November 18, 2025: Adiposity, Heart Failure, and the Future of Cardiometabolic Care | JACC This Week

In the December 2, 2025 episode of JACC This Week, Editor-in-Chief Harlan M. Krumholz, MD, SM, introduces the Spotlight Issue, anchored by the manuscript "Global, Regional, and National Burden of Cardiovascular Disease and Risk Factors in 204 Countries and Territories, 1990–2023." Listen here as he reviews the issue and gives listeners perspective on the issue as a whole, which contains 19 viewpoints providing perspectives from experts around the world, plus his editor's page, aligned with a talk given at the UN with JACC Editor Emeritus Valentin Fuster, MD, and author Gregory A. Roth, MD. Other perspectives include: CVD in Sub-Saharan Africa; access to essential medicines and technologies; confronting inequities in pediatric cardiac care; and perspectives from Japan, Canada, the Middle East & North Africa, South America, Pakistan, and many others.  Listen to the podcast and then check out the full issue online here: https://www.jacc.org/toc/jacc/86/22.

JACC's November 25, 2025 issue kicks off Thanksgiving week with JACC Editor-in-Chief Harlan M. Krumholz, MD, SM, reflecting on his editor's page and the day he became a doctor (0:12).  For original research articles, he discusses a study on colchicine & clonal hematopoiesis, an exploratory study of the LoDoCo2 trial (1:10), and a paired editorial comment with more perspectives and a reminder of the upcoming COLCOT trial (4:33). Next, a study on Lp(a) and IL-6 (4:54) and an editorial (6:12), 30-year CVD risk percentiles based on the PREVENT equations (6:30), and an accompanying editorial from JACC Deputy Editor Erica Spatz, MD, on next-generation strategies to encourage healthier behaviors (7:35).  Other studies and editorials include a fascinating look at alcohol and blood pressure (8:04) and reinforcing the WHO public health guidance (10:05); remnant cholesterol in young adults (10:38) and implications for cholesterol guidelines (12:36). We also include four brief reports on RSV vaccine (13:11), long Covid (13:43), Lp(a) levels (14:06), the predictive power of polygenic risk scores (14:58), a viewpoint on US veterans (15:36), and our regular Amara Yad image (15:53), which we're delighted to be able to continue to promote with JACC: Clinical Electrophysiology Editor-in-Chief Kalyanam Shivkumar, MD.  

In the November 18, 2025 issue of JACC, Editor-in-Chief Harlan M. Krumholz, MD, SM, FACC, uses his editor's page to reflect on the evolving role of editors as partners with authors in strengthening cardiovascular science. The issue itself centers on adiposity, featuring multiple pooled analyses showing that waist-to-height ratio and waist circumference outperform BMI in predicting heart failure and mortality risk. Other highlights include a meta-analysis confirming GLP-1 receptor agonists' broad cardiovascular benefits, new insights into obesity's impact on biomarkers and disease interpretation, and several pieces, including state of the art reviews and viewpoints, on obesity-related conditions. Our issue focus on adiposity as a central driver of cardiometabolic disease shows the need for tailored, collaborative approaches to patient care and research. #stride #adipokinehypothesis

In this week's JACC podcast, Editor-in-Chief Dr. Harlan Krumholz explores how context, precision, and physiology converge to shape modern cardiovascular care. He opens with an editorial on "The Geography Gap," challenging the one-size-fits-all approach to cardiovascular risk models that ignore geographic variation in disease outcomes. Other featured studies in this issue include trials (OCEAN Mitral, PULSE), optimizing outcomes after transcatheter mitral repair, plus uncovering genetic links between placental malperfusion and congenital heart disease, evaluating CT angiography follow-up after left main PCI, and refining emergency triage with high-sensitivity troponin testing. Dr. Krumholz also speaks to editorials in this issue providing insight on the accompanying JACC articles, and a HeartBeat submission, with a reflection on balance and compassion in pediatric cardiology. Finally, he touches on our other JACC journal content, including new findings on blood groups and COVID-19 cardiovascular outcomes, and the first JACC: Basic to Translational Science Editor's page from the new editor-in-chief, Matthias Nahrendorf, MD, PhD, on the evolving landscape of translational science. This week in JACC highlights cardiology's movement toward more localized, integrated, and human-centered precision medicine.

