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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 large, long-term study of over 52,000 women in Israel found that among women ages 45 to 59, initiation of contemporary hormone replacement therapy did not increase the risk of heart attack, stroke, blood clots or death.
• The independent, preliminary study had an average follow-up of 12 years and included hormone replacement therapy in oral, transdermal (patch) or gel form.
• Note: The study featured in this news release is a research abstract. Abstracts presented at 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 a.m. CT/5 a.m. ET, Monday, Nov. 2, 2026

DALLAS, Nov. 2, 2026 — Contemporary hormone replacement therapy (HRT) was not associated with an increased risk for heart attack, stroke, blood clots or death among women ages 45 to 59, according to a large, long-term study of over 52,000 women in Israel. The findings from this new, independent, preliminary research will be presented at the American Heart Association’s Scientific Sessions 2026. The meeting, 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.

“Concerns that hormone replacement therapy may affect the heart is one of the most common reasons women decline hormone therapy to manage menopause symptoms, and why some healthcare professionals may hesitate to offer it,” said lead study researcher Ronen Arbel, Ph.D., a researcher in the community medical services division of Clalit Health Services in Tel Aviv, Israel, and a researcher with Sapir College’s Maximizing Health Outcomes Research Lab in Sderot, Israel.

Previous randomized trials found associations between HRT and cardiovascular harm. However, results were mixed, and much of that evidence was from studies with older HRT formulations that are no longer commonly used, with higher doses and in women who started on HRT long after menopause. Current clinical guidelines from the American College of Obstetricians and Gynecologists recommend starting HRT within 10 years of menopause onset and before age 60. In November 2025, the FDA removed the “black box” warnings from HRT products after a comprehensive review of current scientific data indicating that HRT is not associated with increased risk of cardiovascular disease, breast cancer or dementia.

“For many women, menopause symptoms can significantly affect their quality of life, yet questions about the cardiovascular safety of hormone therapy have remained,” said Stacey E. Rosen, M.D., FAHA, an expert in women’s heart health and past volunteer president of the American Heart Association (2025-2026). “This large, long-term study adds to growing evidence that today's hormone therapy options may not increase the risk of heart disease, stroke or blood clots for healthy women who begin treatment around the time of menopause. These findings can help women and their healthcare teams have more informed conversations about the benefits and risks of treatment based on their individual health needs.” Rosen, who was not involved in this study, is also executive director of the Katz Institute for Women’s Health and senior vice president of women’s health at Northwell Health in New York City.

The study to be presented at the American Heart Association’s Scientific Sessions evaluated data for over 52,000 women, ages 45 to 59, to assess whether the use of contemporary HRT is associated with an increased risk of atherosclerotic cardiovascular disease, venous thromboembolism (blood clots) or premature death (before age 80) in women who had not been previously diagnosed with cardiovascular disease.

After an average of 12 years of follow-up, the health outcomes were similar between the two groups of women, meaning the group who started taking HRT did not show an increase in cardiovascular events or early death compared to the group that was not taking HRT.

What are the study’s main findings?

• 2,311 women in the HRT group (4.4%) experienced a heart attack, stroke or had some type of related heart disease vs. 2,383 (4.6%) of the women in the no-HRT group.
• Death before age 80 occurred in 659 (1.3%) of the women taking HRT vs. 653 (1.2%) of the women not on any form of HRT.
• 0.33% of women in both groups experienced a blood clot (174 women in the group taking HRT vs. 175 from the group that did not take HRT).
• The results were similar across all HRT formulations and administration routes (oral, patch or gel).

“Our results indicate that, for women in their mid-forties to late fifties with no history of heart disease or blood clots, the currently available hormone therapies prescribed to manage menopause symptoms do not appear to raise the risk of heart attack, stroke, clots or early death, even after long-term use,” Arbel said.

