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Wildfire smoke blankets the Seattle skyline in 2020. A new study finds that pregnant people who are exposed to wildfire smoke are more likely to give birth prematurely.

About 10% of American babies are born prematurely. Birth before 37 weeks can lead to a cascade of health risks, both immediate and long-term, making prevention a vital tool for improving public health over generations. 

In recent years, researchers have identified a potential link between wildfire smoke — one of the fastest-growing sources of air pollution in the United States — and preterm birth, but no study has been big or broad enough to draw definitive conclusions. A new study led by the University of Washington makes an important contribution, analyzing data from more than 20,000 births to find that pregnant people who are exposed to wildfire smoke are more likely to give birth prematurely.

“Preventing preterm birth really pays off with lasting benefits for future health,” said lead author Allison Sherris, a UW postdoctoral researcher in environmental and occupational health sciences. “It’s also something of a mystery. We don’t always understand why babies are born preterm, but we know that air pollution contributes to preterm births, and it makes sense that wildfire smoke would as well. This study underscores that wildfire smoke is inseparable from maternal and infant health.”

In the study, published Nov. 3 in The Lancet Planetary Health, researchers used data from the Environmental influences on Child Health Outcomes (ECHO) program, a federal research project focused on how a wide range of environmental factors affect children’s health. The sample included 20,034 births from 2006-2020 across the contiguous United States.

Researchers estimated participants’ average daily exposure to fine particulate matter, or PM2.5, generated by wildfire smoke, and the total number of days they were exposed to any amount of smoke. They estimated the intensity of smoke exposure by how frequently participants were exposed to wildfire PM2.5 levels above certain thresholds.

They found that pregnant people exposed to more intense wildfire smoke were more likely to give birth prematurely. In mid-pregnancy, exposure to any smoke was associated with an elevated risk of preterm birth, with that risk peaking around the 21st week of gestation. In late pregnancy, elevated risk was most closely associated with exposure to high concentrations of wildfire PM2.5, above 10 micrograms per cubic meter.

“The second trimester is a period of pregnancy with the richest and most intense growth of the placenta, which itself is such an important part of fetal health, growth and development,” said co-author Dr. Catherine Karr, a UW professor of environmental and occupational health sciences and of pediatrics in the UW School of Medicine. “So it may be that the wildfire smoke particles are really interfering with placental health. Some of them are so tiny that after inhalation they can actually get into the bloodstream and get delivered directly into the placenta or fetus.” 

The link was strongest and most precise in the Western U.S., where people were exposed to the highest concentrations of wildfire PM2.5 and the greatest number of high-intensity smoke days. Here, the odds of preterm birth increased with each additional microgram per cubic meter of average wildfire PM2.5.

It’s possible those results were more precise simply because the West experiences more wildfire smoke on average, making the exposure model perform better, Sherris said. But there may be other factors behind the regional differences. 

The composition of wildfire smoke is different across the country. In the West, smoke tends to come from fires nearby, while in places like the Midwest, smoke has typically drifted in from faraway fires. Smoke’s toxicity changes as it ages and reacts with sunlight and airborne chemicals, which could have affected the results. Researchers also noted that external factors like co-occurring heat or housing quality may have effects that aren’t fully understood. 

Researchers hope that future studies will examine the exact mechanisms by which wildfire smoke might trigger preterm birth. But in the meantime, Sherris said, evidence for a link is now strong enough to take action. 

“There are a couple avenues for change,” Sherris said. “First, people already get a lot of public health messaging and information throughout pregnancy, so there’s an opportunity to work with clinicians to provide tools for pregnant people to protect themselves during smoke events. Public health agencies’ messaging about wildfire smoke could also be tailored to pregnant people and highlight them as a vulnerable group.”

Co-authors include Logan Dearborn, doctoral student of environmental and occupational health sciences at the UW; Christine Loftus, clinical associate professor of environmental and occupational health sciences at the UW; Adam Szpiro, professor of biostatistics at the UW; Joan Casey, associate professor of environmental and occupational health sciences and of epidemiology at the UW; Sindana Ilango, postdoctoral fellow of epidemiology at the UW; and Marissa Childs, assistant professor of environmental and occupational health sciences at the UW. A full list of co-authors is included with the paper.

This research was funded by the Environmental influences on Child Health Outcomes (ECHO) program at the National Institutes of Health under multiple awards. A full list of ECHO funding awards is included with the paper. 

For more information or to contact the researchers, email Alden Woods at acwoods@uw.edu.

Therapies that are sensitive to multiple biomarkers could allow medicines to reach only the areas of the body where they are needed. The diagram above shows three theoretical biomarkers that are present in specific, sometimes overlapping areas of the body. A therapy designed to find the unique area of overlap between the three will act on only that area.DeForest et al./Nature Chemical Biology

Targeted drug delivery is a powerful and promising area of medicine. Therapies that pinpoint the exact areas of the body where they’re needed — and nowhere they’re not — can reduce the medicine dosage and avoid potentially harmful “off target” effects elsewhere in the body. A targeted immunotherapy, for example, might seek out cancerous tissues and activate immune cells to fight the disease only in those tissues.

The tricky part is making a therapy truly “smart,” where the medicine can move freely through the body and decide which areas to target.

Researchers at the University of Washington took a significant step toward that goal by designing proteins with autonomous decision-making capabilities. In a proof-of-principles study published Oct. 9 in Nature Chemical Biology, researchers demonstrated that by adding smart tail structures to therapeutic proteins, they could control the proteins’ localization based on the presence of specific environmental cues. These protein tails fold themselves into preprogrammed shapes that define how they react to different combinations of cues. In addition, the experiment showed that the smart protein tails could be attached to a carrier material for delivery to living cells.

Advances in synthetic biology also allowed the researchers to manufacture these proteins cheaply and in a matter of days instead of months.

“We’ve been thinking about these concepts for some time but have struggled with ways to increase and automate production,” said senior author Cole DeForest, a UW professor of chemical engineering and bioengineering. “We’ve now finally figured out how to produce these systems faster, at scale and with dramatically enhanced logical complexity. We are excited about how these will lead to more sophisticated and scalable disease-honing therapies.”

The concept of programmable biomaterials isn’t new. Scientists have developed numerous strategies to make systems responsive to individual cues — such as pH levels or the presence of specific enzymes — that are associated with a particular disease or area of the body. But it’s rare to find one cue, or “biomarker,” that’s unique to one spot, so a material that hones in on just one biomarker might act on a few unintended places in addition to the target.

One solution to this problem is to seek out a combination of biomarkers. There might be many areas of the body with particular enzyme or pH levels, but there are likely fewer areas with both of those factors. In theory, the more biomarkers a material can identify, the more finely targeted drug delivery can be.

