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About a decade ago, a group of climate scientists described five scenarios for the future. Called the Shared Socioeconomic Pathways (SSPs), these scenarios suggest how socioeconomic development could evolve in worlds with differing challenges to climate adaptation and mitigation. 

One SSP, “Sustainability,” envisions a collective shift toward green energy, reducing economic inequities and investments in research and development. Another, “Regional Rivalry,” paints a picture of a world riven by nationalism and fighting over resources. In that future, high levels of conflict stifle economic development. Rich countries see slower population growth, while birth rates increase in poorer nations. 

Scientists and policymakers use SSPs to project how today’s choices affect tomorrow’s world. But for complex subjects like public health, these intentionally simple scenarios don’t capture every complexity. Under the SSP “Fossil-Fueled Development,” for example, the world doubles down on fossil fuels, spurring rapid economic growth. That growth, according to the scenario, would spur investments in education and health. But at the same time, increased emissions would degrade the environment, exacerbating health risks.

That description leaves many public health questions unanswered: Would hospital systems be better prepared to handle the increased volume? Could more frequent heat waves lead people to spend more time inside, amplifying mental health burdens? 

Last year, a group of 63 experts in climate change and health met in Vienna to extend the SSPs to better reflect the dynamic nature of public health over the course of the century. Their expanded narratives, published Oct. 5 in The Lancet Planetary Health, provide comprehensive visions of possible population health and health system development and explore how communities might better prepare for shifting future health risks.

Carole Green, a UW doctoral student in environmental and occupational health sciences, attended the workshop and is lead author of the accompanying paper. UW News sat down with Green to talk about where previous climate scenarios fell short, the conference’s work and how we can better prepare to keep each other safe in an uncertain future. 

What are the Shared Socioeconomic Pathways, and how do we use them? 

Carole Green: Shared Socioeconomic Pathways are a narrative framework that can be used in conjunction with pathways of greenhouse gas emissions to project future climate impacts to 2100. The SSPs are basically descriptions of the societal choices that affect the magnitude and pattern of interventions to protect human health and well-being.

The SSPs are essentially five possible alternatives for our future world. These pathways have been expanded to incorporate a wide range of issues of relevance for public health, and have been downscaled to describe what the future might look like in different countries and regions.

SSPs are featured in global processes like United Nations climate conferences, where negotiators come from around the world to debate and agree on approaches to build resilience and sustainability to climate changes. The models help us understand how those choices interact and what the effects might be. 

We also use the SSPs in health research to understand the possible magnitude and geographic pattern of health impacts from climate change over the course of this century. Many projects at UW use future warming levels to analyze things like future wildfire impacts on Washington residents (research done by UW’s Climate Impacts Group). 

What do the SSPs leave out? 

CG: SSPs assume that humans will make socioeconomic changes in the future. The changes described in the pathways originally quantified GDP and population changes. Our work adds complexity, specifically to understand how the future of public health could evolve under these five pathways.

A lot of people are interested in heat waves, for example. Climate modeling alone can capture the planet’s warming, but doesn’t consider issues like how access to hospitals and healthcare could change by 2100. Current heat wave modeling looks at the climate interactions that shape health impacts but don’t explore how concurrent changes in society could interact with climate change to impact people’s well-being. 

Once you added complexity into the SSPs, what changed in your understanding of possible futures? Did you learn anything new or surprising?

CG: We learned that the drivers of health impacts are complex, and many are neither entirely good nor bad. Prioritizing sustainability, mitigation and adaptation will not necessarily lead to the best world for each future health outcome, but it definitely affects the future of health and well-being. Health futures we face globally are not predetermined. Different pathways could lead to vastly different health outcomes, with governance, health-system capacity, resources, equity, and cross-sectoral factors such as water and energy playing critical roles.

For example, under one of the scenarios, people don’t prioritize reducing greenhouse emissions, focusing instead on adapting to the changing climate. Strong investment in technology leads to quite a lot of wealth, which can benefit some health outcomes. But it’s not ideal, because people would also have to spend more time indoors because of the growing heat burden and would have to reduce connection to the outdoors and nature. You really don’t want to live in that scenario.

It’s very much a mix, which is challenging. 

Now that we have these fleshed-out scenarios, what does that allow us to do? 

CG: It allows us to have a more complex understanding of future health risks from climate change. Now we can add a layer of understanding and think about more variables than just warming levels and population numbers. It’s made of a lot of complexities that affect health, and those have their own effects.

In future climate scenarios, what does access to healthcare look like? What is the extent of food insecurity? How are we making sure people have access to clean air and water? When we have some understanding of those interactions, then it can motivate decision-makers to develop appropriate policies. 

What comes next? 

CG: We will apply these narratives to six different countries where there has been limited research using the SSPs. We’re working in Brazil, Senegal, South Africa, India, Vietnam and the Solomon Islands. We’ve started identifying key leads across these countries, where there is quite an appetite for this research. All countries are required to develop national health adaptation plans and to conduct vulnerability and adaptation assessments. They are also interested in modeling future health risks. We want to explore the extent to which the SSP narratives apply in their country’s context. Do they fit? How would they look different? There’s a lot of interest in building on local knowledge and bringing local experts together to talk about possible futures. 

We’re also quantifying specific disease burdens, universal healthcare access, water and sanitation infrastructure and digital health. Some quantifications will look at pairing SSPs with certain warming levels to project impacts. 

Last question: This group — including dozens of the world’s leading experts on climate and health — chose you to write the paper. How did that happen? 

CG: I am definitely not the leading expert in that room, so it was very much an honor to work on this and lead the writing. A lot of it comes from my advisor, Kristie Ebi, who is very supportive of me and my work. That’s been really meaningful. She encouraged me to take this on.

I often tell people that my job is to listen to experts and write down what they say. It was very meaningful to get to make those connections. 

For more information or to reach the researchers, contact Alden Woods at acwoods@uw.edu. Other UW authors include Dr. Jeremy Hess, professor of environmental and occupational health sciences, of global health, and of emergency medicine in the UW School of Medicine; and Helen Pineo, research associate professor of urban design and planning.

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New capybara fossil changes the forecast for the ancient Atacama region

Capybaras like their habitats wet. These large rodents thrive in low-elevation wetlands, migrating along creeks and rivers to nibble on foliage and flowers. That’s why researchers were surprised to find an 8.8 million-year-old fossilized capybara tooth in northern Chile’s Atacama Desert, one of the driest regions on Earth. In a paper published Sept. 5 in Scientific Reports, researchers postulate that the Atacama Desert must have had a wetter climate during the Miocene epoch, based on this discovery. This is the first time a capybara species has ever been seen in the Atacama region of Chile — today these creatures reside in the marshy lowlands across Venezuela, Colombia, Argentina and Uruguay. Researchers had at one time assumed that the Andean mountain chain on the eastern side of Chile would have prevented these short-legged rodents from ever entering the Atacama region. With this discovery, the authors propose that capybaras were able to follow a wetland trail along the northern part of South America, trekking from Bolivia to Peru into northern Chile. In addition to capybaras, the ancient Atacama region also likely had palms and other flowering plants, according to plant fossils analyzed by a UW scientist for the study. These findings challenge the idea that the Atacama was just always a desert, and can help researchers better understand how shifts in climate can drastically affect the environment.

For more information, contact co-author Caroline Strömberg, UW professor of biology, at caestrom@uw.edu.      

A full list of co-authors and funding is included in the paper. Adapted from a release from the University of Arizona.

Multitasking gives marine microbes an edge when nutrients are scarce

The world’s oceans teem with tiny organisms that are difficult to study yet critical to account for. The organisms that make up this microscopic community, many of which are protists, have evolved over time to help keep marine ecosystems balanced. A UW study published Sept. 11 in the ISME Journal, found that organisms that can both photosynthesize and eat to generate energy do better in nutrient-limited environments, which includes warmer water. This flexibility may help them cope with changing conditions and could help researchers gauge how marine ecosystems will respond to future warming. Gathering more data from the bottom of the food web is important for understanding the ecosystem-wide impacts of environmental change. The study also debuted a new genetic method for studying energy production versus consumption that may make it easier to study protists. Samples in this study were collected from the North Pacific, near Hawaii and about 1,000 miles north, but the researchers hope to continue expanding the radius to improve global ocean models.

For more information, contact Sacha Coesel, UW research scientist and engineer of biological oceanography at coesel@uw.edu.

The UW co-authors are Shiri Graff van Creveld, Francois Ribalet and Virginia Armbrust. A full list of co-authors and funding is included in the paper.

UW engineers capture behavior of ‘edge waves’ on beaches, putting popular wave models to the test

Coastal engineers and oceanographers often think of the motion of water on beaches as “one dimensional”: waves propagating directly onto the beach from offshore. These simplified wave models are used widely from designing shoreline infrastructure to forecasting coastal flooding. However, some waves propagate along the coast rather than crashing into it, and may push an additional meter of water depth onto the beach. For decades, these “edge waves” have not been accounted for in the one-dimensional models commonly used to understand wave behavior. To find out how edge waves might be impacting model accuracy, researchers at the UW and UC San Diego deployed an array of pressure and velocity sensors along a beach in Southern California for 60 days. In a paper published Sept. 4 in JGR Oceans, the researchers describe a model they built to tease out the influence of edge waves in the larger system. While edge waves contributed a significant amount of energy, the team found that ultimately the one-dimensional models that exclude edge waves remain accurate enough for predicting total water levels at the shoreline.