Study details, background and design:

• Using records from Clalit Health Services in Israel, researchers evaluated health data for 52,330 women between 45–59 years old with no history of heart disease, blood clots or cancer.
• Half of the women had started HRT, primarily via oral and/or transdermal (patch) methods, while the other half had recently visited a gynecologist but did not begin HRT. The women in the second group did not take HRT throughout the study period.
• The researchers matched the women in both groups by age, BMI, cardiometabolic risk factors (blood pressure, cholesterol levels and whether they had been diagnosed with Type 1 or Type 2 diabetes), smoking status and socioeconomic status and compared their health data.
• Researchers evaluated the health records of both groups for up to 23 years, with an average follow-up period of 12 years, to compare the rate of cardiovascular disease, specifically heart attack, stroke and blood clots, as well as death from any cause before age 80.

The research has several limitations. It is an observational study, so it cannot prove a direct connection between HRT and heart health. The researchers also noted that there may be other differences among the women taking HRT vs. those who do not that was not available or detailed in the health records, such as differences in exercise, diet, other health conditions and severity of menopause symptoms. Additionally, the study grouped women by the first type of hormone therapy they used and did not include any changes in HRT type or formulation throughout the follow-up period.

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, including video interview clips with American Heart Association past volunteer President, Stacey E. Rosen, M.D., FAHA,  is available on the right column of the release link.
• Spanish news release
• Link to abstract and the American Heart Association’s Scientific Sessions 2026 Online Program Planner
• American Heart Association news release: Perimenopause may offer a “window of opportunity” for heart disease prevention in women (May 2026)
• American Heart Association Scientific Statement: Menopause Transition and Cardiovascular Disease Risk: Implications for Timing of Early Prevention (March 2020)
• American Heart Association health information: Menopause and Cardiovascular Risk
• 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: 214-706-1173

American Heart Association Communications & Media Relations in Dallas: ahacommunications@heart.org

Amanda Ebert: Amanda.Ebert@heart.org   

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

heart.org and stroke.org

• Compared to city residents, people living in rural areas who had a heart attack had a nearly threefold higher risk of dying before they got to a hospital, according to an analysis of 20-years of national U.S. hospital data from the CDC’s WONDER database.
• Heart attack-related death prior to hospital arrival, or death while in outpatient or emergency care settings were also more common among Black adults than white adults in rural settings.
• Young adults, particularly those between ages 20 and 44, also disproportionately died from heart attacks outside of the hospital. This may be attributable to delayed recognition of heart attack among younger adults, researchers noted.
• Note: The study featured in this news release is a research abstract. Abstracts presented at 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 a.m. CT/5 a.m. ET, Monday, Nov. 2, 2026

DALLAS, Nov. 2, 2026 — People living in rural areas who experienced a heart attack were nearly three times more likely to die before reaching hospital care, compared to those living in large, metropolitan areas, according to new, independent, preliminary research to be presented at the American Heart Association’s Scientific Sessions 2026. The meeting, 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.

In the U.S., someone experiences a heart attack every 40 seconds, according to the American Heart Association’s 2026 Heart Disease and Stroke Statistics, with about 50% of fatal heart attacks occurring outside of the hospital.

Previously, there was limited data on exactly which populations and demographics were at greater risk of death before reaching hospital care. This study explored participants’ location at the time of heart attack and death, distance to the nearest hospital and whether deaths differed according to their age, sex, race, Hispanic ethnicity, and urban or rural residency.

“Getting emergency care as soon as possible can make a major difference in a life-threatening situation,” said study author Darshan Shivanne Gowda, M.B.B.S, a medical student at Hassan Institute of Medical Sciences in Karnataka, India. “We found that people who live in rural areas and certain other populations were more likely to die before receiving urgent care for a heart attack that would improve their chances of survival.”

What are the study’s main findings?