In this special episode of JACC This Week, Editor-in-Chief Dr. Harlan Krumholz introduces the November 4, 2025 issue, entirely devoted to hypertension and the landmark 2025 HAC Multi-Society High Blood Pressure Guideline. He discusses key updates—from reaffirming lower blood pressure targets and expanding out-of-office monitoring to integrating hypertension within the cardio-kidney-metabolic framework. Dr. Krumholz highlights expert commentaries covering policy, technology, therapeutics, and prevention, emphasizing how this forward-looking issue aims to move beyond publication toward true implementation. The episode calls for a cultural shift—making uncontrolled hypertension a "never event" through better systems, teamwork, and innovation.

Dr. Harlan Krumholz introduces a JACC issue unified around the question of how low to target blood pressure, highlighting growing evidence that aiming near 120 mm Hg improves cardiovascular outcomes without harming quality of life. Several studies from the STEP and ESPRIT trials show that intensive blood pressure control widens retinal arterioles, lowers stroke risk, enhances well-being, and remains safe even in older adults. Long-term follow-up data demonstrate that early initiation of intensive therapy provides lasting cardiovascular protection, while new analyses using the PREVENT equations confirm that higher-risk patients gain the most absolute benefit. The issue underscores that intensive control is both safe and effective, and that the next challenge is implementing these proven strategies consistently in clinical practice.

JACC Editor-in-Chief Harlan M. Krumholz, MD, SM, introduces the October 21, 2025 issue of JACC, which is devoted entirely to Dr. Milton Packer's adipokine hypothesis.  Dr. Krumholz explains the rationale behind dedicating the issue to this bold conceptual framework, which proposes that dysfunctional visceral fat and its secreted adipokines drive HFpEF. We're also thrilled to present readers with 10 accompanying expert commentaries that explore, challenge, and contextualize the hypothesis.

This episode of JACC This Week, hosted by Harlan M. Krumholz, MD, SM, highlights key research and perspectives from the October 14, 2025 issue of JACC. It opens with a call to modernize physician certification by distinguishing core knowledge from clinical reasoning, emphasizing continuous, engaging learning over rote memorization. Featured studies in this week's issue include the cardiovascular risks linked to clonal hematopoiesis in older women, improved clotting outcomes with third-generation LVADs despite ongoing bleeding risks, and how dapagliflozin reduces heart failure events post-TAVI without improving perceived quality of life. The episode also explores inflammation as a target after myocardial infarction, the evolving role of drug-coated balloons in PCI, and cardiac CT's expanding use in prosthetic valve assessment—signaling a shift toward more precise, less invasive cardiovascular care. We also feature an article from JACC: Asia this week on cardiovascular Implications of lipoprotein(a) and its genetic variants in patients from the Middle East.

In the October 7, 2025 issue of JACC, Editor-in-Chief Harlan Krumholz discusses how artificial intelligence can enhance clarity in scientific writing—serving as a tool, not a ghostwriter—while maintaining author accountability. A major study shows that nearly all cardiovascular events occur in people with at least one risk factor, reinforcing the need for early detection and management. Emerging research highlights a percutaneous "debulking" technique that may safely manage infected cardiac device leads, and a revived cholesterol ester transfer protein (CETP) inhibitor showing promising lipid and event outcomes. Additional trials explore the benefits of starting combination therapy earlier in diabetes and kidney disease, and a state-of-the-art review revisits the evolving role of fibrinolysis across thromboembolic conditions.

In the September 30 issue of JACC, Editor-in-Chief Dr. Harlan Krumholz explores the concept of "computable quality" in healthcare, advocating for real-time, data-driven improvement in clinical care. He reviews original research on pop-up cardiovascular screenings in pharmacies and sporting events, AI-driven echocardiographic automation, and anticoagulation in pulmonary arterial hypertension. The episode also features a three-part debate on transcatheter aortic valve replacement (TAVR) in low-risk patients, highlighting evolving evidence, clinical implications, and calls for guideline reassessment. Tune in for insights on innovation, equity, and the future of cardiovascular care.