For more information, contact Cassandra Henderson, a postdoctoral scholar of civil and environmental engineering, at cshender@uw.edu.

A full list of co-authors and funding is included with the paper.

How Colombian environmentalists use law and democracy to redefine mountain landscapes

In 2013 and 2017, Colombian voters in two towns backed a legal effort to stop a large-scale gold mining project. In doing so, they are making the mountainous areas where they live more visible and politically relevant. The decision allowed environmental advocates to organize around a larger area defined by elevation, massive volume, and subterranean and arboreal features. Ángela Castillo Ardila, UW assistant professor of anthropology, recently published a research article in the journal Anthropological Forum that examines how the effort used legal tools for citizen participation to not only voice their opinions on extractive projects, but also reconfigure space in unprecedented ways. The case shows that democratic participation can have far-reaching consequences for how landscapes are defined and lived. The article appears in a special issue, called “Ethnographies of Vertical and Volumetric Worlds,” which was co-edited by Ardila and Steven Schwartz of the University of Rochester.

For more information, contact Castillo at acastil@uw.edu.

Funding information is included in the paper.

Researchers develop new way to measure how blood clots form

A wound stops bleeding because tiny blood cell fragments called platelets clump together to form a clot. Researchers know that platelets generate forces that help compact and strengthen clots. However, they’ve struggled to understand how blood clots form in real time. To better understand this system, UW mechanical engineers created a device that measures how platelet forces and stiffness evolve together during the first minutes of clot formation. In a paper published recently in Advanced Healthcare Materials, the research team used the device to apply magnetic forces to clumps of platelets, causing them to strengthen and stiffen through a process called “mechanotransduction” in which cells convert mechanical forces into biological responses. These findings could be used to study how new drugs affect clot formation, how platelets respond to signals when disease is present, and how blood clotting biomechanics contribute to cardiovascular disorders.

For more information, contact Nate Sniadecki, a UW professor of mechanical engineering, at nsniadec@uw.edu.

The UW co-authors are Nikita Taparia, Ava Obenaus, Yoeur-Man Mach and Nakul Sridhar. A full list of co-authors and funding is included with the paper. Adapted from a story by UW mechanical engineering.

UW researchers probe superconducting materials that defy expectations

Most materials resist the flow of electricity to some degree, but unusual materials known as superconductors can carry an electric current with no resistance at all. Superconductors offer a unique window into the physics of materials at tiny scales, and they could one day revolutionize electronics. In recent years, researchers have discovered new forms of superconductivity in stacks of atomically thin materials such as graphene. Resistance typically drops to zero as these materials are cooled, but in some cases it mysteriously levels off at a small finite value, which contradicts expectations of superconductor behavior. In a paper published Sept. 23 in Nature, UW materials scientists tested this behavior with a device consisting of several layers of graphene stacked in a staircase-like pattern. By adjusting voltages applied to the device, the researchers could control whether the graphene exhibited true superconductivity or the more peculiar “failed” form, providing clear evidence that failed superconductivity is real. The team is now working to uncover the origin of this mysterious behavior.

For more information, contact Matthew Yankowitz, a UW associate professor of both physics and materials science and engineering, at myank@uw.edu..

The UW co-authors are Anna Okounkova, Abigail Sohm, Manish Kumar and Derek Waleffe. A full list of co-authors and funding is included with the paper.

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A city’s sewers say a lot about its residents. Sick people often shed pathogens in their waste, adding traceable amounts of bacteria and viruses into wastewater. Testing that wastewater offers a simple, low-cost way to monitor the spread of disease — a practice that began with polio in the 1940s and became more widespread during the COVID-19 pandemic. Today, the CDC’s wastewater monitoring program tests for a variety of common and emerging viruses.

American public health agencies don’t routinely test wastewater for sexually transmitted infections, but new research led by the University of Washington and the Washington State Department of Health found that such methods could be used to effectively identify Chlamydia trachomatis, the bacteria that causes chlamydia.

The study, published Aug, 7 in ACS ES&T Water, could help public health agencies better identify and respond to increased spread of chlamydia and other STIs, which are notoriously underreported in traditional data. The researchers specifically explored wastewater’s potential as a community monitoring tool, and not as a way to identify cases or trace pathogens back to individual people or locations.

“STIs are known for being underreported because of a lot of factors, especially stigma and the prevalence of asymptomatic cases,” said co-lead author Erica Fuhrmeister, assistant professor of environmental and occupational health sciences and of civil and environmental engineering at the UW. “Wastewater is cool because it’s population level. You don’t need people to go to the doctor and seek out treatment to know that there are people in a community shedding specific pathogens.”

Working in collaboration with local health jurisdictions, researchers collected frequent samples from influent wastewater at five wastewater treatment plants across Washington state and six neighborhood-level sewer sites near Seattle. Collection sites ranged from a large, high-population urban area to a rural treatment plant serving fewer than 5,000 people. Researchers masked the specific names and locations of sample locations to protect the privacy of people and communities.

Researchers tested wastewater samples for the pathogens that cause three common STIs: chlamydia, syphilis and gonorrhea. C. trachomatis was the most prevalent pathogen across all test sites. The bacteria that cause gonorrhea and syphilis were found far less frequently, despite data showing confirmed cases of those diseases in the associated areas. 

Further research could reveal why tests captured C. trachomatis more consistently than other STI-causing bacteria and explore the study’s limitations, which included people moving between sewer sites and the influence of demographics.

The researchers are also eager to investigate several trends they observed in the data, such as spikes in pathogen concentration occurring near the winter holidays and after Valentine’s Day.

Among the neighborhood collection sites was a small, densely populated area adjacent to a college campus. More than 87% of residents were young people between 18 and 34 years old, a population considered high-risk for STIs. Clinical health records showed very low case counts of chlamydia, but researchers consistently detected C. trachomatis in wastewater samples. 

That gap could indicate underreporting driven by stigma or asymptomatic cases. It also gives public health officials an opportunity to react to a previously unknown increase in infection activity.

“From a public health perspective, data like this allows us to elevate awareness that this pathogen is here and spreading in the community, even if cases aren’t presenting to clinics or providers are not identifying the infections in their patients,” said co-lead author Breanna McArdle, program manager of the Washington State Department of Health’s wastewater surveillance program. “A small amount of wastewater can tell you so much about the community while simultaneously filling gaps in the traditional methods we monitor disease activity.” 

A full list of co-authors is available with the paper. 

This research was funded in part by the Epidemiology and Laboratory Capacity Infectious Diseases Cooperative Agreement from the U.S. Centers for Disease Control and Prevention. 

For more information, contact Fuhrmeister at efuhrm@uw.edu.

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Nobody is immune from the hazards of summer wildfires, even the experts. At the University of Washington, researchers study both how to mitigate and understand wildfire behavior and how air quality degrades as a result of burning blazes. While UW faculty contribute to a rapidly emerging body of research into the risks of fire and smoke season, they also contend with the decisions that the rest of us face: how to protect themselves and their families, where to find reliable information, and how to manage the anxieties of summer smoke. 

Who better to learn from? As fires rage and smoke smothers the Pacific Northwest — including historic and devastating blazes in Spokane — UW News sat down with five UW experts in fire science, forestry, air pollution and more to ask how they manage wildfire season. 

This summer, the U.S. has been inundated with wildfire smoke, sometimes from fires burning hundreds of miles away. What sources do you use to track wildfires and air quality?

Ernesto Alvarado, research associate professor of environmental and forest sciences: The most reliable source, in my opinion, is the Fire and Smoke Map from AirNow.gov. This map consolidates data from various government sources related to wildfires, prescribed burns, smoke emissions and up-to-date models. It serves as a comprehensive resource for smoke emissions information.

Susan Prichard, research scientist in environmental and forest sciences: For smoke forecasts, I often turn to AirNow, but the Washington Smoke Blog is an excellent friend when we have been inundated with smoke for days and I’m looking for extended forecasts and analyses. Purple Air is also an incredibly helpful site. I’m careful to check if the readings are U.S. EPA PM2.5 with the conversion applied — otherwise the readings generally are higher than reality.

Brian Harvey, professor of environmental and forest sciences: For personal use and immediate up-to-date information, I really like Watch Duty. As a free app that has lots of options and configurations, it can be really helpful for getting immediate information on any ongoing fire incident and incorporates information from multiple sources. Second, for more detailed maps, photos, and daily incident updates, I frequently check Inciweb, which is the U.S. government interagency website that provides real-time public information and updates on fire incidents. As a forest fire scientist, I also use these sources for archived information about past fires that can better help us in our research.

Let’s say you’re planning a weekend trip, or a hike you’ve been looking forward to. How do you predict and plan around fire and smoke? 

E. Alvarado: I’ll plan my outdoor activities while considering potential smoke impacts. I’ll choose an area that’s unlikely to be affected by smoke for the duration of the activity. During the fire season, I’ll avoid areas with thermal inversions, which can trap smoke at night. For example, canyons or valleys surrounded by mountains are risky.