In 2018, DeForest’s lab created a new class of materials that responded to multiple biomarkers using Boolean logic, a concept traditionally used in computer programming.

The diagrams above show linker structures that can perform different logical operations. In box 1, the protein therapeutic (star) is released from a material (pink wedge) in the presence of either biomarker X or Y; in box 2, the protein will release only if both biomarkers X and Y are present.DeForest et al./Nature Chemical Biology

“We realized that we could program how therapeutics were released based simply on how they were connected to a carrier material,” DeForest said. “For example, if we linked a therapeutic cargo to a material via two degradable groups connected in series — that is, each after the other — it would be released if either group was degraded, acting as an OR gate. When the degradable groups were instead connected in parallel — that is, each on a different half of a cycle — both groups had to be degraded for cargo release, functioning as an AND gate. Excitingly, by combining these basic gates we could readily create advanced logical circuits.”

It was a big step forward, but it wasn’t scalable — the team built these large and complex logic-responsive materials manually through traditional organic chemistry.

But over the next several years, the related field of synthetic biology advanced by leaps and bounds.

“The field has developed exciting new protein-based tools that can allow researchers to form permanent bonds between proteins,” said co-first author Murial Ross, a UW doctoral student of bioengineering. “It opened doors for new protein structures that were previously unachievable, which made more complex logical operations possible.”

Additionally, it became practical to use living cells as factories to produce these complex proteins, allowing scientists to design custom DNA blueprints for new proteins, insert the DNA into bacteria or other host cells, and then collect the proteins with the desired structure directly from the cells.

With these new tools, DeForest and his team streamlined and improved many steps of the process at once. They designed and produced proteins with tails that spontaneously fold into more bespoke shapes, creating complex “circuits” that can respond to up to five different biomarkers. These new proteins can attach to various carriers — hydrogels, tiny beads or living cells — for delivery to a cell, or theoretically a disease site. The team even loaded up one carrier with three different proteins, each programmed to deliver their unique cargo based on different sets of environmental cues.

The research team designed protein tails that fold into custom shapes to create sophisticated logical circuits. Box 1 shows a protein designed to be responsive to five different biomarkers; box 2 shows the logical conditions that must be met to fully break apart the tail and release the protein.DeForest et al./Nature Chemical Biology

“We were so excited about the results,” DeForest said. “Using the old process, it would take months to synthesize just a few milligrams of each of these materials. Now it takes us a couple of weeks to go from construct design to product. It’s been a complete game changer for us.”

“The sky’s the limit. You can create delayed and independent delivery of many different components in one treatment,” Ross said. “And I think we could create much, much larger logical circuits that a protein can be responsive to. We’re at the point now that the technology is outpacing what we’ve seriously considered in terms of applications, which is a great place to be.”

The researchers will now continue searching for more biomarkers that proteins could target. They also hope to start collaborating with other labs at the UW and beyond to build and deploy real-world therapies.

The team outlined other uses for the technology as well. The same tools could manufacture therapies within a single cell and direct them to specific regions, a sort of microcosm of how the process works in the body. DeForest also envisions diagnostic tools like blood tests that could, say, turn a certain color when a complex set of cues within the blood sample are present.

DeForest thinks the first practical applications are likely to be cancer treatments, but with more research, the possibilities feel endless.

“The dream is to be able to pick any arbitrary location inside of the body — down to individual cells — and program a material to go and act there,” he said. “That’s a tall order, but with these technologies we’re getting closer. With the right combination of biomarkers, these materials will just get more and more precise.”

Co-authors include Annabella Li, a former UW undergraduate student of chemical engineering; Shivani Kottantharayil, a UW undergraduate student of bioengineering; and Jack Hoye, a UW doctoral student of chemical engineering.

This research was funded by the National Science Foundation and the National Institutes of Health.

For more information, contact DeForest at profcole@uw.edu. 

Evidence shows that school meals are often more nutritious than meals that students eat elsewhere. Credit: SDI Productions/iStock

In the 10 years since the federal government established the Community Eligibility Provision (CEP), which enabled universal free meal programs for schools in low-income communities, studies have suggested the policy has wide-ranging benefits. Students in participating schools choose lunches with higher nutritional quality, are suspended less frequently and may perform better academically.

Now, as cuts to food assistance programs threaten to slash access to universal school meals, a new study led by the University of Washington finds another potential benefit to the programs: Students in participating schools were less likely to have high blood pressure, suggesting that universal free meals might be a powerful tool for improving public health. 

“High blood pressure is an important public health problem that isn’t studied as much on a population level as obesity,” said Anna Localio, a UW postdoctoral researcher of health systems and population health and lead author of the study. “We have evidence that CEP increases participation in school meals, and we also have evidence that school meals are more nutritious than meals that kids obtain elsewhere. This is a public health policy that is delivering nutritious meals to children who may not have previously had access.”

For the study, published Sept. 25 in JAMA Network Open, researchers linked two datasets that rarely interact. They obtained medical records of patients ages 4-18 from community health organizations, and used patients’ addresses to identify the school they attended. The data encompassed 155,778 young people attending 1,052 schools, mostly in California and Oregon.

Researchers estimated the percentage of students with high blood pressure before and after schools opted into universal free meals, and compared those results against eligible schools that had not yet participated in the program. They also tracked students’ average systolic and diastolic blood pressure readings. All data were aggregated at the school level. 

They found that school participation in the CEP was associated with a 2.71% decrease in the proportion of students with high blood pressure, corresponding to a 10.8% net drop over five years. School participation in CEP was also associated with a decrease in students’ average diastolic blood pressure. 

Participation in universal free meals was associated with an 11% net decrease in the proportion of patients with high blood pressure over a five-year period. The above chart shows the annual difference in the percentage of students with high blood pressure in participating schools and non-participating schools.

“In previous work on the health impacts of universal free school meals, our team found that adoption of free meals is associated with decreases in average body mass index scores and childhood obesity prevalence, which are closely linked to risk of high blood pressure,” said Jessica Jones-Smith, a professor of health, society and behavior at the University of California Irvine’s Joe C. Wen School of Population & Public Health and senior author of the study. Jones-Smith conducted much of this research while on faculty at the UW School of Public Health. “So in addition to directly affecting blood pressure through provision of healthier meals, a second pathway by which providing universal free meals might impact blood pressure is through their impact on lowering risk for high BMI.” 

Improved nutrition of school meals may have helped drive the decrease, researchers said. The 2010 law that established the CEP also created stronger nutritional requirements for school meals. As a result, those meals now more closely resemble the Dietary Approaches to Stop Hypertension (DASH) diet, which studies have shown to be an effective tool for managing hypertension. 