• Rural residents were nearly three times more likely to die before hospital arrival, as well as about 89% more likely to die at home and 58% more likely to die in outpatient or emergency care settings than people who live in large, metropolitan areas.
• Black adults who experienced heart attacks were about 16% more likely to die prior to arrival at the hospital and 25% more likely to die at outpatient facilities compared to white adults, which may reflect racial inequities in pre-hospital care.
• In contrast, Hispanic adults who died from heart attacks were more likely to die in the hospital than non-Hispanic adults.
• Overall, men were 20%-40% more likely to die from a heart attack before hospital arrival than women.
• Adults older than age 65 were up to six times more likely to die in a long-term care facility after a heart attack.
• Young adults, particularly those between ages 20 and 44, disproportionately died from heart attacks that occurred outside of the hospital, potentially because of delayed recognition of heart attacks among this age group.

“The message for patients and families is simple: know the warning signs of a heart attack and do not wait to seek help,” Gowda said. “Call 9-1-1 immediately when symptoms occur. At the same time, our findings show that communities need reliable emergency medical services and timely access to specialized heart attack care, regardless of where people live.”

“We were also struck by the higher likelihood of out-of-hospital death among younger adults,” he said. “Heart attacks are often perceived as primarily affecting older adults, so the finding that younger adults had the highest relative odds of death by the time they reached the hospital underscores the importance of recognizing heart attack symptoms across all age groups.”

The American Heart Association has identified the rural health crisis as one of the top three barriers to achieving health care access and improving care for all people, everywhere. Recognizing the gaps in healthcare for rural Americans, the Association has funded a multi-pronged approach to improving health in rural America. Projects include delivering resources (such as self-measured blood pressure monitors, CPR education, addressing nutrition insecurity and youth engagement program) to strengthen rural and tribal communities by training a public health workforce; funding a scientific research initiative comprised of a network of special projects focused on advancing the understanding of the factors that impact health in rural America; and creating a Rural Health Care Outcomes Accelerator to expand rural hospital participation in Get With The Guidelines®, the American Heart Association’s proven, evidence-based, in-hospital approach to improving patient outcomes by promoting consistent adherence to the latest research-driven guidelines and measurement.

“Heart attack is a time-sensitive emergency,” said Johanna Paola Contreras, M.D., FAHA, a member of the American Heart Association’s International Committee and Community Engagement Committee and founder of the association’s National Hispanic Latino Cardiovascular Collaborative. “Rural communities may face longer distances to hospitals, fewer emergency and specialty cardiovascular services, and challenges with transportation and access to timely care. Although this study cannot tell us which of these factors explains the difference, the findings reinforce the importance of strengthening emergency medical services, prevention, early recognition and access to specialized cardiovascular care in rural communities. Our goal should be simple: where someone lives should not determine whether they survive a cardiovascular emergency.”

Contreras, who was not involved in this research, is an associate professor of medicine (cardiology) at Icahn School of Medicine at Mount Sinai; director of Heart Failure and Cardiomyopathy Clinical and Research Network at Mount Sinai Fuster Heart Hospital and medical director of the Hispanic Heart Center at Mount Sinai Health System in New York City. She noted that the responsibility for improving outcomes among rural patients belongs to families, healthcare professionals and policy makers.

“Everyone must know the warning signs of a heart attack and act quickly,” she said. “If symptoms suggest a heart attack, call 9-1-1 rather than trying to drive yourself to the hospital. And importantly, being young does not exclude the possibility of a heart attack. The disproportionate number of out-of-hospital deaths among younger adults in this study reminds us that serious cardiovascular symptoms need to be recognized at every age. Communities and health systems must also provide reliable emergency medical services and pathways that allow people to reach appropriate cardiovascular care quickly, particularly when they live far from a hospital.”