To predict future smoke concentrations, the National Weather Service is the most reliable source of information. Their weather predictions can indicate fire weather for the duration of the forecast. This is also important for hiking the rest of the year to stay informed about the weather for any outdoor activity.

BH: FireSmoke.ca has nice maps of the U.S. and Canada with high-resolution smoke forecasts over the coming day or two. These maps can be really helpful for planning ahead, though are always subject to change based on changing fire behavior or weather conditions. With our lab group doing field work outdoors all summer long every summer, these are critical tools for us to be able to do our work. 

Do you have an AQI threshold where you’re no longer comfortable being outside? Does that vary depending on what you’re doing outside? If so, how?

Edmund Seto, professor of environmental and occupational health sciences: The AQI is designed for communicating health risk to both general populations as well as populations that may be more susceptible to smoke.  Rather than focusing on the AQI number, I instead focus on the public health messaging (the “Description of Air Quality” column in this figure):

Elena Austin, associate professor of environmental and occupational health sciences: I generally become more concerned when air quality has remained consistently elevated for about 24 hours, because I think about smoke exposure cumulatively over the course of the day.

SP: If it looks like air quality is going to degrade over an AQI of 80, I start thinking about my health and what level of activity I’m going to do. As the science on smoke and human health only becomes more cautionary, I save strenuous exercise like running or climbing mountains for times when the AQI is below 80. 

If you have to be outside during smoky days, how do you protect yourself? 

E. Alvarado: Starting from AQI in the yellow zone, I may wear a N95 mask. However, above the orange zone, an N95 mask is mandatory.

ES: If working outdoors during smoky days, you and your employer should be aware that in Washington State, Labor and Industries has established rules to protect workers from hazardous smoke exposures. Also be aware that oftentimes smoke and heat co-occur, and there are heat exposure rules for working outdoors too.

E. Austin: I always make contingency plans while hiking and camping. In that case, I identify egress routes prior to departing in case a wildfire event limits my ability to return using the route I had planned. I also sign up for emergency text alerts for the county where I am spending time, and check the current fire activity and nearby evacuation status. 

How do you keep your indoor spaces safe during smoke waves?

ES: Thinking ahead and preparing your indoor space for regularly occurring wildfire smoke episodes is just as important as planning for other emergency events.  Can you close doors and windows tightly and have good weather sealing to avoid smoke from infiltrating indoors? Can you set your ventilation system to recirculate air?  Have you replaced your ventilation system (e.g., furnace) filter recently? Have you considered getting a portable HEPA-rated air cleaner that is sized appropriately for your bedroom or living area?  Have you considered building a DIY box-fan filter?

E. Austin: I create a smoke-ready space in my home. This is a separate area, where I set my ventilation system to recirculate indoor air rather than bringing in outdoor air. I also run a HEPA filter, rated to perform well for the square footage of my space, during wildfire events. Lastly, I try to reduce air exchange between the indoor space and outdoors by closing all windows, only opening outdoor doors when necessary, and weatherizing the space around doors and windows prior to the event.

SP: For indoor air, we make sure our HEPA air filters are clean at the end of each fire season so that they are ready to go the following year. When there’s smoke in the air, we make sure windows and doors are closed and use our air filters. We also just got a heat pump so that we can keep windows closed when smoke is a factor at night.

If you find yourself in close proximity to an active wildfire, what steps do you suggest taking?

BH: I suggest being as conservative and cautious as possible. Conditions can change rapidly, and being in the direct line of where a fire is spreading can be extremely dangerous and life-threatening. So first, I would make sure that there is a clear and safe route to safety via a road, trail, path, etc. Second, assessing the situation through any official information or local authorities is critical. If the fire has not been reported, calling 911 immediately is important to alert responders and others. If an evacuation order is issued, leaving immediately is critical to get to safety ASAP.

E. Austin: Many local districts allow you to register your phone and/or email to receive real-time alerts. I also suggest identifying your evacuation route, any obstacles or bottlenecks that would slow down your evacuation and to preplan and even pack critical items that you would need to take with you in an emergency.

SP: I live in the Methow Valley, and we’ve been evacuated around five times in the last 20 years. As a fire ecologist who studies fire behavior and smoke, one of the most upsetting things for me has been to watch neighbors and friends stay to protect their places. We quickly pack a few valuable things — photo albums, laptops, wallets, and passports — and leave. My main message to friends over the years is that it’s not worth the risk — if flames are close that means that smoke and super-heated air may be close, too, and deadly.

How do you manage the stress and anxiety of fire season both here and elsewhere?

E. Austin: I manage that stress by preparing my home before fire season, relying on a small number of curated information sources rather than trying to identify reliable sources in the moment or checking multiple apps, and I try to make flexible backup plans for outdoor activities. I also suggest planning ahead to learn how to obtain and effectively use an N95 respirator to reduce exposures either at work or when outdoors for recreational activities.

SP: Fire and smoke season are stressful. I’ve dealt with some stress and anxiety not only from fast-moving wildfires but also from long-duration smoke events that feel like they will never clear. We have a strong community that is very supportive and understands how fire season can bring up some PTSD-type symptoms. We take care of our place and make sure that we have as low of risk in and around our home as possible. We also remind ourselves how very lucky we are to be able to have flexibility in our work schedules and plenty of friends and family elsewhere to be able to leave when wildfires hit close to home.

BH: Fire is an integral part of life on earth, and in regions like the Pacific Northwest, fire is a key process that will continue to shape this region well into the future. Knowing that it is not if, but when, fire will return to any given area helps me embrace the reality of fire season. Like anything in life, being informed and prepared is a great way to lower stress and anxiety that comes with uncertainty. 

The UW has dozens of experts in wildfires, smoke and related topics. To reach an expert, contact Alden Woods at acwoods@uw.edu.

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Schizophrenia affects approximately 23 million people worldwide, with onset usually occurring during a person’s late adolescence to their 20s. Impairments associated with schizophrenia include hallucinations, delusions and disorganized thinking and behavior.

Now, researchers at the University of Washington are investigating how genetic changes impact the severity of schizophrenia symptoms. A new study, published in the American Journal of Psychiatry, supports the idea that deletions in genes that regulate early brain and neuron development are associated with more severe features of schizophrenia spectrum disorders, particularly lower cognitive abilities.

How schizophrenia manifests — and how severely — differs between patients. Poorer cognitive functioning in schizophrenia is associated with more treatment-resistant forms of the disease. Jennifer Forsyth, co-author and assistant professor of psychology at the UW, said understanding early developmental genetic factors could help identify people who could benefit from earlier, targeted inventions.

“For a subset of individuals, we may need to be thinking about how we can create treatments earlier in brain development that will help compensate for the fact that certain genes are being deleted,” Forsyth said. “Is there some kind of medication that can help with that? Down the road, could there be gene therapies for some of these individuals? I do think this research is going to be important for changing treatment direction.”

The researchers studied the DNA of more than 600 people with schizophrenia spectrum disorders. The team compared these results to data from patients’ relatives, people without schizophrenia and nearly 10,000 children participating in the Adolescent Brain Cognitive Development Study. 

People with schizophrenia who carried the deletions tended to perform worse on cognitive tests — showing poorer memory, thinking and attention skills than people with schizophrenia who didn’t carry the deletions. Similar, weaker associations were also seen in the general population, which suggests these variants may influence brain development more broadly, even in individuals without schizophrenia.

The study also showed these specific genetic deletions were associated with differences in brain structure, including higher gray matter volume and cortical thickness. This is the opposite pattern researchers typically see on average in schizophrenia, Forsyth said, which again suggests variability between patients.

“This study helps us understand the specific way somebody manifests a disorder,” Forsyth said. “It’s sort of a cumulative effect of different risk profiles. We all carry tons of genetic variants, and the specific types of variants we have and how they combine is very complicated. These things aren’t totally deterministic, but I do think understanding which specific aspects of brain development are affected by the genetic variants a person carries, and how this shapes how the disorder manifests, can start to inform how we think about different treatment approaches.”

Other UW co-authors from the Department of Psychology were graduate students Jinhan Zhu, Zachary Trevorrow and Mahnoor Hyat, undergraduate research assistant Ariana Chavannes, research coordinator Sam Sievertsen and research technologist Sophie Ferreira-Ianone. Matthew Conomos, a UW senior research scientist in biostatistics, was also a co-author.

A full list of co-authors is included with the study.

This study was funded by the National Institute of Mental Health, the Brain and Behavior Research Foundation, the National Center for Advancing Translational Sciences UCLA Clinical and Translational Science Institute, the UCLA Brain Research Institute and the Shear Family Foundation.

For more information, contact Forsyth at jenforsy@uw.edu.

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• A study including nearly 3,500 adults in India with heart failure found that participants in a yoga-based cardiac rehabilitation program reported improved quality of life and walking distance compared to the group that received enhanced standard care.
• However, there was no statistically significant difference in the combined rate of death, hospitalization or stroke between the yoga-based cardiac rehab group and the enhanced standard care group.
• The study investigated whether people with heart failure may benefit from participating in yoga-based cardiac rehabilitation alongside usual heart failure treatment. The yoga-based cardiac rehab program was developed to provide an affordable and accessible alternative to a traditional cardiac rehab program in communities with limited resources and for patients who may prefer a low-impact physical activity option.
• Note: The study featured in this news release is a research abstract. Abstracts presented at the American Heart Association’s scientific meetings are not peer-reviewed, and the findings are considered preliminary until published as a full manuscript in a peer-reviewed scientific journal.

