LDL-C Lowering After Myocardial Infarction
https://jamanetwork.com/journals/jama/fullarticle/2853275
When statins first emerged as a potent treatment for elevated low-density lipoprotein cholesterol (LDL-C), the logical population to test was patients with coronary heart disease (CHD) and high LDL-C, providing definitive proof causally linking LDL-C to CHD. Additional statin trials extended the evidence base, demonstrating that clinical benefit from statins could be achieved even in patients with lower LDL-C thresholds. The early statin trials excluded individuals with recent myocardial infarction (MI) in the preceding 4 to 6 months, potentially because of clinical instability or from reasoning that early thrombotic events may not be modifiable from altering the pathology in the artery wall through lowering LDL-C.
https://jamanetwork.com/journals/jama/fullarticle/2853275
When statins first emerged as a potent treatment for elevated low-density lipoprotein cholesterol (LDL-C), the logical population to test was patients with coronary heart disease (CHD) and high LDL-C, providing definitive proof causally linking LDL-C to CHD. Additional statin trials extended the evidence base, demonstrating that clinical benefit from statins could be achieved even in patients with lower LDL-C thresholds. The early statin trials excluded individuals with recent myocardial infarction (MI) in the preceding 4 to 6 months, potentially because of clinical instability or from reasoning that early thrombotic events may not be modifiable from altering the pathology in the artery wall through lowering LDL-C.
Evolocumab Before Percutaneous Coronary Intervention for Acute Myocardial Infarction
https://jamanetwork.com/journals/jama/fullarticle/2853274
This prospective randomized open, blinded end-point adjudication study examines evolocumab as first-line therapy vs standard care in patients with high-risk acute myocardial infarction undergoing percutaneous coronary intervention.
https://jamanetwork.com/journals/jama/fullarticle/2853274
This prospective randomized open, blinded end-point adjudication study examines evolocumab as first-line therapy vs standard care in patients with high-risk acute myocardial infarction undergoing percutaneous coronary intervention.
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LDL Cholesterol Lowering With Evolocumab Before Percutaneous Coronary Intervention for Acute Myocardial Infarction Research Summary
https://jamanetwork.com/journals/jama/fullarticle/2853273
This trial evaluated whether starting evolocumab before percutaneous coronary intervention improved low-density lipoprotein cholesterol target achievement and clinical outcomes after acute myocardial infarction.
https://jamanetwork.com/journals/jama/fullarticle/2853273
This trial evaluated whether starting evolocumab before percutaneous coronary intervention improved low-density lipoprotein cholesterol target achievement and clinical outcomes after acute myocardial infarction.
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The Evolving Process of Myocardial Infarction Classification
https://jamanetwork.com/journals/jamacardiology/fullarticle/2853496
Acute myocardial infarction (MI) has a clear pathological definition: the death of myocardial cells caused by prolonged ischemia. However, in a clinical setting, it is considerably more difficult to establish the diagnosis of MI. In 2007, a consortium of the European Society of Cardiology, the American College of Cardiology Foundation, the American Heart Association, and the World Heart Federation proposed the Universal Definition of Myocardial Infarction (UDMI) to guide diagnosis and classification of MI. Advances in understanding the pathophysiological mechanisms of myocardial injury, advances in diagnostic techniques as well as signals from daily practice regarding performance, and problems of the UDMI led to 3 subsequent iterations of the consensus document. The most recent version, the fourth UDMI, was published in 2018. The current UDMI-based clinical definition of MI requires a combination of a rise and fall in high-sensitivity cardiac troponin, with at least 1 value above the 99th percentile upper reference limit, and evidence of acute myocardial ischemia that includes 1 or more of the following: presence of symptoms, new ischemic changes on electrocardiography, development of pathological Q waves, imaging evidence of new loss of viable myocardium, a new regional wall-motion abnormality, or identification of a coronary thrombus. Although the fourth UDMI provided better pathophysiology-oriented MI diagnoses and classifications than prior versions, the increased complexity of the classification inevitably negatively impacts operational utility and ease of use in daily practice.