Despite the evidence supporting the DASH diet’s effectiveness, public health officials previously lacked an effective mechanism to encourage people with high blood pressure to follow its recommendations. “We know there are a lot of barriers to people eating this diet,” Localio said, but the combination of universal free meals and increased nutritional standards likely helped students overcome those barriers.

The study also contradicts the common misperception that universal free meals mostly benefit wealthier students, because students from low-income families would already receive free meals. The study sample consists primarily of low-income patients, with 85% of included students enrolled in public health insurance such as Medicaid.

“There is a perception that providing universally free school meals will only improve outcomes for students of relatively higher-income families, but our findings suggest that there are benefits for lower-income children as well,” Jones-Smith said. “Potential mechanisms for this include decreasing the income-related stigma around eating school lunch by providing it free to all students and eliminating the time and paperwork burden of individually applying, thus decreasing barriers to participation in school meals.”

These findings come at an uncertain time for universal free meals. A school is eligible to participate in the CEP if at least 25% of its students are identified as eligible for free meals via participation in a means-tested safety net program. In this way, recent cuts to the Supplemental Nutrition Assistance Program (SNAP), the nation’s largest food assistance program, may affect schools’ access to the program.

“We’re in a contentious time for public health, but it seems like there’s bipartisan support for healthy school meals,” Localio said. “There’s legislation being considered in a number of states to expand universal free meals, and these findings could inform that decision-making. Cutting funding to school meals would not promote children’s health.” 

Co-authors on the study include Paul Hebert, research professor emeritus of health systems and population health at the UW; Melissa Knox, teaching professor of economics at the UW; Wyatt Benksen and Aileen Ochoa of OCHIN; and Jennifer Sonney, associate professor of nursing at the UW. This study was funded by the Eunice Kennedy Shriver National Institute of Child Health & Human Development. 

For more information or to contact the researchers, email Alden Woods at acwoods@uw.edu.

Over its 80-year history, the University of Washington School of Dentistry has trained nearly 7,000 dental professionals, many of whom stay in Washington. But the School’s service doesn’t start at graduation. UW dental students, faculty members and community volunteers provide free care to communities across Washington, serving hundreds of patients each academic quarter.  

The UW’s community collaborations span the state. In recent months, the School of Dentistry has offered care in Toppenish, Moses Lake and Longview, alongside monthly service days at Union Gospel Mission in Seattle and quarterly mobile clinics. Patients receive oral health exams, fillings, tooth extractions and cleanings. 

A patient receives care at a free clinic led by the UW School of Dentistry in Aberdeen, Washington.

“The work we do in communities across the state is a great example of why the UW is often called the University for Washington,” said André Ritter, dean of the UW School of Dentistry. “These programs and partnerships advance the mission of the UW and the School in significant ways through education and clinical care.” 

The clinics are organized through the School’s Office of Educational Partnerships, which is solely focused on improving the oral health of people in the Pacific Northwest. OEP coordinates outreach programs that address the distinct needs of each community. Dental students have the opportunity to serve in outreach clinics or act as mentors for middle- and high-school students, encouraging them to pursue dental education and eventually serve their own communities.  

Dental students typically begin seeing patients near the start of their third year. At the UW, however, students have the opportunity to work in clinical settings in underserved communities the summer after their first year through the Rural and Underserved Opportunities Program (RUOP).  

The School also offers a specific educational track that trains dentists to work in rural and underserved communities. Operated in conjunction with Eastern Washington University and the UW School of Medicine, the program — Regional Initiatives in Dental Education (RIDE) — has seen over 80% of its graduates return to rural and underserved communities across the Pacific Northwest. 

“Oral health is an essential part of overall well-being, and everyone deserves access to high-quality dental care,” said Amy Kim, a UW clinical associate professor of pediatric dentistry and director of the Office of Educational Partnerships. “We recognize that it is our duty and privilege to serve those who need it most.” 

 The UW School of Dentistry will continue its service and outreach programs throughout the fall and winter quarters. For more information or to learn about upcoming service days, contact Alden Woods at acwoods@uw.edu.

A worker conducts anti-mosquito fogging in Bali, Indonesia. Credit: Pepszi/Getty Images

Warmer weather across the globe is reshaping the landscape of human health. Case in point: Dengue fever incidence could rise as much as 76% by 2050 due to climate warming across a large swath of Asia and the Americas, according to a new study led by Marissa Childs, a researcher at the University of Washington. 

Dengue fever, a mosquito-borne disease once confined largely to the tropics, often brings flu-like symptoms. Without proper medical care, it can escalate to severe bleeding, organ failure, and even death.  

The study, published Sept. 9 in PNAS, is the most comprehensive estimate yet of how temperature shifts affect dengue’s spread. It provides the first direct evidence that a warming climate has already increased the disease’s toll.  

“The effects of temperature were much larger than I expected,” said Childs, a UW assistant professor of environmental and occupational health sciences who conducted much of the research as a doctoral student at Stanford University. “Even small shifts in temperature can have a big impact for dengue transmission, and we’re already seeing the fingerprint of climate warming.” 

The study analyzed over 1.4 million observations of local dengue incidence across 21 countries in Central and South America and Southeast and South Asia, capturing both epidemic spikes and background levels of infection.  

Dengue thrives in a “Goldilocks zone” of temperatures — incidence peaks at about 27.8 degrees Celsius, or 82 degrees Fahrenheit, rising sharply as cooler regions warm but dropping slightly when already-hot areas exceed the optimal range. As a result, some of the largest increases are projected for cooler, high-population regions in countries such as Mexico, Peru and Brazil. Many other endemic regions will continue to experience larger, warming-fueled dengue burdens. By contrast, a few of the hottest lowland areas may see slight declines.  

Still, the net global effect is a steep rise in disease. 

The findings suggest that higher temperatures from climate change were responsible for an average 18% increase of dengue incidence across 21 countries in Asia and the Americas from 1995 to 2014 — translating to more than 4.6 million extra infections annually, based on current incidence estimates. Cases could climb another 49% to 76% by 2050 depending on greenhouse gas emissions levels, according to the study. At the higher end of the projections, incidence of dengue would more than double in many cooler locations, including areas in the study countries that are already home to over 260 million people.  

“Many studies have linked temperature and dengue transmission,” said senior author Erin Mordecai, a professor of biology in the Stanford School of Humanities and Sciences. “What’s unique about this work is that we are able to separate warming from all the other factors that influence dengue — mobility, land use change, population dynamics — to estimate its effect on the real-world dengue burden. This is not just hypothetical future change but a large amount of human suffering that has already happened because of warming-driven dengue transmission.” 