Study details, background, design and limitations:

• Researchers reviewed death certificate data from the CDC WONDER database for deaths occurring in the U.S. between 2003 and 2023.
• The study analyzed the place of the heart attack and death for more than 2.5 million adults (ages 20 or older) who died from heart attack.
• Rural areas were defined as counties outside metropolitan areas and classified as either micropolitan or noncore areas. Micropolitan areas center around small urban clusters of 10,000–49,999 residents, whereas noncore areas lack a substantial urban center and represent more geographically isolated rural communities, Gowda explained.
• Place of death was categorized as upon hospital arrival, outpatient or emergency setting, home, hospice or nursing home/long-term care facilities.
• The retrospective, observational study cannot prove direct causation among social demographic factors, location and death.
• Place of death is an indirect measure of emergency care access because it does not directly account for when heart attack symptoms began, emergency response and transportation times, distance to hospitals, proximity to heart attack specialty care, or other delays in seeking or accessing care.

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.
• Spanish news release
• Link to abstract and the American Heart Association’s Scientific Sessions 2026 Online Program Planner
• American Heart Association health information: Warning Signs of a Heart Attack
• American Heart Association health information: Rural Health | American Heart Association
• American Heart Association news release: Deaths from cardiovascular disease increased among younger U.S adults in rural areas (Nov. 2024)
• American Heart Association news release: Original YouTube TM docuseries focuses on health inequities and challenges in rural America (May 2024)
• 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: 214-706-1173

American Heart Association Communications & Media Relations in Dallas: ahacommunications@heart.org

Bridgette McNeill: Bridgette.McNeill@heart.org

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

heart.org and stroke.org

• After nearly two decades of decline, valvular heart disease death rates among U.S. adults ages 65 and older have increased by nearly 5% from 2018 to 2023, rising from 104 to more than 109 deaths per 100,000 people.
• The impact of heart valve disease was highest among men, non-Hispanic white adults, adults ages 85 and older and people living in nonmetropolitan areas.
• Death rates from heart valve disease are projected to remain elevated through 2040 rather than continuing the decline observed before the pandemic era, highlighting the need for earlier detection and timely access to heart valve care, researchers said.
• Note: The study featured in this news release is a research abstract. Abstracts presented at 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 a.m. CT/5 a.m. ET, Monday, Nov. 2, 2026

DALLAS, Nov. 2, 2026 — After nearly two decades of decline, valvular heart disease death rates have increased from 2018 to 2023 and are predicted to remain elevated through 2040, according to independent, new preliminary research to be presented at the American Heart Association’s Scientific Sessions 2026. The meeting, 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.

Heart valve disease is an umbrella term for conditions that arise when any of the heart’s four valves — aortic, mitral, pulmonary or tricuspid — stop working properly. According to the American Heart Association’s 2026 Heart Disease and Stroke Statistics, more than 80 million people worldwide live with heart valve disease and the number is growing. In the U.S., heart valve disease contributes to more than 57,000 deaths each year.

“Heart valve disease is an increasingly important health concern as the U.S. population ages, but information has been limited on just how much specific populations are currently impacted and what trends are expected for the future,” said study author Hritvik Jain, M.D., a resident physician in internal medicine at Allegheny General Hospital in Pittsburgh. “Our study found that the decades-long decline in deaths from heart valve disease has stopped. As the U.S. population continues to age, we need to focus on earlier detection, timely treatment and equitable access to specialized valve care, particularly for the oldest adults and those living in rural communities.”

To learn more about the potential impact on the aging population, researchers analyzed death information from the U.S. Centers for Disease Control and Prevention’s Wide-ranging Online Data for Epidemiologic Research (WONDER) resource, from 1999 to 2023, focused on U.S. adults ages 65 and older. They evaluated death rate trends, examined generational and age-related patterns and used statistical software to forecast death rates through 2040.

What are the key findings of the study?

• There were more than 1.2 million heart valve disease-related deaths from 1999 to 2023.
• The death rate declined from a high of 123.2 deaths per 100,000 in 1999 to its lowest levels immediately before the pandemic period, after which rates increased and reached 109.2 deaths per 100,000 in 2023.
• Men had higher rates of valvular heart disease death than women (124.7 vs. 103.1/100,000), while non-Hispanic white adults had the highest valvular heart disease death rates (122.4/100,000) among all racial/ethnic groups included in the analysis.
• Nonmetropolitan areas also had higher death rates than metropolitan areas (120.5 versus 110.1/100,000).
• Adults ages 85 and older had more than 15 times the death rate from valvular heart disease in comparison to adults ages 65 to 69 in 1999 (when death rates from heart valve disease were highest).
• Researchers projected that death rates from heart valve disease would remain around 109.2/100,000 through 2040, rather than continuing the previous decline.