Embargoed until 4:00 p.m. CT/5:00 p.m., ET, Saturday, Nov. 7, 2026

This news release contains updated information provided by the researchers and not listed in the abstract.

CHICAGO, Nov. 7, 2026 —A yoga-based cardiac rehabilitation program improved the quality of life for people with heart failure with reduced ejection fraction, compared to patients who received enhanced standard cardiac rehab. The yoga-based cardiac rehab program did not, however, significantly reduce the combined rate of death, hospitalization or stroke. All this according to late-breaking science presented today at the American Heart Association’s Scientific Sessions 2026. The meeting on Nov. 6-9 in Chicago is a premier global exchange of the latest scientific advancements, research and evidence-based clinical practice updates in cardiovascular science.

“Between 8 and 10 million people in India are living with heart failure, many of whom are typically 10 years younger, on average (most younger than age 65) compared to adults with heart failure living in high-income countries,” said lead study author Dorairaj Prabhakaran, M.B.B.S., M.D., D.M., executive director of the Centre for Chronic Disease Control in India, President-Elect, World Heart Federation, Geneva and adjunct professor at Rollins School of Public Health at Emory University in Atlanta. “Reducing hospitalizations and improving quality of life and physical function for heart failure patients, these are valuable shifts that are much needed in countries like India.”

Cardiac rehabilitation programs are medically guided and designed for people who have experienced a heart attack, heart failure, or heart surgery. Cardiac rehab programs can lower the risk of another cardiac event and improve a person's ability to engage in daily living and activities through exercise guidance, education on healthy living, and counselling for stress relief. However, cardiac rehabilitation can be costly, and participation rates are low, particularly among women, older adults and people from some racial and ethnic groups, according to the 2025 American Heart Association Scientific Statement: Cardiac Rehabilitation in Women.

“Cardiac rehab programs are inaccessible to many, and their uptake is poor in many countries,” said Prabhakaran. “Innovations are needed to reduce costs, scale up cardiac rehab and make it sustainable. Yoga is culturally acceptable in countries like India, and it can provide many of the benefits of cardiac rehab at a lower cost. A yoga-based cardiac rehabilitation delivered by a single healthcare professional may be effective, scalable and sustainable. However, the evidence for such an approach is sparse.”

What are the study’s key findings?

• At three months, participants in the yoga-based cardiac rehab group had significantly greater improvement in quality of life than the enhanced standard care group: their Minnesota Living with Heart Failure Questionnaire scores improved by about 8 points (lower scores indicate better quality of life).
•  There was no statistically significant difference between groups in the combined rate of death, hospitalization or stroke: 364 participants (21.0%) in the yoga-based rehab group died, were hospitalized or had a stroke during a median follow-up of 15 months, compared to 401 (22.8%) in the enhanced standard care group.
• Greater improvements were also observed in the yoga cardiac rehabilitation group patients’ physical functioning abilities compared to the enhanced standard care group when based on the distance participants could walk in six minutes and the between-group difference in change from baseline. Participants in the yoga group walked, on average, 25.5 meters farther than the participants in the enhanced standard care group.
• The health status based on EQ-5D-5L questionnaire (Quality-adjusted utility-values with Indian dataset) was better among the people who underwent the yoga-based cardiac rehabilitation than the comparison group.

“This study tested a yoga-based cardiac rehabilitation program incorporating health education and tailored behavior change with individual participant goals and a standardized set of physical practices of yoga,” said Prabhakaran. “We found the Yoga-CaRe program helped improve quality of life and physical function in people living with heart failure. In our trial, a board-certified yoga & naturopathy practitioner delivered this structured, yoga-based cardiac rehabilitation package for adults with heart failure. These results are potentially scalable and sustainable in settings where cardiac rehab is not easily available and resources are limited. The cultural acceptability of the yoga-based rehab was also high, as shown by strong participation in the supervised sessions and in home practice. Though a formal cost-effectiveness analysis is yet to be conducted, we expect it to be affordable and accessible for patients with heart failure.”

What are the study’s details, background, design and limitations?

• Between April 2023 and December 2025, the trial recruited almost 3,500 adults with heart failure across 16 medical centers in India; 27% were women; and the median age was 57 years. Nearly 40% of participants were recruited from inpatient/hospital settings.
• Study participants had heart failure with reduced ejection fraction, or HFrEF, which means the heart’s main pumping chamber pushes out 40% or less of the blood it contains with each heartbeat. The study also included patients hospitalized for acute decompensated heart failure and those with chronic heart failure.
• About half of the study participants had New York Heart Association (NYHA) Class III heart failure, which means they had marked limitation of physical activity: they were comfortable at rest, but less-than-ordinary activity caused fatigue, heart palpitations or shortness of breath.
• Of the 3,492 heart failure patients with reduced ejection fraction, half were randomly assigned to participate in the yoga-based cardiac rehabilitation program (n=1,737 in the intervention group), and the other half received enhanced standard care (n=1,755 in the control group).
• The intervention group received Yoga CaRe – a standardized and structured yoga program – and health education using “Healthy Living with Heart Failure” booklet with tailored advice using a goals-based approach. The program was delivered in 20 supervised sessions over three months, and then one session every three months until the end of follow-up.
• The second group received enhanced standard care that included three health education/information sessions over three months, and the same health information booklet used by the patients in the intervention group.
• The researchers measured the time to the first medical event, which was a composite of death by any cause, hospitalization for any reason or a stroke occurrence during the study follow-up period.
• The study also measured the participants’ quality of life after three months using the Minnesota Living with Heart Failure Questionnaire. The self-reported questionnaire includes 21 questions pertaining to the physical, emotional and socioeconomic ways heart failure can adversely affect a person’s life.
• Researchers also assessed the participants’ 6-minute walk distance.
• The EuroQol 5D-5L (EQ-5D-5L), a standardized, self-reported survey to measure a person’s health-related quality of life, including mobility, self-care, usual activities, pain/discomfort and anxiety/depression, was conducted at three months.
• The quality of life, 6-minute walk distance and quality-adjusted utility value (a score that describes how good or difficult a person's health condition feels in everyday life that is often used to compare the benefit of different treatments) were assessed at 6, 12 and 24 months.
• The study has some limitations. As is the case with all cardiac rehabilitation trials or behavioral interventional trials, the study intervention cannot be blinded because participants knew which cardiac rehab they were participating in. Secondly, the number of interactions between the patients and yoga instructors in the intervention sessions was higher than the enhanced standard care (20 sessions versus 3 sessions), which could have impacted the results.

The authors note that future research should be centered around implementing yoga-based cardiac rehab at-scale and also evaluating this approach in other healthcare settings and countries.

“This trial is one of the largest studies of cardiac rehabilitation in people with heart failure that evaluated an alternative cardiac rehab program that may be easier and more cost-effective to deliver in limited-resource settings,” said Prabhakaran.

Co-authors, disclosures and funding sources are listed in the abstract.

Statements and conclusions of studies that are presented at the American Heart Association’s scientific meetings are solely those of the study authors and do not necessarily reflect the Association’s policy or position. The Association makes no representation or guarantee as to their accuracy or reliability. Abstracts presented at the Association’s scientific meetings are not peer-reviewed, rather, they are curated by independent review panels and are considered based on the potential to add to the diversity of scientific issues and views discussed at the meeting. The findings are considered preliminary until published as a full manuscript in a peer-reviewed scientific journal.

The Association receives more than 85% of its revenue from sources other than corporations. These sources include contributions from individuals, foundations and estates, as well as investment earnings and revenue from the sale of our educational materials. Corporations (including pharmaceutical, device manufacturers and other companies) also make donations to the Association. The Association has strict policies to prevent any donations from influencing its science content and policy positions. Overall financial information is available here.

Additional Resources:

• Multimedia is available on the right column of the release link.
• View the abstract in the American Heart Association Scientific Sessions 2026 Online Program Planner
• American Heart Association news release: Women face barriers in accessing, participating in cardiac rehab despite proven benefits (October 2025)
• American Heart Association health information: How Will I Benefit from Cardiac Rehab?
• American Heart Association health initiative: Core Components of Cardiac Rehabilitation Programs: 2024 Update: A Scientific Statement From the American Heart Association and the American Association of Cardiovascular and Pulmonary Rehabilitation
• About Scientific Sessions 2026
• For more news at the American Heart Association’s Scientific Sessions 2026, follow us on X @HeartNews, #ScientificSessions26

###

About the American Heart Association

The American Heart Association is a relentless force for a world of longer, healthier lives. Dedicated to ensuring equitable health in all communities, the organization has been a leading source of health information for more than one hundred years. Supported by more than 35 million volunteers globally, we fund groundbreaking research, advocate for the public’s health, and provide critical resources to save and improve lives affected by cardiovascular disease and stroke. By driving breakthroughs and implementing proven solutions in science, policy, and care, we work tirelessly to advance health and transform lives every day. Connect with us on heart.org, Facebook, X or by calling 1-800-AHA-USA1.