The researchers cautioned that their estimates are likely conservative. They do not account for regions where dengue transmission is sporadic or poorly reported, nor do they include large endemic areas such as India or Africa where detailed data is lacking or not publicly available. The researchers also highlighted recent locally acquired cases in California, Texas, Hawaii, Florida, and in Europe — a signal of the expanding range of dengue. Urbanization, human migration and the evolution of the virus could amplify risks, while medical advances may help blunt them, making projections uncertain. 

Aggressive climate mitigation would significantly reduce the dengue disease burden, according to the study. At the same time, adaptation will be essential. This includes better mosquito control, stronger health systems and potential widespread use of new dengue vaccines. 

In the meantime, the findings could help guide public health planning and strengthen efforts to hold governments and fossil fuel companies accountable for climate change damages. Attribution studies are increasingly entering courtrooms and policy debates, used to assign responsibility for climate damages and to support funds compensating countries most affected.  

“Climate change is not just affecting the weather — it has cascading consequences for human health, including fueling disease transmission by mosquitoes,” Mordecai said. “Even as the U.S. federal government moves away from investing in climate mitigation and climate and health research, this work is more crucial than ever for anticipating and mitigating the human suffering caused by fossil fuel emissions.” 

Co-authors of the study include Kelsey Lyberger of Arizona State University, Mallory Harris of the University of Maryland, and Marshall Burke of Stanford. Lyberger and Harris completed much of their work while at Stanford.   

The research was funded by the Illich-Sadowsky Fellowship through the Interdisciplinary Graduate Fellowship program at Stanford University; an Environmental Fellowship at the Harvard University Center for the Environment; the National Institutes of Health; the National Science Foundation (with the Fogarty International Center); the Stanford Center for Innovation in Global Health; the Stanford King Center on Global Development; and the Stanford Woods Institute for the Environment. 

Adapted from a press release by Stanford University. For more information or to contact the researchers, email Alden Woods at acwoods@uw.edu.

• After 24 months, 34% of veterans who have heart and blood vessel disease and high cholesterol in a quality improvement program that included health care coaches and other resources had improved cholesterol levels to below 70 mg/dL.
• The quality-improvement program increased the number of military veterans with better LDL (“bad” cholesterol) levels of less than 70mg/dL, and more than a third of those ages 75 and older achieved their lower cholesterol goal.
• 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 3:47 p.m. CT/4:47 p.m. ET, Monday, Nov. 10, 2025

This news release contains updated information from the research authors that was not in the abstract.

NEW ORLEANS, Nov. 10, 2025 — A quality improvement program helped reduce “bad cholesterol” (LDL or low-density lipoprotein) levels among military veterans who have heart and blood vessel disease, according to a preliminary late-breaking science presentation today at the American Heart Association’s Scientific Sessions 2025. The meeting, Nov. 7-10, in New Orleans, is a premier global exchange of the latest scientific advancements, research and evidence-based clinical practice updates in cardiovascular science.

“Heart disease and stroke are the leading causes of death among veterans, and elevated low-density lipoprotein is a major risk factor for both. While there are medications that work well to lower this bad cholesterol, two-thirds of veterans with heart disease do not have cholesterol treated to goal,” said study author Luc Djoussé, M.D., a research health scientist (cardiovascular epidemiologist) at Massachusetts Veterans Epidemiology Research and Information Collaborative (MAVERIC), the Boston VA Medical Center and an associate professor of medicine at Harvard Medical School, all in Boston. “Lowering LDL cholesterol reduces the chances of having another heart attack or stroke. For veterans, keeping LDL cholesterol levels low leads to better heart health and reduces health care costs. This shows how important it is for veterans to manage their cholesterol levels in order to have longer, healthier lives.”

This study investigated if the quality improvement program would expand the use of cholesterol-lowering medications, improve patient adherence to taking these medications and/or increase the percentage of veterans meeting an LDL-cholesterol goal of below 70 mg/dL.

The study identified barriers to lowering cholesterol, including poor medication adherence among veterans, gaps in health information and education support for veterans and professionals on cholesterol management and lifestyle changes, and staffing shortages at Veterans Affairs health care centers. The quality improvement program addressed these issues with a multipronged approach: health care coaches, multidisciplinary teams, engagement lists for at-risk veterans, improved medication prescribing practices and health information and resources about cholesterol and lifestyle management.

The analysis found:                                                                                                       

• A 32% increase in the number of veterans reducing their bad cholesterol below 70 mg/dL during the program.
• For those who were in the program for at least 2 years and had a second LDL cholesterol measurement, 33.5% achieved the LDL cholesterol goal. This benefit was seen in both men and women and in veterans who were 75 years and older.
• Among all participants, there was a 15.9 mg/dL reduction in LDL cholesterol, with the greatest reduction occurring among veterans who initially had the highest LDL cholesterol levels.
• The proportion of veterans being prescribed cholesterol-lowering medication increased from 78% at baseline to 88%, and patient adherence to cholesterol-lowering medications improved from 65% to 77%. These benefits were observed in both men and women.
• Among veterans ages 75 and older, 36% achieved the goal of LDL cholesterol or less than 70 mg/dL.

“We were surprised to see similar reductions in LDL levels among veterans ages 75 and older. This is important because fewer older adults have been included in previous clinical trials of LDL cholesterol medications. This knowledge, if confirmed by ongoing large trials among older adults, could change clinical practice for this age group,” Djoussé said.

The study’s strengths include the large number of participants — veterans of various ages and races, both men and women, which means the results may be more widely applicable to the general population. In addition, the use of a health coach and simple, inexpensive approaches can lead to a significant improvement in cholesterol management.

Limitations include that the program was not designed to evaluate its impact on heart attacks or strokes, so its impact cannot be directly tied to those events. Also, participating veterans were not required to give blood samples at frequent intervals, so researchers relied on LDL cholesterol measurements taken as part of routine clinical care.

Study background, details and design:

• Approximately 160,000 veterans with heart and vascular diseases are enrolled in the VALOR-QI program, which started in December 2022 and will conclude in December 2025. This analysis covers data through June 2025 for the select participants in this study.
• The current analysis is based on 83,232 veterans who had prevalent ASCVD, LDL cholesterol of 70 mg/dL or higher at baseline and had another measurement of LDL cholesterol during the program.
• Participants’ average age was 70 years old; 7% of participants were women; 69% self-reported they are white adults, and 22% self-identified as Black adults.
• 50 VA health care sites participated in the VALOR-QI program. Each site is headed by a local clinical champion who leads a team of health care professionals and health care coaches who work with American Heart Association consultants to identify and address site-specific barriers to optimal cholesterol management among participating veterans.
• Adherence to treatment plans was assessed via prescription refills and cholesterol lab values recorded in participants’ VA electronic health records.
• In addition to continuing to follow participants’ health, the researchers are evaluating the impact of the quality improvement program on health care costs.