https://jamanetwork.com/journals/jamacardiology/fullarticle/2853496
Acute myocardial infarction (MI) has a clear pathological definition: the death of myocardial cells caused by prolonged ischemia. However, in a clinical setting, it is considerably more difficult to establish the diagnosis of MI. In 2007, a consortium of the European Society of Cardiology, the American College of Cardiology Foundation, the American Heart Association, and the World Heart Federation proposed the Universal Definition of Myocardial Infarction (UDMI) to guide diagnosis and classification of MI. Advances in understanding the pathophysiological mechanisms of myocardial injury, advances in diagnostic techniques as well as signals from daily practice regarding performance, and problems of the UDMI led to 3 subsequent iterations of the consensus document. The most recent version, the fourth UDMI, was published in 2018. The current UDMI-based clinical definition of MI requires a combination of a rise and fall in high-sensitivity cardiac troponin, with at least 1 value above the 99th percentile upper reference limit, and evidence of acute myocardial ischemia that includes 1 or more of the following: presence of symptoms, new ischemic changes on electrocardiography, development of pathological Q waves, imaging evidence of new loss of viable myocardium, a new regional wall-motion abnormality, or identification of a coronary thrombus. Although the fourth UDMI provided better pathophysiology-oriented MI diagnoses and classifications than prior versions, the increased complexity of the classification inevitably negatively impacts operational utility and ease of use in daily practice.
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Causal Endotype–Based Classification of Myocardial Infarction
https://jamanetwork.com/journals/jamacardiology/fullarticle/2853495
This study characterizes the distribution and clinical features of myocardial infarction causal endotypes in a large contemporary cohort with a descriptive assessment of associated 1-year outcomes.
https://jamanetwork.com/journals/jamacardiology/fullarticle/2853495
This study characterizes the distribution and clinical features of myocardial infarction causal endotypes in a large contemporary cohort with a descriptive assessment of associated 1-year outcomes.
Specialist Referral for Cardiovascular Risk in Patients With Prostate Cancer
https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2853474
This randomized clinical trial evaluates the effect of routine referral of patients with prostate cancer to a cardiovascular specialist for systematic risk factor control compared with usual care.
https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2853474
This randomized clinical trial evaluates the effect of routine referral of patients with prostate cancer to a cardiovascular specialist for systematic risk factor control compared with usual care.
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Antithrombotic Therapy After TAVI
https://jamanetwork.com/journals/jama/fullarticle/2853401
This randomized trial compares whether monotherapy anticoagulation compared with antiplatelet monotherapy can prevent leaflet thrombosis without compromising safety.
https://jamanetwork.com/journals/jama/fullarticle/2853401
This randomized trial compares whether monotherapy anticoagulation compared with antiplatelet monotherapy can prevent leaflet thrombosis without compromising safety.
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Anticoagulation Monotherapy vs Antiplatelet Monotherapy After Transcatheter Aortic Valve Implant Research Summary
https://jamanetwork.com/journals/jama/fullarticle/2853400
This trial examined whether anticoagulation monotherapy compared with antiplatelet monotherapy could prevent leaflet thrombosis after transcatheter aortic valve implant (TAVI) without reducing safety.
https://jamanetwork.com/journals/jama/fullarticle/2853400
This trial examined whether anticoagulation monotherapy compared with antiplatelet monotherapy could prevent leaflet thrombosis after transcatheter aortic valve implant (TAVI) without reducing safety.
Errors in Discussion and References
https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2853168
The Original Investigation, “Mailed Outreach for Colorectal Cancer Screening in Community Health Centers: The CARES Pragmatic Cluster Randomized Clinical Trial,” published online first April 27, 2026, and in the June 2026 issue of JAMA Internal Medicine, contained 2 errors in the Discussion section. The price of the Cologuard Plus test is $599, and a reference about the cost was updated in the References list. Additionally, a statement about estimated Medicare reimbursement costs for fecal immunochemical tests was removed along with a corresponding reference. This article was corrected online.
https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2853168
The Original Investigation, “Mailed Outreach for Colorectal Cancer Screening in Community Health Centers: The CARES Pragmatic Cluster Randomized Clinical Trial,” published online first April 27, 2026, and in the June 2026 issue of JAMA Internal Medicine, contained 2 errors in the Discussion section. The price of the Cologuard Plus test is $599, and a reference about the cost was updated in the References list. Additionally, a statement about estimated Medicare reimbursement costs for fecal immunochemical tests was removed along with a corresponding reference. This article was corrected online.
