article walks through what the new guideline says on this topic, what the underlying evidence shows, and what you can specifically raise with your GP. For the full breakdown of mechanisms and figures, it points to the existing, more detailed article on metabolic syndromeMetabolic Syndrome: A cluster of cardiovascular risk factors — central obesity, raised blood pressure, raised fasting glucose, abnormal cholesterol. Significantly more common in Acne Inversa patients than in the general population, independent of weight alone.Metabolic SyndromeA cluster of cardiovascular risk factors — central obesity, raised blood pressure, raised fasting glucose, abnormal cholesterol. Significantly more common in Acne Inversa patients than in the general population, independent of weight alone.Read more in the glossary and HS.

For information only. This article explains a screening recommendation from current guidance. It cannot assess your individual cardiovascular risk and does not replace a clinical assessment.

Key takeaways

• The new European S2k guideline (2026) recommends a cardiovascular risk assessment in HS at the first visit and then at least annually.
• That rests on observational studies showing higher rates of cardiovascular risk factors and events in HS groups than in comparison groups — a group-level association, not an individual prediction.
• The recommended check is mostly general-practice routine: blood pressure, history, lipids depending on risk profile.
• A cardiology referral isn’t routinely needed — it makes sense for specific symptoms or a substantially elevated risk.
• This preventive care is already something you’re entitled to; HS is one more reason not to overlook it, not a new special service.

What the new guideline actually says

As described in the companion article on comorbidity screening, the new European S2k guideline (Part 1, 2026) assigns several comorbidityComorbidity: An additional condition existing alongside the primary disease. Acne Inversa is frequently associated with comorbidities including metabolic syndrome, inflammatory bowel disease, spondyloarthritis, and depression.ComorbidityAn additional condition existing alongside the primary disease. Acne Inversa is frequently associated with comorbidities including metabolic syndrome, inflammatory bowel disease, spondyloarthritis, and depression.Read more in the glossary areas an explicit recommendation about timing. For heart and circulation, that recommendation is: at the first visit and then at least annually. That places HS in a category treated with a recurring, routine rhythm — similar to general preventive care, not a rare special investigation.

That’s a step forward from the predecessor guideline of 2015, which named cardiovascular and metabolic comorbidities but without a comparable framework for exactly when a check should happen.

What the evidence shows — briefly

The cardiovascular dimension of HS is one of the best-supported comorbidity associations of all:

• A population-based cohort study found roughly double the risk of major adverse cardiovascular events and 1.7- to 2-fold higher cardiovascular-related mortality in HS compared with control subjects.
• Metabolic syndrome — a cluster of obesity, high blood pressure, dyslipidaemia and disrupted glucose metabolism — occurs roughly four times more often in people with HS than in comparable control groups.
• The increased risk isn’t explained by obesity alone: even after adjusting for BMI, HS contributes independently to cardiovascular risk, a pattern consistent with chronic systemic inflammation as its own risk factor.

These figures are group-level associations from observational studies. They say these events were found more often in HS populations than in comparison groups — they say nothing about your own personal likelihood, and they don’t prove that HS caused a heart condition in any one person. For the full derivation of these figures, the biologicalBiologic: A class of medications derived from living cells that target specific components of the inflammatory process. For Acne Inversa, biologics such as adalimumab and secukinumab are used when other treatments are insufficient.BiologicA class of medications derived from living cells that target specific components of the inflammatory process. For Acne Inversa, biologics such as adalimumab and secukinumab are used when other treatments are insufficient.Read more in the glossary explanation, and treatment implications, see the companion article on metabolic syndrome and HS.

What this means for your preventive care

The cardiovascular risk assessment the guideline recommends is mostly what already belongs to general preventive care:

• Blood pressure measurement — a regular part of any GP check-up, regardless of age.
• History and risk factors — smoking status, family history, activity level, other known conditions.
• Blood lipids — routinely included from age 35 as part of the general health check-up; before that, depending on individual risk profile.

None of this is an HS-specific special test. The point of the new guideline isn’t to invent a new investigation, but to make sure this existing preventive care doesn’t get overlooked in people with HS — for instance because appointments focus mostly on the skin.

What you can say to your GP

One possible way to open the conversation:

“I have HS (hidradenitis suppurativa). The new European guideline on it recommends checking cardiovascular risk at the first visit and then at least annually. Could we quickly check whether my blood pressure and other risk factors are up to date?”

That isn’t a demand for a specific test — it’s an invitation to put the topic explicitly on the agenda, something that can easily get lost when an appointment is entirely about the skin.

What this does not mean

• It doesn’t mean you have, or will develop, a heart condition.
• It doesn’t mean you routinely need cardiology in addition to your GP.
• It isn’t a reason to order your own blood tests or insist on a specific test without a clinical assessment behind it.
• A single elevated odds ratio from an observational study is not a personal risk number for you.

What the evidence does not show

Current evidence does not show that:

• every person with HS has an elevated individual cardiovascular risk;
• one specific test or interval is equally appropriate for everyone regardless of age and risk profile;
• effective HS treatment reliably lowers cardiovascular risk in HS — the evidence for that is suggestive so far, not conclusive.

The bottom line

The new European guideline turns a years-known association — HS and elevated cardiovascular risk — into a concrete, recurring recommendation: at the first visit, then at least annually. That isn’t a reason to worry; it’s an invitation not to let preventive care you’re already entitled to slip because attention is on HS appointments. The useful next step is rarely a new test — usually it’s just asking whether the existing one is still up to date.