“For patients, our study results mean participation in the quality improvement program increased the likelihood of improvement in cardiovascular health. Many tools and strategies used in VALOR-QI were simple, inexpensive and accessible to clinicians and patients at each point of care. This is important for sustainability within the VA system and could lead to adoption of these strategies throughout the vast VA system and also non-VA health care systems,” Djoussé said.

The Veterans Affairs Lipid Optimization Reimagined Quality Improvement (VALOR-QI) program — a collaboration between the Department of Veterans Affairs (VA) and the American Heart Association — is the first large-scale quality-improvement program designed to support former military service personnel with atherosclerotic cardiovascular disease (ASCVD) or who are at high risk of a cardiovascular event. Nearly 160,000 veterans have been engaged in VALOR-QI since it launched in 2022, and the program is supported by Novartis.

The Veterans Health Administration (VHA) is the largest integrated health care system in the United States, providing care at 1,380 health care facilities, including 170 VA Medical Centers and 1,193 outpatient sites of care of varying complexity (VHA outpatient clinics) to over 9.1 million veterans enrolled in the VA health care program.

Co-authors, disclosures and funding sources are listed in the abstract. Please note: Novartis was not involved in this study.

These statements do not represent the views of the Department of Veterans Affairs or the US government.

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 2025 Online Program Planner
• American Heart Association news release: New program for veterans with high cholesterol, associated cardiovascular disease (March 2023)
• American Heart Association news release: British veterans severely injured in the Afghanistan War had higher risk of CVD (Nov. 2021)
• About Scientific Sessions 2025  
• For more news at the American Heart Association’s Scientific Sessions 2025, follow us on X @HeartNews,#AHA25

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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:

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• Among 150 adults who had been recently hospitalized for heart failure, those who received deliveries of prepared meals or fresh produce along with dietary counseling reported improved quality of life compared to adults who only received dietary guidance without food delivery.
• There were no differences in the number of hospital readmissions or emergency department visits for heart failure between participants who received food delivery compared to those who did not.
• 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 full manuscripts in a peer-reviewed scientific journal.

Embargoed until 10:15 a.m. CT/11:15 a.m. ET, Monday, Nov. 10, 2025

This news release contains updated information from the research authors that was not in the abstract.

NEW ORLEANS, Nov. 10, 2025 — Providing healthy, medically tailored meals or boxes of fresh produce along with nutrition counseling with a dietitian led to improved quality of life for people with heart failure compared to people who received dietary counseling without healthy food deliveries, according to a preliminary late-breaking science presentation today at the American Heart Association’s Scientific Sessions 2025. The meeting, Nov. 7-10, in New Orleans, is a premier global exchange of the latest scientific advancements, research and evidence-based clinical practice updates in cardiovascular science.

“People with heart failure can often experience their condition worsening if they are not eating the right kind of food after they go home from the hospital,” said lead study author Ambarish Pandey, M.D., M.S., FAHA, an associate professor of internal medicine in the division of cardiology and geriatrics at UT Southwestern Medical Center in Dallas and medical director of the center’s heart failure with preserved ejection fraction program. “People need nutritious meals that can provide them with the right nutrients for optimal health, including the appropriate calorie intake, the right amount of protein and limited sodium, sugar and fat.”

This randomized trial included 150 adults who were enrolled within two weeks of being discharged from the hospital for acute heart failure. Researchers assigned participants to one of three groups: one group received medically tailored meals and dietary counseling with a dietitian; the second group received fresh produce boxes and dietary counseling; and the third group received dietary counseling without food delivery. Participants receiving either meals or produce were also divided into two subgroups. One subgroup only received food if they picked up their medications from the pharmacy and attended their follow-up clinic appointments. The other subgroup received food whether or not they picked up their medications or attended appointments at the clinic. The meals and grocery food delivery programs lasted for 90 days.

The study’s key findings include:

• Participants in both food delivery groups (receiving either medically tailored meals or fresh produce boxes) reported a higher quality of life compared to those who received dietary guidance without food delivery, based on their responses in the Kansas City Cardiomyopathy Questionnaire.
• People in the conditional delivery groups (confirmed prescription pick-up) reported higher quality of life compared to people in the unconditional delivery group (no prescription pick-up required).
• Participants who received boxes of fresh produce and were able to use fresh produce in their own meals reported greater patient satisfaction than people who received prepared meals, based on their responses in the end-of-study survey.
• There were no significant differences in the number of hospital readmissions or emergency department visits between participants in the food delivery groups compared with people who did not receive food deliveries, or between the two groups receiving food. The study found a total of 32 hospital readmissions and emergency department visits for heart failure during the 90-day study, with 18% of participants having one or more readmissions or emergency visits.

“These findings indicate the potential for healthy foods to affect outcomes and disease progression for people with chronic conditions like heart failure. If we can identify the best strategy for providing access to healthy food, this could be transformative for people with heart failure who are particularly vulnerable after hospitalization,” Pandey said. “I think healthy food can be as powerful as medications for people with chronic conditions like heart failure.”

Access to healthy food is a social factor that contributes to overall health including cardiovascular disease risk and outcomes. Current evidence indicates that food insecurity, or limited access to enough food, and nutrition insecurity, or limited access to healthy foods, are both associated with more chronic health conditions and worse outcomes. According to the American Heart Association’s 2025 Scientific Statement, Systematic Review of “Food Is Medicine” Randomized Controlled Trials for Noncommunicable Disease in U.S., programs that incorporate healthy food and health care for people with or at high risk for chronic disease showed great potential in improving diet quality and food security.

Study details, background and design:

• 150 adults who had been hospitalized for acute heart failure at UT Southwestern Medical Center or Parkland Hospital in Dallas were enrolled within two weeks of hospital discharge.
• Participants had a median age of 60 years, and 39% were women.
• About 4 in 10 (42%) participants self-identified as Black, about 1 in 3 (33%) self-identified as Hispanic and 23% self-identified as non-Hispanic white.
• 95% of participants had a diagnosis of high blood pressure, and 54% had Type 2 diabetes; 53% of participants reported food insecurity (limited access to enough food); 55% reported nutrition insecurity (limited access to healthy food); and 69% of participants self-reported that they did not regularly take their medication as prescribed.
• Participants in the intervention groups either received medically tailored meals or boxes of fresh produce along with dietary counseling for 90 days. Participants in the third group received dietary counseling without food delivery.
• Participants in the conditional delivery group were required to pick up their medication from the pharmacy and attend their follow-up clinic visits throughout the study period after hospital discharge in order to receive their medically tailored, prepared meals or fresh produce boxes. Participants in the unconditional delivery group received food whether or not they picked up their medications or attended follow-up appointments.