Respiratory Syncytial Virus Vaccine Effectiveness in Medicare Beneficiaries Residing in Nursing Homes
https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2853166
This cohort study assesses respiratory syncytial virus vaccine effectiveness among Medicare beneficiaries aged 65 years or older residing in nursing homes.
https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2853166
This cohort study assesses respiratory syncytial virus vaccine effectiveness among Medicare beneficiaries aged 65 years or older residing in nursing homes.
Protecting Nursing Home Residents From Respiratory Syncytial Virus
https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2853167
Respiratory syncytial virus (RSV) is a major cause of morbidity and mortality in nursing homes, with attributable mortality rivaling that of influenza during some seasons. Advanced age, multiple chronic conditions, and immunosenescence, combined with the congregate nature of nursing homes, facilitate the acquisition and transmission of respiratory viral infections. However, unlike influenza and SARS-CoV-2, there are no widely available antivirals to halt the progression of symptomatic RSV infection. Vaccination is therefore critical to protecting this vulnerable population.
https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2853167
Respiratory syncytial virus (RSV) is a major cause of morbidity and mortality in nursing homes, with attributable mortality rivaling that of influenza during some seasons. Advanced age, multiple chronic conditions, and immunosenescence, combined with the congregate nature of nursing homes, facilitate the acquisition and transmission of respiratory viral infections. However, unlike influenza and SARS-CoV-2, there are no widely available antivirals to halt the progression of symptomatic RSV infection. Vaccination is therefore critical to protecting this vulnerable population.
When an Algorithm Renews a Prescription
https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2853165
This Viewpoint discusses problems at each stage of the artificial intelligence prescription refill encounter.
https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2853165
This Viewpoint discusses problems at each stage of the artificial intelligence prescription refill encounter.
The Veteran Affairs’ Whole Health Approach for Chronic Pain Management
https://jamanetwork.com/journals/jama/fullarticle/2853371
To the Editor Chronic pain trials increasingly enroll populations with substantial psychiatric symptoms, yet suicidality is often treated as a safety observation rather than a clinically meaningful outcome. The Whole Health Options and Pain Education (wHOPE) trial illustrates this tension. Despite excluding patients with active suicidality at baseline, suicidal ideation was the most common adverse event, occurring in 13.7% of the whole health group, 15.9% of the cognitive behavioral therapy (CBT) group, and 13.4% of the usual care group, with no differential reduction by intervention. Together, these findings reflect that suicidal ideation in people with chronic pain is often documented for safety surveillance but not evaluated as a pain-linked clinical outcome.
https://jamanetwork.com/journals/jama/fullarticle/2853371
To the Editor Chronic pain trials increasingly enroll populations with substantial psychiatric symptoms, yet suicidality is often treated as a safety observation rather than a clinically meaningful outcome. The Whole Health Options and Pain Education (wHOPE) trial illustrates this tension. Despite excluding patients with active suicidality at baseline, suicidal ideation was the most common adverse event, occurring in 13.7% of the whole health group, 15.9% of the cognitive behavioral therapy (CBT) group, and 13.4% of the usual care group, with no differential reduction by intervention. Together, these findings reflect that suicidal ideation in people with chronic pain is often documented for safety surveillance but not evaluated as a pain-linked clinical outcome.
The Veteran Affairs’ Whole Health Approach for Chronic Pain Management—Reply
https://jamanetwork.com/journals/jama/fullarticle/2853370
In Reply We thank Drs Mendes Neto and Mendes for their letter about the wHOPE trial. We agree there is a blind spot in addressing the relationship between chronic pain and psychological conditions, including suicidal ideation, and the need to assess suicidal ideation and behaviors as clinical outcomes in trials of patients with chronic pain. In addition, trials are needed that enroll individuals with co-occurring chronic pain and mental health conditions, including suicidal ideation, to rigorously evaluate integrated interventions that address pain and mood.
https://jamanetwork.com/journals/jama/fullarticle/2853370
In Reply We thank Drs Mendes Neto and Mendes for their letter about the wHOPE trial. We agree there is a blind spot in addressing the relationship between chronic pain and psychological conditions, including suicidal ideation, and the need to assess suicidal ideation and behaviors as clinical outcomes in trials of patients with chronic pain. In addition, trials are needed that enroll individuals with co-occurring chronic pain and mental health conditions, including suicidal ideation, to rigorously evaluate integrated interventions that address pain and mood.