“We also found that while death rates improved for newer generations in their late 60s, those gains did not continue into very old age. At age 85 and older, newer generations had higher death rates than earlier generations at the same age,” Jain said.

In 2020, the American Heart Association launched Target: Aortic Stenosis™  (Target: AS) to help improve outcomes for people living with the disease. The program supports earlier and more accurate diagnosis, timely treatment and ongoing disease management. It provides hospital care teams with tools and resources to deliver consistent, evidence-based care for patients with aortic stenosis. In addition, in 2025, the Association launched the Heart Valve Initiative, a comprehensive national effort to ensure individuals with heart valve disease are identified earlier, treated sooner and supported throughout their care journey.

“The recent reversal of progress in valvular heart disease mortality is especially alarming in light of the substantial advances in treatment achieved over the past decade and a half,” said Sreekanth Vemulapalli, M.D., a volunteer member of the American Heart Association’s Target: Aortic Stenosis Scientific Advisory Group, an associate professor of medicine at Duke University, a core faculty member at the Duke-Margolis Institute for Health Policy and a member of the Duke Clinical Research Institute. “This disconnect between therapeutic innovation and population-level outcomes highlights the critical need for the American Heart Association’s quality improvement and educational initiatives to improve awareness, care delivery and patient outcomes.”

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

• Study population included: 1,204,490 valvular heart disease-related deaths among U.S. adults 65 years of age and older from 1999–2023; 42.9% were men and 57.1% were women. The study population included people whose death records listed valvular heart disease, including rheumatic and non-rheumatic valvular disorders. Nonrheumatic aortic valve disease accounted for the majority of the deaths.
• The study analyzed U.S. national mortality data covering 1999–2023, from the U.S. Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (WONDER) Multiple Cause of Death database. VHD-related deaths were identified using ICD-10 codes listed as either the underlying or contributing cause of death.
• Age-adjusted death rates were calculated using the 2000 U.S. Standard Population. Joinpoint regression software was used to assess temporal trends. In addition, age-period-cohort analysis evaluated age, calendar-period and birth-cohort effects; and ARIMA models projected mortality through 2040.
• Study limitations include that, because cause of death was sourced from death-certificate data, it may be subject to coding inaccuracies and cannot capture disease severity, echocardiographic findings or individual treatment history. In addition, the study cannot establish causality, and the COVID-19 pandemic may have influenced trends during the final years of the study.

Co-authors and disclosures 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.
• Link to abstract; and the American Heart Association’s Scientific Sessions 2026 Online Program Planner
• American Heart Association news release: Scientific researchers awarded $15 million to study heart valve disease (April 2026)
• American Heart Association news release: New effort launched to support earlier diagnosis, treatment of aortic stenosis (Nov. 2025)
• 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: 214-706-1173

American Heart Association Communications & Media Relations in Dallas: ahacommunications@heart.org

Cathy Lewis: Cathy.Lewis@heart.org

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

heart.org and stroke.org

• In a survey of almost 100 primary care outpatient facilities and other clinical sites in the U.S., fewer than one-third were using cardiovascular-kidney-metabolic syndrome (CKM syndrome) staging or the PREVENT equations to assess cardiovascular risk.
• The survey was a baseline assessment of sites that have joined the American Heart Association’s Cardiovascular-Kidney-Metabolic Health Initiative™, a quality improvement program meant to improve early recognition and management of CKM syndrome.
• Standardized screenings for individual components of CKM syndrome were common, while newer protocols for comprehensive CKM syndrome assessment were less common.
• The study findings highlight opportunities to improve routine, coordinated heart, kidney and metabolic health screening.
• Note: The study in this news release is a research abstract. Abstracts presented at 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 a.m. CT/5 a.m. ET, Monday, Nov. 2, 2026