For Media Inquiries and American Heart Association Expert Perspective:

American Heart Association Communications & Media Relations in Dallas: 214-706-1173; ahacommunications@heart.org

Michelle Kirkwood: michelle.kirkwood@heart.org

For Public Inquiries: 1-800-AHA-USA1 (242-8721)

heart.org and stroke.org

• In a small feasibility study of 39 patients in England, physician responders used a minimally invasive procedure called Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) to try to improve blood flow to the heart and brain during out-of-hospital cardiac arrest.
• Several key measures of circulation improved during resuscitation: the lower blood pressure number (which is particularly important for restarting the heart during CPR) increased 62%, the upper number (an important determinant of blood flow to the brain) rose 20%, and carbon dioxide in exhaled breath, an important sign of effective circulation during CPR, increased 50%.
• The technique is currently used in trauma centers to treat life-threatening internal bleeding and is now being explored as a potential way to improve outcomes after out-of-hospital cardiac arrest by prehospital professionals.
• Researchers said if future research shows that the technique can be delivered to patients earlier and on a wider scale, potentially by training advanced critical care paramedics, it could increase the chances of restarting the heart and ultimately save more lives.
• Note: The study featured in this news release is a research abstract. Abstracts presented at the American Heart Association’s scientific meetings are not peer-reviewed, and the findings are considered preliminary until published as a full manuscript in a peer-reviewed scientific journal.

Embargoed until 4 p.m. CT/5 p.m. ET, Saturday, Nov. 7, 2026

CHICAGO, Nov. 7, 2026 — A procedure to inflate a balloon in the body’s largest artery to temporarily send more blood to the heart and brain may help improve the low chance of survival (1 in 10) for people who experience cardiac arrest outside of the hospital, according to new, independent, preliminary late-breaking science presented at the American Heart Association’s Resuscitation Science Symposium 2026. The meeting will be held Nov. 7-8 in Chicago and will feature the most recent advances related to treating cardiopulmonary arrest and life-threatening traumatic injury.

“After cardiac arrest, people whose hearts cannot be restarted despite prolonged, high-quality resuscitation efforts, including CPR, breaths, use of an AED, medications and other techniques to restore the heartbeat, currently have very few treatment options and an extremely low chance of survival. Furthermore, survival and treatment options have not meaningfully increased in the last 50 years, so we need to do more in this area,” said James Price, M.B.B.S., lead author of the study, who is a consultant emergency physician at Cambridge University Hospitals NHS Foundation Trust and consultant lead for research and development with the East Anglian Air Ambulance (EAAA) in Norwich, England.

During CPR (cardiopulmonary resuscitation) after cardiac arrest, only a fraction of normal blood flow is restored to vital organs, and death occurs either because the heart has not restarted or the brain is lacking oxygenated blood.

For the current feasibility study, investigators borrowed a technique used for the emergency control of internal bleeding. Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) is a minimally invasive procedure in which a small balloon is passed through an artery in the groin and inflated inside the aorta. When used for life-threatening internal bleeding, the temporary blockage reduces blood flow to areas of major bleeding below the balloon while maintaining blood flow to vital organs above it. The technique is most often used in trauma centers and is not routinely available in emergency medical services in either the United Kingdom or the United States.

Previously, laboratory studies confirmed the theory that REBOA in the upper part of the aorta (called Zone 1 – above the diaphragm) might send more blood to the brain and increase pressure from the aorta into the blood vessels that supply the heart muscle itself, making it an important technique to study in patients whose cardiac arrest had not responded to conventional advanced cardiac life support (ACLS) techniques.

The new study involves attempted use of REBOA by physicians of the East Anglian Air Ambulance helicopter emergency medical service after they arrived at out-of-hospital emergency sites — at the roadside or in the patient’s home — when patients in cardiac arrest had not responded to ACLS including high-quality CPR, defibrillation when appropriate, medications, intubation to place a breathing tube in the airway and treatment of potentially reversible causes of the cardiac arrest. Researchers wanted to know whether REBOA could be deployed quickly and safely and improve blood flow to the heart and brain.

What are study’s key findings?

In the 2-year feasibility study, the researchers successfully used REBOA to block the upper aorta in 33 of the 36 patients, with the procedure taking about 7 minutes from start to finish (with a median time from actual cardiac arrest to balloon inflation of 51 minutes).

Changes in patients after the REBOA procedure included:

• An immediate 59% increase in the aortic diastolic blood pressure (the lower number, which is particularly important for restarting the heart during CPR), from 26 to 42 mm Hg, reaching a maximum of 58 mm Hg (118% increase).
• A 20% increase in average systolic blood pressure (the upper number, an important determinant of blood flow to the brain), from 76 to 91 mm Hg.
• A 50% increase in the average amount of carbon dioxide measured in exhaled breath, an important indicator of blood flow through the lungs and the effectiveness of circulation during resuscitation.
• There were no serious adverse effects related to the procedures.

“Taken together, these findings suggest that aortic occlusion was redirecting blood flow towards the heart and brain as intended,” Price said. “What surprised us most was the size of the physiological response despite the relatively late stage at which REBOA was performed in our study. To still see substantial improvements in blood pressure after such a prolonged period of cardiac arrest (average of 51 minutes after cardiac arrest) is really encouraging.”

Although this preliminary study was not intended to assess changes in long-term patient outcomes, there were indications that survival might be enhanced by adding REBOA to other resuscitation and life support techniques, particularly in certain patient groups and when the procedure is done earlier after cardiac arrest:

• Overall, in 33 patients in which the balloon successfully blocked blood flow to the lower aorta (confirmed occlusion), 8 patients regained a sustained return of spontaneous circulation (pulse and effective circulation to hospital), and 2 survived and were discharged from the hospital with a good neurological outcome.
• In a subgroup of patients with witnessed cardiac arrest related to ventricular fibrillation (a life-threatening abnormal heart rhythm with rapid and uncoordinated contractions of the heart’s lower pumping chambers) and who were treated with REBOA earlier (with occlusion achieved at a median of 44 minutes after cardiac arrest), 4 out of 5 regained a sustained return to spontaneous circulation, and 2 survived and were discharged from the hospital with a good neurological outcome.
• Although this was a very small sub-group of patients, these findings are particularly encouraging given that the chances of surviving with good brain function after such a prolonged cardiac arrest, despite repeated attempts at resuscitation, are normally extremely low.

“This study is an important first step, but it is not yet proof that REBOA saves lives. A key part of our additional work will be to understand which patients are more likely to benefit from this advanced technique and at what point in their resuscitation care,” Price said. “These questions will need larger prospective studies with appropriate comparison groups and a focus on patient-centered outcomes rather than physiological measurements alone. Future research should also explore strategies for delivering the procedure earlier in resuscitation, potentially by expanding its use to specially trained non-physician emergency responders, such as advanced paramedics.”

What are the study’s details, background, design and limitations?

• Participants included 39 adults (average age of 59 years; 35 male and 4 female) experiencing out-of-hospital cardiac arrest who had not responded to standard advanced cardiac life support by the time helicopter emergency medical services arrived. The cardiac arrests resulted from medical conditions rather than injury.
• The study was conducted between June 2024 and June 2026 by the East Anglian Air Ambulance, in the Eastern region of England, United Kingdom.
• Patients received REBOA, a minimally invasive technique using a small balloon inserted through an artery in the groin and inflated in the upper part of the aorta to temporarily block blood flow to the lowest part of the body, if ongoing advanced cardiac life support was not successful.
• In addition to timing and safety information, data was collected on 3 measures that may indicate increased blood flow to the brain and heart muscle: aortic diastolic blood pressure, with numbers above 35 mmHg associated with a higher chance of restarting the heart; systolic blood pressure; and end-tidal carbon dioxide, the amount of carbon dioxide measured in exhaled breath, an important indicator of blood flow through the lungs and the effectiveness of circulation during resuscitation.
• This feasibility study did not include a control group and was not designed to determine if REBOA improves survival or long-term patient outcomes.

Co-authors, disclosures and funding sources are listed in the manuscript.

Statements and conclusions of studies that are presented at the American Heart Association’s scientific meetings are solely those of the study authors and do not necessarily reflect the Association’s policy or position. The Association makes no representation or guarantee as to their accuracy or reliability. Abstracts presented at the Association’s scientific meetings are not peer-reviewed, rather, they are curated by independent review panels and are considered based on the potential to add to the diversity of scientific issues and views discussed at the meeting. The findings are considered preliminary until published as a full manuscript in a peer-reviewed scientific journal.

The Association receives more than 85% of its revenue from sources other than corporations. These sources include contributions from individuals, foundations and estates, as well as investment earnings and revenue from the sale of our educational materials. Corporations (including pharmaceutical, device manufacturers and other companies) also make donations to the Association. The Association has strict policies to prevent any donations from influencing its science content and policy positions. Overall financial information is available here.

Additional Resources:

• Multimedia is available on the right column of the release link 
• Link to abstract and the American Heart Association’s Resuscitation Science Symposium 2026 Online Program Planner
• American Heart Association news release: Updated CPR guidelines tackle choking response, opioid-related emergencies and a revised Chain of Survival (Oct. 2025)
• Recovering from a Cardiac Arrest
• Join the Nation of Lifesavers by learning CPR
• About Resuscitation Science Symposium 2026
• For more news at the American Heart Association’s Resuscitation Science Symposium 2026, follow us on X @HeartNews, #ReSS26

###

About the American Heart Association

The American Heart Association is a relentless force for a world of longer, healthier lives. Dedicated to ensuring equitable health in all communities, the organization has been a leading source of health information for more than one hundred years. Supported by more than 35 million volunteers globally, we fund groundbreaking research, advocate for the public’s health, and provide critical resources to save and improve lives affected by cardiovascular disease and stroke. By driving breakthroughs and implementing proven solutions in science, policy, and care, we work tirelessly to advance health and transform lives every day. Connect with us on heart.org, Facebook, X or by calling 1-800-AHA-USA1.