Tirofiban for Branch Atheromatous Disease
https://jamanetwork.com/journals/jamaneurology/fullarticle/2853601
Branch atheromatous disease (BAD) is a subtype of ischemic stroke in which atherosclerosis of a parent artery impinges the origin of perforating branches to produce subcortical infarcts. Although these infarcts can resemble lacunes from arteriolosclerosis, BAD-related strokes carry distinct pathophysiological and clinical characteristics, including a high rate of early neurological deterioration (END). This progressive nature of BAD-related strokes commonly leads to poor functional outcomes, especially as treatments to prevent END are limited.
https://jamanetwork.com/journals/jamaneurology/fullarticle/2853601
Branch atheromatous disease (BAD) is a subtype of ischemic stroke in which atherosclerosis of a parent artery impinges the origin of perforating branches to produce subcortical infarcts. Although these infarcts can resemble lacunes from arteriolosclerosis, BAD-related strokes carry distinct pathophysiological and clinical characteristics, including a high rate of early neurological deterioration (END). This progressive nature of BAD-related strokes commonly leads to poor functional outcomes, especially as treatments to prevent END are limited.
Treatment Discontinuation in MOGAD—One Size Does Not Fit All
https://jamanetwork.com/journals/jamaneurology/fullarticle/2853600
To the Editor The Boudot de la Motte et al study provides real-world data suggesting that planned treatment discontinuation may be feasible in selected patients, with a Kaplan-Meier estimated cumulative relapse incidence of 8.7% at 1 year. The identification of 2 parameters—treatment duration exceeding 1 year and a relapse-free interval of more than 2 years—offers a pragmatic starting point for shared decision-making regarding treatment discontinuation.
https://jamanetwork.com/journals/jamaneurology/fullarticle/2853600
To the Editor The Boudot de la Motte et al study provides real-world data suggesting that planned treatment discontinuation may be feasible in selected patients, with a Kaplan-Meier estimated cumulative relapse incidence of 8.7% at 1 year. The identification of 2 parameters—treatment duration exceeding 1 year and a relapse-free interval of more than 2 years—offers a pragmatic starting point for shared decision-making regarding treatment discontinuation.
Treatment Discontinuation in MOGAD—One Size Does Not Fit All—Reply
https://jamanetwork.com/journals/jamaneurology/fullarticle/2853599
In Reply We thank Kim and Kim for their thoughtful comments on our study published in JAMA Neurology and for emphasizing the need to better define treatment discontinuation strategies in myelin oligodendrocyte glycoprotein antibody–associated disease (MOGAD).
https://jamanetwork.com/journals/jamaneurology/fullarticle/2853599
In Reply We thank Kim and Kim for their thoughtful comments on our study published in JAMA Neurology and for emphasizing the need to better define treatment discontinuation strategies in myelin oligodendrocyte glycoprotein antibody–associated disease (MOGAD).
Tirofiban for Branch Atheromatous Disease–Related Stroke
https://jamanetwork.com/journals/jamaneurology/fullarticle/2853598
This randomized clinical trial investigates whether the combination of tirofiban and aspirin safely reduces the risk of early neurological deterioration or new stroke for patients with branch atheromatous disease–related stroke within 48 hours of onset.
https://jamanetwork.com/journals/jamaneurology/fullarticle/2853598
This randomized clinical trial investigates whether the combination of tirofiban and aspirin safely reduces the risk of early neurological deterioration or new stroke for patients with branch atheromatous disease–related stroke within 48 hours of onset.
ATTs in Patients With Non-AD Copathologies
https://jamanetwork.com/journals/jamaneurology/fullarticle/2853597
This Viewpoint examines how clinicians should approach amyloid-targeting therapies in patients with Alzheimer disease and suspected copathologies, emphasizing individualized decision-making, current evidence gaps, and the need for prospective studies.
https://jamanetwork.com/journals/jamaneurology/fullarticle/2853597
This Viewpoint examines how clinicians should approach amyloid-targeting therapies in patients with Alzheimer disease and suspected copathologies, emphasizing individualized decision-making, current evidence gaps, and the need for prospective studies.