DALLAS, Nov. 2, 2026 — In a survey of health clinics participating in a new initiative to improve care for cardiovascular-kidney-metabolic (CKM) syndrome, most sites reported conducting basic screening for heart, kidney and metabolic risks, however, far fewer are using newer guideline-recommended tools such as the CKM syndrome staging framework and the American Heart Association’s PREVENT™ (Predicting Risk of cardiovascular EVENT) equations, according to new, preliminary research to be presented at the American Heart Association’s Scientific Sessions 2026. The meeting, 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.

The American Heart Association defines cardiovascular-kidney-metabolic syndrome as a multi-system health disorder due to connections between obesity, Type 2 diabetes, chronic kidney disease and heart disease. Nearly 90% of U.S. adults have at least one of the components of CKM syndrome, including high blood pressure, abnormal cholesterol, high blood glucose (sugar), excess weight, reduced kidney function or related heart conditions.

In 2025, the Association launched a learning collaborative and quality improvement initiative focused on the adoption of a CKM-coordinated care model in about 150 clinical sites across the U.S. Participating sites in the initial launch were selected based on factors such as the burden of CKM syndrome in their community, structural and societal influences, being in rural areas and by the health organization type.

All participating clinics were surveyed between Aug. 2025 – June 2026, to document a baseline of the implementation status of the initiative recommendations. A total of 97 clinical sites completed the standardized questionnaire.

“We found that most of the sites were actively screening patients for CKM risk factors and related conditions. Far fewer were using specifically recommended clinical assessment tools such as CKM syndrome staging and the PREVENT equations,” said lead author Chiadi Ndumele, M.D., Ph.D., M.H.S., FAHA, director of the Penn Center for Cardiometabolic Heath and Presidential Professor of Medicine at the University of Pennsylvania in Philadelphia. “However, that isn’t entirely surprising. These tools — and even CKM syndrome as a medical condition — embrace relatively new concepts just beginning to be adopted. This baseline is important because it shows we have opportunity to improve patient care as we help clinicians understand how to better incorporate these tools into their practices.”

What are the key findings of this survey?

• 75% of clinical sites screened for CKM-related conditions;
• 73% systematically tested patient populations for CKM risk factors;
• Only 28% used the PREVENT equations to estimate cardiovascular disease risk; and
• Only 22% used CKM syndrome staging.

“We see these conditions that define CKM syndrome clustering together — if a person has one condition, they’re more likely to be at risk for the others. Because they are so closely interconnected, we need to look at these all together, which led to this initiative,” Ndumele said. “The baseline assessments highlight areas most requiring targeted focus of implementation efforts to improve CKM syndrome care. Additionally, the details from this analysis inform the blueprint for adoption of evidence-based standards and a CKM model of care and provide evidence to support implementation. These findings could also pave the way for other healthcare sites and hospital systems seeking to improve care for patients with CKM syndrome within their clinical population.”

Ndumele said the CKM syndrome stages assessment and the PREVENT equations more closely identify specific risks and opportunities for improved care management.

There are four CKM syndrome stages, reflecting the typical evolution of CKM syndrome over time: 1.) Excess or dysfunctional fat which may accumulate around the liver, pancreas, heart and kidneys. 2.) Chronic kidney disease and/or metabolic risk factors 3.) Subclinical heart disease or high-risk equivalents and 4.) clinical heart disease. With early detection and preventive care to reduce progression along CKM syndrome stages, outcomes can improve substantially.

The American Heart Association’s PREVENT™ equations, based on contemporary data from more than 6.5 million diverse U.S. adults, have improved accuracy and are more generalizable to U.S. population than previous risk predicting tools. They can estimate 10-year and 30-year risk for cardiovascular disease development for people ages 30-79 without known heart disease, thereby helping to inform the use of preventive therapies.

