October 21, 2025 - The Adipokine Hypothesis, Adipose-Cardiac Signaling, Sex Differences, Therapeutic Implications, and Diverse Populations | JACC This Week

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 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.

In this episode, Editor-in-Chief Harlan Krumholz explores the evolving landscape of cardiovascular medicine, beginning with a call for responsible stewardship of artificial intelligence. Highlights include a major registry study on percutaneous aspiration for right-sided endocarditis, the predictive power of polygenic risk scores in heart failure, and the diverse causes of myocardial infarction in younger adults—especially women. The episode also covers a randomized trial on Intensive versus conventional intraoperative blood pressure management on cardiovascular events after major abdominal surgery, a state-of-the-art review on stressor-associated atrial fibrillation, and insights into long-term antithrombotic therapy after PCI. Each segment underscores the need for precision, equity, and innovation in clinical practice.

In this episode, Dr. Harlan Krumholz introduces the September 16, 2025 issue of JACC, which features studies that challenge conventional clinical thinking, including a detailed ECMO physiology study showing that higher ECMO flow does not uniformly raise pulmonary capillary wedge pressure, suggesting the need for individualized management. A novel analysis of the ISCHEMIA trial revealed distinct angina symptom trajectories, emphasizing that recovery is not binary and supporting a more personalized approach to treatment and monitoring. A landmark target trial emulation found that statins significantly reduce cardiovascular risk in patients with type 1 diabetes—filling a key evidence gap. Additional highlights include a call to redefine early cardiogenic shock, a nuanced review of moderate secondary mitral regurgitation, and an editorial reaffirming JACC's commitment to independent, transparent science in alignment with new "Gold Standard Science" principles.

In this episode, Dr. Harlan Krumholz reviews the September 9, 2025 issue of JACC, covering key studies on artificial intelligence in cardiovascular research, the effects of tirzepatide in heart failure with preserved ejection fraction (HFpEF), and how social, racial, and genetic factors influence heart failure risk. He discusses the growing burden of heart failure in the elderly, the need to disaggregate data in Asian American and Pacific Islander populations, and the role of rare genetic variants in atrial fibrillation outcomes. The episode also features perspectives on clinical trial design, complex case reports, and emphasizes the need for AI submissions to meet high standards of clinical relevance, feasibility, and long-term impact.

In the September 2, 2025 JACC This Week, Editor-in-Chief Harlan M. Krumholz, MD, SM, FACC highlights the issue. Listen here for a summary of our latest content, including new research on cognitive dysfunction in adults with congenital heart disease, a review of calcific aortic valve stenosis, and insights into cardiologists’ own lifestyle habits. We also have an article on the limitations of binary thresholds in cardiovascular risk assessment, as well as several articles reprinted from across the JACC journals.

In this week’s issue, Dr. Harlan Krumholz highlights new science with direct clinical implications: a randomized trial showing conduction system pacing outperforms RV pacing in AV block, a pragmatic study suggesting HEPA filtration may modestly lower blood pressure, and long-term data from FLAVOR comparing FFR and IVUS-guided PCI. Also featured are a state-of-the-art review on heart failure therapy implementation, a brief report refining NT-proBNP thresholds for pre–heart failure, and an updated JACC Report Card revealing persistent cardiovascular mortality disparities among Black Americans. The issue closes with reflections on equity, anatomy, and two complex case reports.

In this episode  of JACC This Week, Editor-in-Chief Dr. Harlan Krumholz explores device safety, abbreviated DAPT, drug-coated balloons, and a novel surgical polymer valve. Plus: expert insights on cardiovascular innovation, obesity management, fellowship signaling, and more.