The study limitations include its small size of only 150 patients and short follow-up period of only 90 days. Larger studies with more participants and following patients for a longer time period are needed to assess whether food programs may lower hospitalizations or improve survival rates. Pandey and colleagues are planning a phase 3 trial with 1,200–1,500 people at multiple hospitals.

The trial was funded by the American Heart Association’s Health Care by Food™ initiative. This initiative is conducting scientific research, public policy advocacy and stakeholder education to advance food is medicine interventions that incorporate healthy food into health care to treat, manage and prevent diet-related diseases.

Co-authors and disclosures 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.
• View the abstract in the American Heart Association’s Scientific Sessions Online Program Planner
• American Heart Association Science Advisory news release: Excessive ultraprocessed foods (UPFs) and poor nutrition tied to poor health (Aug. 2025)
• American Heart Association Scientific Statement news release: ‘Food is medicine’ shows potential for improving diet quality and food security (June 2025)
• American Heart Association Presidential Advisory: Food Is Medicine (Sept. 2023)
• American Heart Association Scientific Statement: Dietary Guidance to Improve Cardiovascular Health (Nov. 2021)
• American Heart Association health information: Living with Heart Failure and Managing Advance HF
• About Scientific Sessions 2025  
• For more news at the American Heart Association’s Scientific Sessions 2025, follow us on X @HeartNews, #AHA25

###

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: 214-706-1173;ahacommunications@heart.org

Amanda Ebert: Amanda.Ebert@heart.org

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

heart.org and stroke.org

• The cholesterol-lowering medication alirocumab, a PCSK9 inhibitor, along with a statin, lowered LDL cholesterol levels more than 50% in patients after a heart transplant, compared to those taking a placebo plus statin, according to the results of a new clinical trial.
• Researchers found alirocumab did not reduce the risk of developing cardiac allograft vasculopathy, a progressive coronary artery disease that occurs after a heart transplant.
• Note: This trial is simultaneously published today as a full manuscript in the peer-reviewed scientific journal Circulation.

Embargoed until 10:00 a.m. CT/11:00 a.m. ET, Monday, Nov. 10, 2025

NEW ORLEANS, Nov. 10, 2025 — The cholesterol medication alirocumab, a PCSK9 inhibitor, combined with a statin appeared to reduce LDL cholesterol levels by more than 50% among patients after a heart transplant, according to a late-breaking science presentation today at the American Heart Association’s Scientific Sessions 2025. The meeting, Nov. 7-10, in New Orleans, is a premier global exchange of the latest scientific advancements, research and evidence-based clinical practice updates in cardiovascular science.

“Our study found treating patients who have had a heart transplant with a more aggressive cholesterol management regimen was safe and lowered their LDL-cholesterol levels significantly,” said study author William F. Fearon, M.D., FAHA, a professor of medicine and chief of interventional cardiology at Stanford University School of Medicine in Stanford, California. “These results support PCSK9 inhibitors for patients who have high LDL cholesterol levels in conjunction with statin therapy, however, we need more studies testing treatment with PCSK9 inhibitors with longer term follow-up with more participants to confirm if PCSK9s can reduce the development of cardiac allograft vasculopathy.”

According to the American Heart Association, high LDL (low-density lipoprotein) cholesterol, known as “bad” cholesterol, has no symptoms, but it can increase risk for cardiovascular issues because it can cause plaque to build up in the arteries. This buildup may block blood flow or break loose and cause a heart attack or stroke.

In this clinical trial, called CAVIAR (Cardiac Allograft Vasculopathy Inhibition with AliRocumab), researchers tested the safety and effectiveness of adding the PCSK9 inhibitor alirocumab to a statin regimen among patients soon after a heart transplant to prevent the development of cardiac allograft vasculopathy (CAV). CAV is common and the primary cause of death for many patients after a heart transplant. The study, which included more than 100 adults after a heart transplant, also evaluated the change in coronary artery plaque volume soon after the heart transplant through one year later. Participants were assigned to take either alirocumab or a placebo, together with rosuvastatin, a commonly prescribed cholesterol-lowering medication.

The trial results showed that one-year post-transplant, alirocumab plus rosuvastatin was safe and effectively lowered LDL cholesterol. The cholesterol-lowering impact of taking both medications was beyond what was achieved with rosuvastatin alone. Coronary plaque reduction was not significant in either group though, and there was no statistically significant difference between the plaque progression in the groups.

After one year, the study found:

• The average LDL cholesterol levels decreased by more than 50% among participants in the alirocumab group—from 72.7 mg/dL at enrollment to 31.5 mg/dL. The average LDL cholesterol levels among participants in the placebo group did not statistically change from the average 69.0 mg/dL at enrollment.
• Although the coronary artery plaque volume increased numerically in both groups from baseline to 12 months, there was no change in plaque volume between the alirocumab and placebo group.
• Plaque progression was minimal in both the alirocumab groups and the placebo group.
• There were no significant side effects in either group.

The study had some limitations, with researchers noting that because there was less plaque progression than expected between both groups and because the LDL levels were low at baseline in the rosuvastatin alone (placebo) arm, the study power to detect a difference when adding alirocumab was reduced. Based on various research studies, the American Heart Association recommends a "lower is better" approach for cholesterol, especially LDL-C, rather than a single ideal number for everyone. For healthy adults, an LDL-C level below 100 mg/dl is considered ideal. For those with pre-existing conditions like atherosclerotic cardiovascular disease or diabetes, target levels are more stringent and the guidelines focus on reducing LDL-C to 70 mg/dL or lower.

Study details, background and design:

• The study group included 114 adults who had heart transplants; their mean age was 58 years old.
• Stanford University conducted the trial, starting in 2019. Transplant patients were identified at two health care centers: Stanford Medical Center and Kaiser Permanente in Santa Clara, California.
• Participants were enrolled in the trial within eight weeks after the heart transplant and randomly assigned to one of two groups: group one (57 adults) was prescribed 150 mg of alirocumab with rosuvastatin; group two (57 adults) was assigned to take a placebo with rosuvastatin.
• At time of enrollment in the trial and one year after the heart transplant, all participants underwent additional screening procedures to evaluate the blood flow and plaque buildup in their coronary arteries.