Study details, background, design and limitations:

• After launching and onboarding novel assessments that screen for heart, kidney and metabolic risks, 97 clinical sites completed a standardized questionnaire to document their status and progress in implementing the new and improved screening and risk estimation tools.
• 92% of clinical sites identified as outpatient facilities with the highest representation in primary care; organization types were 44% safety net, 39% non-academic and 16% academic.
• Respondents reported which CKM-related screening their clinics currently conduct: social drivers of health screenings (75%), screening for clinical CKM-related comorbidities (75%), and actively screening patient populations for CKM risk factors (73%) were the most performed.
• Only 22% of sites reported measuring patients’ waist circumference as standard practice.
• Only 28% of sites reported CVD risk estimation via the PREVENT equations, while only 22% reported use of CKM syndrome staging.

Study limitations include that although 150 clinical sites are included in the initiative, data from only 97 sites was available at the time of this analysis. The survey represents self-reported data from clinical sites, which is subject to recall bias and potential misclassification. Also clinical sites were chosen by initiative which is subject to selection bias. Ongoing assessments will provide a more comprehensive understanding of the implementation of CKM syndrome practices, as well as related barriers and opportunities, researchers said.

“We hope adoption of the newer, more comprehensive tools can help identify patients at higher risk and guide the effective provision of more whole-person care,” Ndumele said.

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 pharmaceuticals, 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 Scientific Sessions 2026 Online Program Planner
• American Heart Association news release: First-ever guideline on cardiovascular-kidney-metabolic syndrome issued (June 2026)
• American Heart Association news release: Millions are unaware of heart risks that don’t start in the heart (Feb. 2026)
• American Heart Association news release: 15 regions chosen for groundbreaking effort to reduce cardiovascular disease (July 2025)
• 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: 214-706-1173

American Heart Association Communications & Media Relations in Dallas: ahacommunications@heart.org

Maggie Francis; maggie.francis@heart.org  

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

heart.org and stroke.org

• People exposed to high levels of residential transportation noise, including road traffic (such as cars and buses), trains and aviation, face a higher risk of serious heart-related conditions.
• The link was similar for people with healthy sleep patterns and those with unhealthy sleep patterns, defined in this study as a sleep disorder diagnosis, or sleeping more or less than 7-9 hours per night.
• The findings suggest that chronic exposure to loud transportation noise may be an environmental risk factor that increases the risk of cardiovascular disease, which regular, healthy sleep patterns may not counteract, researchers said.
• 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 a.m. CT/5 a.m. ET, Monday, Nov. 2, 2026

DALLAS, Nov. 2, 2026 — Adults exposed to high levels of residential transportation noise from traffic (cars and buses), as well as planes and trains, were linked to a higher risk of serious heart-related events and a higher likelihood of developing cardiovascular risk factors, such as high cholesterol, high blood pressure or diabetes, even among people with healthy sleep, according to new, independent, preliminary research to be presented at the American Heart Association’s Scientific Sessions 2026. The meeting, 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.

“The key finding of our study is that the relationship between noise exposure and cardiovascular disease events, and the number of cardiovascular risk factors developed, was similar among people with and without unhealthy sleep, suggesting that healthy sleep is not protective against adverse heart impacts of noise exposure,” said lead study author Joseph Nguyen, M.D., an internal medicine resident physician at Massachusetts General Hospital and a member of the Cardiovascular Imaging Research Center in Boston. “We expected that disordered sleep would influence the relationship between noise exposure and heart disease. It was surprising to find that sleep health appeared to play no role.

Road traffic noise has become a significant issue; however, research indicates that noise from other forms of transportation, such as aircraft noise, can also increase the risk of heart disease. The World Health Organization states that noise is a public health risk and has set limits on noise exposure to help reduce these effects,” Nguyen said.

