In this episode of Behind the Science, host Adith Arun sits down with Dr. Evangelos Oikonomou to discuss groundbreaking research published in JACC: "Early Prediction of Heart Failure from Routine Cardiac CT Using Radiomic Phenotyping of Epicardial Fat." Dr. Oikonomou walks us through how AI-powered radiomic analysis of epicardial adipose tissue, the fat layer directly surrounding the heart, can serve as an early biomarker for heart failure risk, even in patients with no prior diagnosis. The study draws on over 60,000 coronary CT angiography cases from nine UK sites (the ORFNI consortium) to build and validate a fully automated risk scoring model. Topics covered: Why BMI falls short as a cardiovascular risk measure What epicardial fat reveals about myocardial disease How radiomics extracts hidden phenotypic features from CT images Model training, validation, and multi-site generalizability How the FRP (Fat Radiomic Profile) score is orthogonal to existing tools like PREVENT Implications for GLP-1 therapies and obesity-directed treatment eligibility The future of longitudinal monitoring and prospective enrichment studies This research represents a major step toward extracting untapped prognostic value from CT scans already being performed in clinical practice.

In this episode of Behind the Science, we explore how coronary artery calcium scoring improves cardiovascular risk assessment in patients with elevated lipoprotein(a). This multicohort study highlights how Lp(a) and CAC serve as independent predictors of ASCVD and how combining both tools enhances risk stratification in clinical practice. Learn how calcium scoring can help identify higher risk individuals, guide preventive cardiology decisions, and support personalized treatment strategies. This discussion is essential for clinicians focused on heart disease prevention, lipid disorders, and advanced cardiovascular imaging.

Listen in to JACC's perspective on our newest research, published on June 19 and featuring co-authors Adith Arun, BS, Clyde W. Yancy, MD, MSc. We present readers with another update in our Data Report Series, evaluating trends in excess cardiovascular mortality among Black Americans compared with White Americans from 2000 to 2024 and persistent disparities in outcomes. While modest improvements were observed in 2024 after pandemic-related increases, progress remains uneven, with heart failure mortality continuing to rise—especially among women. The overall burden remains high, with more than one million excess years of potential life lost annually and hypertension as the leading contributor. Long-term patterns show that earlier gains in reducing disparities have stalled, with current gaps resembling those seen in the mid-2010s. The findings emphasize that advances in cardiovascular care have not translated into equitable outcomes and call for sustained structural and policy interventions. #jacc #jaccjournals #jaccdatareport

Dr. Aaysha Cader, Social Media editor for JACC Interventions and Dr. Chao Gao discuss the pre-specified subgroup analysis of the REC-CAGEFREE I trial: Drug-Coated Balloon Angioplasty vs Drug-Eluting Stents in Noncomplex Coronary Bifurcation Lesions.

Dr. Aaysha Cader, Social Media editor for JACC Interventions and Dr. Antoinette Neylon discuss the randomised KISS trial: Side Branch Additional Treatment for Coronary Bifurcation Lesion Revascularization.

Join us for the latest Behind the Science discussion, featuring an article published in JACC's May 12 focus issue on hypertension. Adith Arun, MD, joins author William B. White, MD, as they discuss a phase 2 randomized trial of the NPR1 agonist XXB750 in patients with resistant hypertension. The interview highlights the study, a randomized, double-blind, placebo-controlled trial of 4 doses of XXB750, administered once-monthly by subcutaneous injection in 189 patients with resistant hypertension. Dose-related changes in cyclic GMP were observed, supporting target engagement of XXB750 at the NPR-1 receptor. However, there was no dose-response pattern observed with respect to change from baseline in 24-hour systolic BP after 12 weeks; none of the doses of XXB750 had a greater BP lowering effect than placebo. #jacc #jaccjournals #behindthescience

In this interview in JACC's May 12 issue focusing on hypertension, JACC Editor-in-Chief Harlan M. Krumholz, MD, SM, MACC speaks with first author Samantha S. O'Connell, MS, MD, as they discuss a comprehensive global analysis of hypertension trends from 2000 to 2020, drawing on data from nearly 300 population-based studies across 119 countries. The findings show that while awareness and treatment have improved modestly—especially in high-income countries—the global burden of hypertension has grown to 1.7 billion adults, with most uncontrolled cases now concentrated in low- and middle-income countries. The conversation emphasizes widening disparities, persistently low control rates, and the urgent need to implement proven strategies worldwide.

Can artificial intelligence really adjudicate heart attacks, strokes, and cardiovascular deaths in clinical trials? Adith Arun sits down with Jonathan W. Cunningham to discuss cutting-edge research using AI to automate major adverse cardiovascular event (MACE) adjudication—one of the most expensive and time‑consuming parts of global clinical trials. They explore how AI models review extensive medical records, assess uncertainty, and work alongside physicians in a hybrid approach that can preserve accuracy while improving efficiency and scalability in large trials.

At ACC.26, JACC Editor-in-Chief Dr. Harlan Krumholz speaks with Dr. Wayne Batchelor about the ALERT Trial, published in JACC. Their discussion explores how automated EHR-based clinician alerts can help identify patients with significant valvular heart disease who may otherwise be overlooked, improving timely referral, heart team evaluation, and valve intervention. The conversation also covers the trial's rigorous cluster-randomized design, the promise of low-cost digital interventions at scale, and important considerations around workflow integration, equity, and implementation across health systems.

In a panel at ACC.26, this video features Dr. Clyde Yancy of Northwestern University in conversation with Ambarish Pandey, Lauren Eberly, Jennifer Cluett, and Oluwabunmi Ogugngbe, exploring how social determinants of health can be studied as measurable variables in clinical research. The discussion highlights innovative trials examining "food as medicine," community-based nutrition interventions, and direct financial support for patients with cardiovascular disease. Through examples involving Indigenous, African American, and socioeconomically disadvantaged populations, the speakers emphasize the importance of trust, community engagement, and culturally tailored approaches. The video underscores a shift toward integrating social factors into cardiovascular science to reduce disparities and improve real-world health outcomes.