CAV, which causes narrowing and blockage of vessels supplying blood to the heart, is a common complication after a heart transplant and a primary cause of death after a transplant. High LDL cholesterol is a contributing factor to CAV, and it is usually treated with statins. Treatment with statins alone, however, often falls short in achieving the target levels for low cholesterol.
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
• View the abstract in the American Heart Association Scientific Sessions 2025 Online Program Planner
• American Heart Association news release: Pay attention to 4 health factors to prevent new heart syndrome (February, 2025)
• American Heart Association health information: Prevention and Treatment of High Cholesterol
• About Scientific Sessions 2025
• For more news at AHA Scientific Sessions 2025, follow us on X @HeartNews,#AHA25

###

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

• Among patients with heart failure and reduced ejection fraction (HFrEF), those taking a “polypill” combination of three medications typically prescribed for heart failure, once daily for six months, had improved heart function and symptoms, better quality of life, fewer hospitalizations and greater medication adherence in comparison to those who took the same medications as separate pills.
• This is the first study to evaluate a polypill strategy in people with HFrEF, focused on improving medication adherence and simplifying treatment.
• The people who took the polypill, when compared to the those who took the medications in separate pills, had increased heart function (3.4% higher absolute left ventricular ejection fraction), reduced rates of hospitalization or emergency care for heart failure by more than half, and reported a higher quality of life.
• 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 9:45 a.m. CT/10:45 a.m. ET, Monday, Nov. 10, 2025

NEW ORLEANS, Nov. 10, 2025 — Adults with heart failure with reduced ejection fraction (HFrEF) who took a “polypill” combining medications prescribed for the treatment of heart failure, had improved heart function and symptoms, better quality of life, fewer hospitalizations and greater medication adherence than those taking the medications individually, according to a late-breaking science presentation today at the American Heart Association’s Scientific Sessions 2025. The meeting, Nov. 7-10, in New Orleans, is a premier global exchange of the latest scientific advancements, research and evidence-based clinical practice updates in cardiovascular science.

“In recent decades, there have been important, effective treatment advances for patients with heart failure, however, use of these treatments remains disappointingly low, with only 15% of patients receiving all guideline-recommended therapies at any dose for heart failure after hospitalization,” said study author Ambarish Pandey, M.D., M.S., FAHA, an associate professor of internal medicine in the division of cardiology and geriatrics at UT Southwestern Medical Center in Dallas and medical director of the center’s heart failure with preserved ejection fraction program. “In our study, we focused on socially disadvantaged populations to demonstrate the positive impact of an easier-to-follow medication regimen of only one pill vs. three pills daily, and we found significant improvements even after six months. Our findings provide the first evidence that a polypill approach could be effective for our patients with heart failure.”

The trial included 212 adults with HFrEF who were not receiving guideline-recommended treatment. Participants were randomly assigned to one of two groups: 108 participants were prescribed the polypill regimen, which included metoprolol succinate (a beta-blocker), spironolactone (a mineralocorticoid receptor antagonist) and empagliflozin (a SGLT2 inhibitor). The second group of 104 adults were assigned to enhanced standard care, taking guideline-recommended medications as individual pills. Everyone also took an angiotensin receptor-neprilysin inhibitor (ARNI), sacubitril-valsartan, which is dosed twice-daily and not well suited for a once-daily polypill.

After six months, the study found:

• Measures of left ventricular ejection fraction (LVEF) improved among all participants, with a 3% higher absolute LVEF among the polypill group vs. the enhanced standard care group.
• The polypill reduced heart failure-related hospitalizations and emergency room visits by 60%—meaning patients in the polypill group were less than half as likely to need emergency care.
• Patients in the polypill group reported higher quality of life scores than those in the enhanced standard care group (72 points vs. 63 points, on a 100-point scale). This approximate 9-point improvement means patients experienced less fatigue, fewer symptoms, and better overall well-being.
• Blood tests confirmed that 79% of polypill patients had detectable levels of the tested medications (metoprolol and/or spironolactone), compared to only 54% in the enhanced standard care group, with more than 4-fold greater odds of taking all tested medications with the polypill.

The study group plans more research on how best to address heart failure in specific groups.

“Moving forward, we are planning additional studies to evaluate broader implementation of the polypill approach in heart failure,” Pandey said.

Study details, background or design:

• 212 adults with HFrEF (left ventricular ejection fraction of equal to or less than 40%) were enrolled. Participants were a median age of 54 years old; 22% were female; 54% self-identified as Black, and 33% were Hispanic; 68% of participants had no health insurance or were receiving county-sponsored health coverage; 42% reported food insecurity; and 32% reported housing instability.
• Participants were recruited from Parkland Health and Hospital System, Dallas County's safety-net health care system, UT Southwestern Medical Center and the William F. Clements University Hospital, all in Dallas.
• The trial enrolled participants over approximately 3.5 years, and enrollment closed in May 2025.
• Nearly half of participants were prescribed all four medication types at enrollment, however, 73% had moderate-to-low medication adherence.
• When the study started, the participants’ average left ventricular ejection fraction was 26%.
• Various health measures and data were collected at time of enrollment, one month, three months and the final patient data was collected at six months.
• All participants had their heart’s left ventricular ejection fraction measured by cardiac magnetic resonance imaging (MRI) at enrollment and at the six-month follow-up.
• Blood samples were collected at all study visits to measure levels of a protein hormone that is released by the heart in response to stress, such as heart failure. This is referred to as NT-proBNP testing.
• Health-related quality of life was assessed using the Kansas City Cardiomyopathy Questionnaire-12, a standard patient questionnaire.
• Medication adherence was assessed through multiple methods including the Morisky Medication Adherence Questionnaire-8, and therapeutic medication monitoring at six months looking at levels in blood samples.

According to the American Heart Association, heart failure is a serious, long-term condition. It’s more likely to happen as you age, but anyone can get it. Heart failure cases have been rising in the U.S. due in part to the aging population. About 6.7 million adults in the U.S. are living with heart failure—and expected to increase to more than 8 million by 2030. Heart failure with reduced ejection fraction (HFrEF) means the individual’s ejection fraction is equal to or less than 40%, indicating percentage of blood that leaves the left ventricle with each heartbeat. Left ventricular ejection fraction (LVEF) is a metric typically used in heart failure assessments, as it defines the percentage of blood pumped from the left ventricle of the heart to the other organs in the body.

