The future of cardiovascular health depends on prevention that begins early in life. This episode reviews strategies for recognizing cardiovascular risk at an early stage and implementing interventions that can alter the trajectory of atherosclerotic cardiovascular disease before complications occur.

In this interview, Allen J. Taylor, MD, FACC and Michael J. Blaha MD, MPH discuss Primordial Prevention of Cardiovascular Disease (CVD) in Young.

Cardiovascular protection during cancer treatment is critical to help prevent complications such as heart failure. Patients should be educated on risk factors, symptom awareness, and heart-healthy behaviors. Oncologists should incorporate cardiovascular risk assessment and surveillance into treatment planning, while general cardiologists should understand the potential cardiotoxic effects of cancer therapies and partner closely with oncology teams to support long-term patient health.

In this interview, Dipti Itchhaporia MD, MACC and Ana Barac, MD, PhD, FACC discuss Umbrella: Cardioprotection During Treatment.

Nonobstructive hypertrophic cardiomyopathy (HCM) represents one of the greatest areas of unmet need in HCM management. A key question is identifying the primary driver of symptoms in these patients, as many experience significant functional limitations despite the absence of left ventricular outflow tract obstruction. Understanding the rate and mechanisms of heart failure progression in nonobstructive HCM is also critical, given the substantial morbidity associated with the disease. As a result, there is strong interest in novel therapies that may address underlying disease pathology and improve long-term patient outcomes.

In this interview, Matthew Martinez, MD, FACC and Martin Maron, MD examine treatment for nonobstructive HCM.

The VESALIUS-CV trial demonstrated that the PCSK9 inhibitor evolocumab significantly reduced the risk of a first major cardiovascular event in patients with diabetes who had no known significant atherosclerosis. These findings challenge current clinical practice, where PCSK9 inhibitors are typically reserved for secondary prevention in patients with prior heart attack or stroke. Importantly, the results support earlier, more proactive lipid-lowering intervention, showing benefit even before overt atherosclerotic disease is evident. This paradigm shift underscores the opportunity to intensify preventive strategies and reduce cardiovascular risk earlier in high-risk populations.

In this interview, Nanette Kass Wenger MD, MACC and Nicholas Marston, MD discuss the VESALIUS-CV Trial.

Randomized trials in stable ischemic heart disease (SIHD) show revascularization does not reduce death or myocardial infarction versus guideline-directed medical therapy, with benefit limited to symptom relief. This likely reflects lesion–ischemia mismatch, unclear ischemia origin, effective modern medical therapy, and trial design constraints. As a result, a prognostic advantage is difficult to demonstrate in broad SIHD populations. Exceptions where revascularization may improve outcomes include severe left main disease, significant left ventricle dysfunction, large ischemic burden, and refractory angina.

In this interview, Allen J. Taylor MD, FACC and Sanjay Kaul, MBBS examine 'Why Can't We Prove Revascularization Is Better Than Medical Therapy for SIHD?'

ecent advancements in echocardiography since ACC.25 highlight a shift toward greater precision, efficiency, and consistency in cardiac imaging. Standardized echo reporting is now recognized as a key marker of quality care, improving communication and supporting more reliable clinical decisions, while artificial intelligence enhances imaging through automated measurements and diagnostic support. Together, these innovations strengthen echocardiography's foundational role in heart disease management by improving accuracy, consistency, and overall patient outcomes.

In this interview, Steven E. Nissen MD, MACC David H. Wiener, MD, FACC discuss practice-changing advancements in echocardiography.

The "Food is Medicine" approach is central to cardiovascular disease (CVD) prevention because diet directly shapes key risk factors, making nutrition a powerful, modifiable intervention. Medically tailored meals (MTMs) are fully prepared, condition-specific meals prescribed to meet the clinical needs of patients with chronic disease. Evidence shows that MTMs can improve health outcomes, enhance diet quality, and reduce hospitalizations and costs. Together, prescribing food as part of care highlights a scalable strategy to improve individual health and drive meaningful public health impact.

In this interview, Matthew W. Martinez MD, FACC and Laurence S. Sperling, MD, FACC discuss "Prescribing Meals, Not Just Meds: The Case For Medically Tailored Meals".

The detection of subclinical, or "silent," atrial fibrillation (AFib) has increased substantially with the widespread use of implantable devices (e.g., pacemakers, defibrillators) and consumer wearables such as smartwatches. A key clinical question is the threshold of cumulative AFib burden—such as duration identified on device interrogation—at which anticoagulation should be considered. Additionally, clinicians should consider when consumer wearable rhythm monitoring is appropriate, such as in patients with symptoms or elevated stroke risk. Best practices are needed to guide counseling and management of patients with subclinical AFib, including when to initiate stroke and systemic embolism prevention strategies.

In this interview, W. Douglas Weaver MD, MACC and Deepak Bhakta, MD, MBA, FACC discuss managing subclinical AFib detected by devices, ambulatory monitors and wearables.

Is tirzepatide associated with a broader reduction in cardiorenal adverse outcomes compared with dulaglutide in patients with type 2 diabetes and cardiovascular disease (CVD? The SURPASS-CVOT, the first cardiovascular outcomes trial using an active incretin-based comparator, previously demonstrated that tirzepatide was noninferior to dulaglutide for major adverse cardiovascular events, including CV death, myocardial infarction, and stroke. A current analysis expands these findings by examining a wider spectrum of adverse events to further characterize the comparative cardiorenal effects of tirzepatide.

In this interview, Matthew Martinez, MD, FACC and Steven E. Nissen, MD, MACC examine the SURPASS-CVOT Randomized Clinical Trial.

The Recover-Autonomic Trial evaluates the impact of ivabradine on orthostatic intolerance, quality of life, and heart rate in patients with post-COVID postural orthostatic tachycardia syndrome (POTS). Recognizing that POTS disproportionately affects women, the study addresses a growing clinical need for targeted management strategies in this population. It examines ivabradine as part of a broader treatment approach that combines pharmacotherapy with lifestyle modifications, which together are associated with improved patient outcomes. The trial aims to inform more effective, evidence-based care for individuals experiencing persistent autonomic dysfunction following COVID-19.

In this interview, Thomas F. Deering, MD, FACC and Pam Taub, MD, FACC discuss the Recover-Autonomic Trial.