Researchers analyzed medical records and lifestyle survey data for more than 100,000 adults, as well as U.S. government transportation noise data, to examine whether transportation noise-related heart risks differed between people with normal and abnormal sleep. Specifically, they examined average noise levels above 45-50 decibels, which is similar to moderate rainfall or typing on a keyboard.

“It is important to note that the noise levels in our dataset are a 24-hour average, rather than peak noise levels, which may be much higher. For example, subway stations have an average noise level of about 75 decibels at rest and can be more than 100 decibels when trains are arriving or leaving,” Nguyen said.

What are the study’s main findings?

• Exposure to elevated levels of transportation noise (above 50 decibels) was associated with an 8%– 10% increase in the development of major heart disease risk factors, such as high cholesterol, high blood pressure and diabetes.
• Transportation noise exposure at more than 50 decibels was linked to greater odds of developing a major adverse heart event, even after accounting for age, sex and sleep quality.

“While our primary analysis focused on the number of risk factors developed, as opposed to which specific risk factor was most affected, when analyzing risk factors individually, the strongest relationship was seen with high cholesterol, followed by high blood pressure and then diabetes,” Nguyen said.

The link between transportation noise and cardiovascular events was similar for those with healthy and unhealthy sleep even after considering other factors that affect heart disease risk, such as high blood pressure, high cholesterol and diabetes; socioenvironmental factors, such as air pollution and income; and mental health factors, such as depression and anxiety.

Nguyen said the findings highlight the importance of limiting environmental noise exposure to the extent possible for all people with high noise exposure.

“People with noise exposure should consider strategies to reduce noise levels, such as installing thicker drywall, windows and doors in their home; placing bedrooms in the quietest areas of the house; planting dense trees and vegetation in the yard to absorb noise; and using earplugs during sleep,” he said.

“This study adds to the growing evidence that shows environmental factors such as air pollution, noise, artificial light, chemical pollutants and climate-related events may be contributing to the significant burden of cardiovascular disease as a leading cause of death worldwide. Creating stronger policies to reduce adverse environmental exposures and building durable infrastructure that emphasizes wellness, will help us tackle these environmental issues and help improve heart health, and create healthier, more sustainable communities for our children and our children’s children,“ said co-author of the American Heart Association joint scientific statement: Environmental Stressors and Cardiovascular Health: Acting Locally for Global Impact in a Changing World, past American Heart Association volunteer President Keith Churchwell, M.D., FAHA, adjunct associate professor of medicine at the Vanderbilt School of Medicine in Nashville, Tenn. Dr. Churchwell was not involved in this study.

Study details, background, design and limitations:

• The study included data from 2010-2020 for 108,051 adults (median age of 57 years; 58% women) who enrolled in the Massachusetts General Brigham Biobank.
• Transportation noise exposure was estimated using a U.S. Department of Transportation tool that measures average 24-hour transportation noise levels near a person’s home.
• Just over one-third of participants, 34.7%, had abnormal sleep, which included sleep apnea, insomnia, sleepwalking, night terrors (parasomnia), excessive daytime sleepiness (hypersomnia), narcolepsy, or sleeping less than seven hours or more than nine hours per night.
• About one-third of participants (33%) were exposed to transportation noise louder than 50 decibels, and 54.5% were exposed to noise louder than 45 decibels.
• The study has some limitations. First, it reviewed data already collected, which means it cannot prove cause and effect. The analysis considered various transportation noise sources, including road traffic (cars, buses, etc.), trains and aviation, so the effects may vary based on the type of noise.

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, including video interview clips with American Heart Association past volunteer President Keith Churchwell, M.D., FAHA, is available on the right column of the release link.
• Spanish news release
• Link to abstract poster MDP2871; and the American Heart Association’s Scientific Sessions 2026 Online Program Planner
• American Heart Association scientific statement: Global societies unite to address environmental threats to heart health (Jan 2026)
• American Heart Association news release: Years of exposure to air pollution and road traffic noise may raise heart failure risk (Oct. 2021)
• 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.

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