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
• View the abstract in the American Heart Association Scientific Sessions 2025 Online Program Planner
• American Heart Association health information: Managing Heart Failure Symptoms
• American Heart Association guideline: 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure
• American Heart Association patient initiative: New initiative launched to improve care for people with certain types of heart failure | American Heart Association
• American Heart Association news release: Spironolactone, a blood pressure medication, may help reduce risk of new heart failure | American Heart Association (Nov. 2024)
• About Scientific Sessions 2025
• For more news at the American Heart Association’s Scientific Sessions 2025, follow us on X @HeartNews,#AHA25

###

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

Michelle Kirkwood: Michelle.Kirkwood@heart.org

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

heart.org and stroke.org

• Chest pain may still be angina even when the main heart arteries look clear. Using cardiac stress MRI (a heart scan that measures blood flow with magnetic resonance imaging), testing uncovered small vessel problems in about half of participants in a study of people who had prior coronary angiography that indicated no obstructive coronary artery disease.
• A cardiac stress MRI led to more people being correctly diagnosed with microvascular angina and to major improvements in chest pain and quality of life after six months to one year.
• 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 8:45 a.m. CT/9:45 a.m. ET, Monday, Nov. 10, 2025

NEW ORLEANS, Nov. 10, 2025 — Chest pain may still be angina even when coronary angiogram testing shows the main heart arteries look clear. Using stress cardiac stress MRI testing to measure blood flow around the heart appears to improve diagnosis and patient quality of life. These finding were shared at a late-breaking science presentation today at the American Heart Association’s Scientific Sessions 2025. The meeting, Nov. 7-10, in New Orleans, is a premier global exchange of the latest scientific advancements, research and evidence-based clinical practice updates in cardiovascular science.

“People may have real angina even when the main arteries appear wide open,” said study author Colin Berry, M.B.Ch.B., Ph.D., professor of cardiology at the University of Glasgow and consultant at Golden Jubilee University National Hospital. “By measuring blood flow with a stress cardiac MRI test, we found that small vessel problems were common. Our findings show that an angiogram alone is not always enough to explain chest pain. A functional test of blood flow should be considered before sending people home, especially women, who are more likely to have small vessel angina that otherwise goes unrecognized.”

According to the American Heart Association, angina is chest pain that occurs if the heart is not getting enough oxygen-rich blood. About half of all patients with angina who undergo coronary angiogram testing have no obstructive coronary artery disease identified. This study aimed to determine if stress cardiac MRI testing (a heart scan that measures blood flow with magnetic resonance imaging) could help improve diagnosis and treatment for people with suspected angina.

A total of 250 adults with chest pain but no blocked coronary arteries based on testing were enrolled in the CorCMR trial. All of the participants had a coronary angiogram test within three months prior to enrollment in the study, with the results indicating they had suspected angina and no obstructive coronary arteries (ANOCA). The study participants were randomly assigned to one of two groups. People in both groups had a stress cardiac MRI test. In one group, the stress cardiac MRI results were shared with doctors and patients to help guide diagnosis and treatment. In the other group, results of the stress cardiac MRI were not disclosed to the doctors or the patients, and treatment decisions were based only on the results of the angiogram conducted before enrolling in the study. Neither the participants nor their doctors knew which group they were assigned to until after the one-year study ended.

After following all participants for at least 12 months, the analysis found:

• About half of all participants (53%) had a diagnosis change after the stress cardiac MRI was completed.
• About 1 in 2 participants had chest pain from small vessels in the heart (microvascular angina); about 1 in 2 (48%) had chest pain not linked to the heart; and a few (2%) had other conditions, such as heart muscle inflammation (myocarditis) or thickened heart muscle (hypertrophic cardiomyopathy).
• When doctors reviewed the stress cardiac MRI images, about 1 in 2 participants were diagnosed with microvascular angina, compared with fewer than 1 in 100 when doctors relied only on angiogram tests.
• More than half of those diagnosed with microvascular angina were women.
• After six- and twelve- months, all participants were surveyed using the Seattle Angina Questionnaire, a commonly used evaluation of 19 questions to assess individual levels of physical mobility or limitations, frequency and severity of chest pain, and quality of life (treatment satisfaction and disease perception).
• Quality-of-life scores were improved in the stress cardiac MRI group, with small improvements at six months that became more pronounced after a year.
  • Participants in the stress cardiac MRI group improved by an average of 18 points at six months, and 22 points at one year on the Questionnaire.
  • People in the angiogram-guided group improved by less than 1 point.
  • After one year, the difference in the Questionnaire results between the two groups increased to about 21 points.
• No participants had any serious side effects from the stress cardiac MRI screening, and there were no deaths during the year of follow-up.

“The results of our study open a new path for people with chest pain,” Berry said. “It indicates that symptoms and well-being are worse when diagnoses are made based only on an angiogram. Clinical practice should now change to include a stress cardiac MRI test for angina, especially for women with chest pain and no blockages in the main arteries. These results may also help inform future clinical recommendations for anyone presenting with angina, and help improve clinical outcomes.”

Study details, background and design:

• Out of 273 people screened to join the trial, 250 adults were enrolled. Participants were an average age of 63 years old, about half were women, and about 1 in 6 had Type 2 diabetes. All had a recent angiogram to indicate their main arteries were visibly clear with no blockages.
• All participants then had a stress cardiac MRI scan to measure blood flow in the heart’s arteries, and a medication was given to mimic the effects of exercise on the heart while the scan was being done.
• Participants were randomly assigned to one of two groups. In one group, doctors saw the scan results and used them to make the final diagnosis and choose treatment. In the second group, doctors did not see the results and made decisions based only on the cardiac angiogram. Neither participants nor their doctors knew which group they were in until the trial ended.
• Enrollment for the study began in February 2021, and follow-up began in 2024, at three hospitals in the West of Scotland.
• All participants were followed for 12 months after enrollment, and there were no dropouts in either group.
• The study was coordinated by an independent clinical trials unit, data were collected centrally, and results were analyzed by a blinded statistician to minimize bias.

The study had some limitations to note. More research is needed to confirm these findings in different health care settings and to test whether this approach may improve longer-term outcomes for patients, such as re-hospitalization and survival. Because chest pain from small vessels is often under-recognized, especially in women and among people in groups historically excluded from scientific research studies, future trials should ensure these populations are well represented.
After physical injuries, chest pain is the second most common reason adults visit hospital emergency departments in the U.S., accounting for more than 6.5 million visits each year (about 1 in 20 ED visits). Chest pain also leads to nearly four million outpatient visits annually, according to the American Heart Association’s Heart Disease and Stroke Statistics – 2025 Update.

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
• View the abstract in the American Heart Association Scientific Sessions 2025 Online Program Planner
• American Heart Association health information: Angina (Chest Pain)
• American Heart Association health information: Microvascular Angina
• American Heart Association Report: 2022 ACC/AHA Key Data Elements and Definitions for Chest Pain and Acute Myocardial Infarction: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Data Standards | Circulation: Cardiovascular Quality and Outcomes (August 2022)
• About Scientific Sessions 2025
• For more news at the American Heart Association’s Scientific Sessions 2025, follow us on X @HeartNews,#AHA25

###

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