For Media Inquiries and American Heart Association Expert Perspective:

American Heart Association Communications & Media Relations in Dallas: 214-706-1173; ahacommunications@heart.org

Sarah Johnson: sarah.johnson@heart.org  

For Public Inquiries: 1-800-AHA-USA1 (242-8721)

heart.org and stroke.org

• In a study of more than 3,000 adults in South Korea with heart or blood vessel disease, starting cholesterol treatment with a statin alone or with a statin plus ezetimibe (a non-statin medication that reduces the absorption of cholesterol from foods and the production of cholesterol by the body) led to similar rates of heart and stroke events. Researchers measured heart-related death, heart attack, stroke, procedures to reopen blocked arteries, and hospitalization for worsening chest pain over three years, and medications were adjusted during follow-up to reach an assigned low-density lipoprotein (LDL) or “bad” cholesterol goal.
• The researchers said that, regardless of the starting treatment, regularly checking LDL cholesterol and adjusting medications to reach the goal is important. They noted that for adults with stable heart or blood vessel disease, starting with a statin and adding ezetimibe if needed appears reasonable, and that starting both medications together may lower LDL cholesterol more quickly when levels are far above the goal.
• Note: This trial is simultaneously published today as a full manuscript in the peer-reviewed scientific journal Circulation.

Embargoed until 3:45 p.m. CT/4:45 p.m. ET, Saturday, Nov. 07, 2026

CHICAGO, Nov. 7, 2026 — Adults with heart or blood vessel disease who started treatment with a statin alone had rates of heart attack, stroke and other heart problems over three years similar to those who started with a statin plus ezetimibe (a non-statin medication to help limit cholesterol absorption in the intestine), when medications were adjusted to reach an assigned goal for low-density lipoprotein (LDL) or “bad” cholesterol, according to new, independent, preliminary late-breaking science presented today at the American Heart Association’s Scientific Sessions 2026. The meeting on Nov. 6-9 in Chicago is a premier global exchange of the latest scientific advancements, research and evidence-based clinical practice updates in cardiovascular science.

According to the American Heart Association’s 2026 Heart Disease and Stroke Statistics, about 1 in 4 U.S. adults (25.5%) had high LDL cholesterol (130 mg/dL or higher), based on 2017 to 2020 data.

“Lowering high LDL is among the most effective ways to reduce the risk of heart attack and stroke,” said study author Byeong-Keuk Kim, M.D., Ph.D., a professor of cardiology at Yonsei University College of Medicine’s Severance Hospital in Seoul, South Korea. “Doctors can lower LDL cholesterol with a statin alone or in combination with ezetimibe, which lowers cholesterol more. However, it remains unclear if starting both together reduces heart attacks, strokes and other heart issues compared to starting with a statin alone and adding additional medications like ezetimibe later. This is a crucial question for doctors.”

Statins work by reducing cholesterol production in the liver and are often the first medication prescribed to lower LDL. Ezetimibe is a non-statin medication that reduces the amount of cholesterol absorbed in the intestines. It is often the first non-statin medication added when a statin alone does not lower LDL cholesterol levels enough.

Researchers in the Ez-PAVE study enrolled more than 3,000 adults with heart or blood vessel disease across 17 study sites in South Korea. At enrollment, participants were randomly assigned to one of two LDL cholesterol goals: a lower LDL goal (less than 55 mg/dL) or a conventional LDL goal (less than 70 mg/dL). Participants were also randomly assigned to start treatment with either a statin plus ezetimibe or a statin alone, with about half of participants in each group.

In both groups, medication doses were adjusted during follow-up to help reach the target LDL goals. During follow-up visits, lipid-lowering therapy could be modified in either group according to a predefined protocol, based on each participant’s LDL cholesterol level relative to the assigned target. Medication changes were permitted in both directions, from monotherapy to combination therapy, and from combination therapy to monotherapy, as long as they were consistent with the protocol. Then, all participants’ results were analyzed according to the group to which they were originally assigned.

At three years, after annual follow-up, the analysis reviewed rates of heart-related death, heart attack, stroke, procedures to reopen blocked arteries and hospitalization for worsening chest pain for all participants.

What are the study’s main findings?

• The participants receiving combination treatment with a statin plus ezetimibe achieved lower LDL cholesterol levels than those treated with statins alone.
• For the lower cholesterol goal group (<55 mg/dL), average LDL was 53 mg/dL with combination therapy vs. 62 mg/dL for those in the statin-only group.
• For the conventional LDL goal group (<70 mg/dL), average LDL was 63 mg/dL with combination therapy vs. 70 mg/dL for the statin-only group.
• Many participants who started treatment with only a statin eventually had ezetimibe added during follow-up, as directed by the study protocol, to reach their LDL goal: about 1 in 3 people (more than 34%) in the lower-goal LDL group, and about 1 in 4 people (nearly 25%) in the conventional LDL-goal group.
• During the three-year study, the rate of heart disease-related death, heart attack, stroke, procedures to reopen blocked arteries or hospitalization for worsening chest pain was 8.5% among people who started on combination therapy vs. 7.9% among those in the statin-only group. This small difference is not statistically meaningful.
• The benefit of the lower LDL goal, reported previously from this study, was consistent whether people started on combination therapy or a statin alone.
• Side effects and safety concerns were similar whether adults started on combination therapy or statin-only treatment.

“We expected that starting with combination therapy would lead to fewer heart attacks, strokes and other heart problems, but this was not the case,” Kim said. “A previous large study published in the New England Journal of Medicine showed that adding ezetimibe to a statin reduced the rate of cardiovascular deaths, nonfatal heart attacks, unstable angina requiring rehospitalization, coronary revascularization or nonfatal stroke. However, that study was not primarily designed to adjust treatment to reach a target LDL cholesterol goal, and medication dose changes were limited. We believe the difference was that in our study, medication doses in both treatment groups were adjusted to reach the target LDL cholesterol goal.”

“Starting with a statin and adding ezetimibe as needed appears to be a reasonable strategy for people with long-term, stable heart or blood vessel disease whose cholesterol levels are checked regularly and medication doses are adjusted to reach their goals,” said Kim. “Starting with combination therapy can lower cholesterol more quickly and may be a practical option, particularly for people whose LDL cholesterol numbers are much higher than their goal LDL level.”

Future research is needed to help identify which patients with high LDL cholesterol would likely benefit the most from starting with combination therapy.

Study details, background, design and limitations:

• A total of 3,048 adults with a diagnosis of atherosclerotic cardiovascular disease (average age of 64.4 years; 79.1% men and 20.9% women) were enrolled in the study. Of these, 1,525 were assigned to statin-ezetimibe combination therapy, and 1,523 were assigned to the statin-only treatment group.
• Participants were enrolled from January 2021 to July 2022 and received care at 17 hospitals in South Korea, with a median follow-up of three years.
• Participants’ lipid levels, safety laboratory data and clinical events were collected at scheduled follow-up visits at one, 12, 24 and 36 months during the three-year study period.
• At these visits, participants’ LDL cholesterol levels were measured, and lipid-lowering therapy was adjusted as needed to reach each participant’s assigned LDL cholesterol target.
• Ez-PAVE was a multicenter, open-label, randomized trial with a 2-by-2 factorial design, meaning participants were randomly assigned twice: once to an LDL cholesterol goal and once to a starting treatment. This design lets researchers answer two questions in the same study and check whether the results of one assignment differ depending on the other. The study compared intensive vs. conventional LDL cholesterol goals, and combination therapy vs. statin-alone treatment. Medication doses were adjusted according to the protocol to achieve the assigned LDL cholesterol target.
• The study then calculated the three-year composite risk of cardiovascular death, nonfatal heart attack, nonfatal stroke, any revascularization or hospitalization for unstable angina.
• Limitations of this research include that the study population may not have been large enough to detect small differences in heart-related conditions in the two treatment groups. Another limitation is that the study’s three years of follow-up may not have been long enough to detect differences between the two groups that could emerge over a longer period of time. In addition, the number of participants in this part of the study was not specifically calculated to compare the two starting treatments. The study was also open-label, meaning participants and their doctors knew which treatment was assigned, and all participants were in South Korea and about 4 in 5 were men, so the results may not apply to other populations.

Co-authors and disclosures are listed in the abstract. The Yuhan Corporation and Cardiovascular Research Center (Seoul, South Korea) funded the study.

Statements and conclusions of studies that are presented at the American Heart Association’s scientific meetings are solely those of the study authors and do not necessarily reflect the Association’s policy or position. The Association makes no representation or guarantee as to their accuracy or reliability. Abstracts presented at the Association’s scientific meetings are not peer-reviewed, rather, they are curated by independent review panels and are considered based on the potential to add to the diversity of scientific issues and views discussed at the meeting. The findings are considered preliminary until published as a full manuscript in a peer-reviewed scientific journal.

The Association receives more than 85% of its revenue from sources other than corporations. These sources include contributions from individuals, foundations and estates, as well as investment earnings and revenue from the sale of our educational materials. Corporations (including pharmaceutical, device manufacturers and other companies) also make donations to the Association. The Association has strict policies to prevent any donations from influencing its science content and policy positions. Overall financial information is available here.

Additional Resources:

• Multimedia is available on the right column of the release link
• View the abstract in the American Heart Association Scientific Sessions 2026 Online Program Planner
• American Heart Association news release: ACC/American Heart Association Issue Updated Guideline for Managing Lipids, Cholesterol (March, 2026)
• American Heart Association health information: Cholesterol Tools and Resources
• American Heart Association health information: Life's Essential 8™ Your checklist for lifelong good health
• About Scientific Sessions 2026
• For more news at the American Heart Association’s Scientific Sessions 2026, follow us on X @HeartNews, #ScientificSessions26

###

About the American Heart Association

The American Heart Association is a relentless force for a world of longer, healthier lives. Dedicated to ensuring equitable health in all communities, the organization has been a leading source of health information for more than one hundred years. Supported by more than 35 million volunteers globally, we fund groundbreaking research, advocate for the public’s health, and provide critical resources to save and improve lives affected by cardiovascular disease and stroke. By driving breakthroughs and implementing proven solutions in science, policy, and care, we work tirelessly to advance health and transform lives every day. Connect with us on heart.org, Facebook, X or by calling 1-800-AHA-USA1.

For Media Inquiries and American Heart Association Expert Perspective:

American Heart Association Communications & Media Relations in Dallas: 214-706-1173; ahacommunications@heart.org

Michelle Kirkwood: michelle.kirkwood@heart.org

For Public Inquiries: 1-800-AHA-USA1 (242-8721)

heart.org and stroke.org

• Compared to standard treatment, using antihypertensive medications to lower systolic blood pressure (the top number in a reading) below 120 mm Hg in middle-aged adults with Type 2 diabetes did not significantly reduce the incidence of cardiovascular death, stroke, heart attack and other cardiovascular events.
• There is still a chance of a modest but clinically relevant benefit from more intensive blood pressure-lowering treatment, and high blood pressure management in people with Type 2 diabetes should remain individualized, researchers said.
• In the OPTIMAL-DIABETES trial, more than 9,000 middle-aged adults with Type 2 diabetes and other risk factors including elevated blood pressure between 130 and 180 mm Hg were randomly assigned to receive either intensive therapy to lower systolic blood pressure to less than 120 mm Hg or standard treatment to reduce systolic pressure to less than 140 mm Hg.
• Note: This trial is simultaneously published today as a full manuscript in the peer-reviewed scientific journal New England Journal of Medicine.

Embargoed until 3:30 p.m. CT, 4:30 p.m. ET, Saturday, Nov. 7, 2026

CHICAGO, Nov. 7, 2026 — Intensive blood pressure-lowering treatment to reduce systolic pressure below 120 mm Hg in adults with Type 2 diabetes, who are at increased risk of cardiovascular events, did not significantly reduce the incidence of cardiovascular death, stroke, heart attack or other cardiovascular events, compared to standard treatment targeting a systolic blood pressure of less than 140 mm Hg. These were the results of new, independent, preliminary late-breaking science presented today at the American Heart Association’s Scientific Sessions 2026. The meeting on Nov. 6-9 in Chicago is a premier global exchange of the latest scientific advancements, research and evidence-based clinical practice updates in cardiovascular science.

People with Type 2 diabetes and high blood pressure are at increased risk of heart attacks and strokes. The American Heart Association/American College of Cardiology’s 2025 Joint Guideline for the Prevention, Detection, Evaluation and Management of High Blood Pressure in Adults notes that high blood pressure (≥130/80 mm Hg) is the #1 preventable risk factor for cardiovascular disease, including heart attack, stroke and heart failure, as well as kidney disease, cognitive decline and dementia. The guideline recommends keeping systolic blood pressure lower than 130 mm Hg and diastolic blood pressure less than 80 mm Hg; and encourages reaching less than 120 mm Hg for people with increased risk of cardiovascular disease.  

“These findings add important evidence about optimal blood pressure targets for adults with Type 2 diabetes,” said lead study author Karla Santo, M.D., Ph.D., head of Decentralized Clinical Studies and Innovative Trial Models at the Academic Research Organization of Einstein Hospital Israelita in São Paulo, Brazil.

“While this trial did not find a statistically significant reduction in major cardiovascular events, more intensive blood pressure treatment may still have modest yet meaningful health benefits for adults with Type 2 diabetes,” she said.

Researchers analyzed data from the OPTIMAL-DIABETES trial, which enrolled more than 9,000 men and women, ages 50 and older, at 33 sites in Brazil. Participants had elevated blood pressure (systolic blood pressure between 130 and 180 mm Hg), Type 2 diabetes, and a history of cardiovascular disease, subclinical cardiovascular disease (early heart or blood vessel disease that has not yet caused symptoms), chronic kidney disease or other cardiovascular risk factors. Participants were randomly assigned to receive either intensive treatment to lower systolic blood pressure to below 120 mm Hg or standard treatment targeting a systolic level below 140 mm Hg. Researchers sought to determine if more intensive blood pressure management could reduce incidence of cardiovascular death, stroke, heart attack or other cardiovascular events, including hospitalization due to heart failure or unstable angina (chest pain), compared to standard treatment.

What are the key findings of the study?

• During a median follow-up of four years, participants who received intensive blood pressure-lowering treatment had about a 10% lower risk of experiencing a major cardiovascular event (cardiovascular death, stroke, heart attack, hospitalization due to heart failure or unstable angina). The results were not statistically significant.
• In the intensive-treatment group, 286 participants (6.0%) experienced a major cardiovascular event, compared to 315 participants (6.7%) in the standard-treatment group.
• The occurrence rate for kidney-related events was about 55% higher in the intensive-treatment group (270 participants, or 5.7%) compared to the standard-treatment group (175 participants, or 3.7%). These were primarily declines in kidney function with only a small number of participants developing end-stage renal disease. Importantly, the occurrence of end-stage renal disease was similar between groups.
• Serious adverse events were similar between groups.

“These findings should not be interpreted as evidence that more intensive blood pressure lowering is ineffective for people with Type 2 diabetes. Rather, they suggest that any cardiovascular benefit may be smaller than that observed in individuals without Type 2 diabetes. As a result, even a large trial such as OPTIMAL-DIABETES may not have been able to definitively detect a modest treatment effect,” said Otavio Berwanger, M.D., Ph.D., chair of the OPTIMAL-DIABETES trial Steering Committee and executive director at The George Institute for Global Health – Imperial College London in London, UK.

Berwanger said the broader, important message is that blood pressure management for people with Type 2 diabetes should remain individualized.

“A target below 120 mm Hg should not necessarily be applied universally to all patients, and treatment decisions should balance potential cardiovascular benefits, kidney effects, treatment burden and patient preferences,” he said. “Ultimately, our study adds an important piece to the overall evidence base and highlights the need to consider the totality of evidence, rather than any single trial alone, when defining optimal blood pressure targets in patients with Type 2 diabetes.”

Study design, background, details and limitations:

• The OPTIMAL-DIABETES trial enrolled 9,476 adults, ages 50 and older (average age 65) with elevated systolic blood pressure between 130-180 mm Hg; Type 2 diabetes; and established cardiovascular disease, subclinical cardiovascular disease, chronic kidney disease or cardiovascular risk factors, such as smoking, high cholesterol, or age 75 or older. Among the participants, 62% identified as women; 42.5% self-identified as mixed-race adults; 41.9% as white adults; and 14.5% as Black adults.
• Participants were enrolled in the study from August 2019 to October 2021 and followed up for 4 years at 33 sites in Brazil.
• The analysis found that 2,697 participants (28.5%) had cardiovascular disease; 371 (3.9%) had subclinical cardiovascular disease; and 2,113 (22.6%) had chronic kidney disease at baseline.
• At the beginning of the study, participants’ average systolic blood pressure was 146 mm Hg, and diastolic blood pressure was 80 mm Hg. Participants were randomly assigned to either an intensive treatment group to lower systolic blood pressure below 120 mm Hg, or a standard treatment group targeting systolic blood pressure less than 140 mm Hg. Blood pressure medications were adjusted throughout the study to reach those targets. The average systolic blood pressure throughout follow-up (excluding the first 3 months) was 122 mm Hg in the intensive-treatment group and 135 mm Hg in the standard-treatment group.
• Researchers evaluated whether participants experienced cardiovascular death, heart attack, stroke, hospitalization for chest pain or heart failure during the 4-year study period. They also examined deaths from any cause, each of these cardiovascular outcomes individually and kidney-related outcomes.
• The main limitation of the study is that the trial was open-label, meaning participants and investigators knew which treatment strategy they were receiving. Additionally, the results may not be generalizable to populations outside Brazil.

Co-authors, disclosures and funding sources are listed in the abstract.

Statements and conclusions of studies that are presented at the American Heart Association’s scientific meetings are solely those of the study authors and do not necessarily reflect the Association’s policy or position. The Association makes no representation or guarantee as to their accuracy or reliability. Abstracts presented at the Association’s scientific meetings are not peer-reviewed, rather, they are curated by independent review panels and are considered based on the potential to add to the diversity of scientific issues and views discussed at the meeting. The findings are considered preliminary until published as a full manuscript in a peer-reviewed scientific journal.

The Association receives more than 85% of its revenue from sources other than corporations. These sources include contributions from individuals, foundations and estates, as well as investment earnings and revenue from the sale of our educational materials. Corporations (including pharmaceutical, device manufacturers and other companies) also make donations to the Association. The Association has strict policies to prevent any donations from influencing its science content and policy positions. Overall financial information is available here.

Additional Resources:

• Multimedia is available on the right column of the release link
• View the abstract in the American Heart Association Scientific Sessions 2026 Online Program Planner
• American Heart Association news release: Managing high blood pressure could prevent >500K CVD deaths annually in 20 countries (Oct. 2026)
• American Heart Association news release: New high blood pressure guideline emphasizes prevention, early treatment to reduce CVD risk (Aug. 2025)
• American Heart Association health information: Understanding Blood Pressure Readings
• About Scientific Sessions 2026
• For more news at the American Heart Association’s Scientific Sessions 2026, follow us on X @HeartNews, #ScientificSessions26

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About the American Heart Association

The American Heart Association is a relentless force for a world of longer, healthier lives. Dedicated to ensuring equitable health in all communities, the organization has been a leading source of health information for more than one hundred years. Supported by more than 35 million volunteers globally, we fund groundbreaking research, advocate for the public’s health, and provide critical resources to save and improve lives affected by cardiovascular disease and stroke. By driving breakthroughs and implementing proven solutions in science, policy, and care, we work tirelessly to advance health and transform lives every day. Connect with us on heart.org, Facebook, X or by calling 1-800-AHA-USA1.

For Media Inquiries and American Heart Association Expert Perspective:

American Heart Association Communications & Media Relations in Dallas: 214-706-1173; ahacommunications@heart.org

Bridgette McNeill: bridgette.mcneill@heart.org

For Public Inquiries: 1-800-AHA-USA1 (242-8721)

heart.org and stroke.org

• In a study of almost 1,900 adults, ages 70 years and older who had other chronic health conditions but not cardiovascular disease, those who stopped taking cholesterol-lowering statins had similar rates of heart attack, stroke and death after two years when compared to peers who continued taking statins.
• There was an increase in the number of heart attacks and strokes among a small number of older adults who discontinued statins in an extended follow-up of up to four years, compared to peers who continued taking the medications.
• While discontinuing statin therapy for primary prevention is generally safe for adults ages 70 and older without cardiovascular disease, a slight increased risk for cardiovascular events over time reinforces the need for shared decision-making between patients and their healthcare team.
• Note: This trial is simultaneously published today as a full manuscript in the peer-reviewed scientific journal, The New England Journal of Medicine.

Embargoed until 3:15 p.m. CT/4:15 p.m. ET, Saturday, Nov. 7, 2026

CHICAGO, Nov. 7, 2026 — It is generally safe for adults ages 70 and older who take statins to prevent cardiovascular disease but who have not had a heart attack or stroke to discontinue taking the cholesterol-lowering medications, according to new, independent, preliminary late-breaking science presented today at the American Heart Association’s Scientific Sessions 2026. The meeting on Nov. 6-9 in Chicago is a premier global exchange of the latest scientific advancements, research and evidence-based clinical practice updates in cardiovascular science.

About 25% of U.S. adults are estimated to have high low-density lipoprotein-cholesterol (LDL-C), or “bad cholesterol,” which can build up in the arteries, affecting blood flow and increasing the risk of heart attack and/or stroke. Statin therapy is the foundation of lipid-lowering and risk reduction, which includes primary prevention aimed at preventing a first heart attack or stroke, as detailed in the Association’s 2026 joint guideline on dyslipidemia. 

“While the Association’s recent joint guideline recommends lifestyle and potentially medication for people with high LDL-C at younger ages to reduce the risk of heart attack and stroke, recent studies question the health benefits of continuing statins in the later decades of life,” said study author Rita F. Redberg, M.D., M.Sc., FAHA, professor of cardiology and the Araxe Vilensky Endowed Chair in Cardiology at the University of California, San Francisco School of Medicine. “A few previous studies assessed the safety of discontinuing statins for primary prevention at age 70 and later, and they found no difference in mortality. One study suggested quality of life improvements after stopping statins. Whether it is safe to discontinue statins to prevent a first CVD event in the elderly remained unclear and the question we explored in our study.”

This study included nearly 1,900 adults, ages 70 and older, who took statins to prevent a first cardiovascular event and had at least two chronic health conditions, such as past cancer or pulmonary disease. Half of the participants discontinued taking statins, while the other half continued taking them. The researchers monitored the participants during the next two years, and for up to four years, for heart attack, stroke or death. They also assessed quality of life, muscle pain, falls and muscle wasting (known as sarcopenia).

What are the study’s key findings?

• At about two years, discontinuation of statins was safe, without a significant increase in heart attack, stroke or death, compared to those who continued the therapy.
• There were no differences between the groups when researchers assessed the study participants’ quality of life, muscle pain, falls and sarcopenia.
• Statistically speaking, over the course of two years, for every 40 individuals in the group who discontinued statins, one additional cardiovascular event occurred among them.
• In a follow-up period of up to four years, 12.7% of those who discontinued statins had a heart attack, stroke or death, compared to 9.2% who continued the therapy.

Redberg noted the increased risk at four years among a small number of older adults was a new finding in scientific literature, one which she said could be because this trial had more people and a longer follow-up than previous studies.

“This small, increased risk of cardiovascular events means that one cannot make a general recommendation about stopping statins in this patient population,” she said. “There should be shared decision-making between the patient and the healthcare professional to know if it is appropriate for an individual to discontinue the medication. In general, however, discontinuation is safe for most people who are in this age group and without a previous CVD event.”

What are the study’s details, background, design and limitations?

• The research included 1,880 total adults, age 70 and older (average age of 77; 53% men, and 47% women) with at least two chronic health conditions. People with existing cardiovascular disease or a prior cardiovascular event were excluded from the study.
• The study was conducted from November 2021 to April 2026, at 24 clinical centers in Switzerland, France and the Netherlands.
• Of the participants, 938 were assigned to the group to discontinue statins, and 942 of the participants continued taking their statin medications.
• Researchers collected data on heart attack, acute ischemic stroke and all-cause death. In addition, participants were surveyed throughout the study and during follow-up about quality of life, muscle pain, falls and sarcopenia.
• A limitation of the study was that there was crossover in both groups during the study period, meaning some people in the discontinuation group restarted their statins while some in the continuation group stopped them. Overall, about 14% of participants crossed over to the other group during the study. To account for this shift, the researchers conducted several additional analyses that yielded no change in the results.

Co-authors, disclosures and funding sources are listed in the abstract.

Statements and conclusions of studies that are presented at the American Heart Association’s scientific meetings are solely those of the study authors and do not necessarily reflect the Association’s policy or position. The Association makes no representation or guarantee as to their accuracy or reliability. Abstracts presented at the Association’s scientific meetings are not peer-reviewed, rather, they are curated by independent review panels and are considered based on the potential to add to the diversity of scientific issues and views discussed at the meeting. The findings are considered preliminary until published as a full manuscript in a peer-reviewed scientific journal.

The Association receives more than 85% of its revenue from sources other than corporations. These sources include contributions from individuals, foundations and estates, as well as investment earnings and revenue from the sale of our educational materials. Corporations (including pharmaceutical, device manufacturers and other companies) also make donations to the Association. The Association has strict policies to prevent any donations from influencing its science content and policy positions. Overall financial information is available here.

Additional Resources:

• Multimedia is available on the right column of the release link
• View the abstract in the American Heart Association Scientific Sessions 2026 Online Program Planner
• American Heart Association health information: Cholesterol-Lowering Medications
• American Heart Association health information:  Prevention and Treatment of High Cholesterol (Hyperlipidemia)
• American Heart Association health initiative: Life’s Essential 8™ - How to Control Cholesterol Fact Sheet
• About Scientific Sessions 2026
• For more news at the American Heart Association’s Scientific Sessions 2026, follow us on X @HeartNews, #ScientificSessions26

###

About the American Heart Association

The American Heart Association is a relentless force for a world of longer, healthier lives. Dedicated to ensuring equitable health in all communities, the organization has been a leading source of health information for more than one hundred years. Supported by more than 35 million volunteers globally, we fund groundbreaking research, advocate for the public’s health, and provide critical resources to save and improve lives affected by cardiovascular disease and stroke. By driving breakthroughs and implementing proven solutions in science, policy, and care, we work tirelessly to advance health and transform lives every day. Connect with us on heart.org, Facebook, X or by calling 1-800-AHA-USA1.

For Media Inquiries and American Heart Association Expert Perspective:

American Heart Association Communications & Media Relations in Dallas: 214-706-1173; ahacommunications@heart.org

Michelle Kirkwood: michelle.kirkwood@heart.org

For Public Inquiries: 1-800-AHA-USA1 (242-8721)

heart.org and stroke.org