Dr. Harlan Krumholz reviews the STEP trial, which studied over 8,500 older adults in China to compare intensive versus standard blood pressure control. The trial found that lowering systolic blood pressure to 110–130 mm Hg significantly reduced major cardiovascular events by 26% without added safety risks, confirming benefits previously shown in the SPRINT trial. A six-year follow-up revealed a lasting "legacy effect," showing that starting intensive treatment earlier produced enduring cardiovascular protection even after pressures equalized. The key takeaway: early, sustained, and carefully monitored intensive control is safe, effective, and time-sensitive—each year of delay means missed opportunities to prevent heart attacks and strokes.

In this episode of JACC Deep Dive, Editor-in-Chief Dr. Harlan Krumholz explores groundbreaking findings from the CLEAR-IE registry—the largest study to date on percutaneous mechanical aspiration (PMA) for right-sided infective endocarditis. He discusses the procedure's feasibility, outcomes, and its role alongside surgery, offering insights into how PMA may reshape treatment options for high-risk patients.

In this JACC Deep Dive, Dr. Harlan Krumholz highlights a study by Ikemura et al. that used data from the ISCHEMIA trial to model how angina symptoms evolve over three years in patients with stable coronary disease treated either invasively or conservatively. The study identified six distinct symptom trajectories, showing that while most patients improved over time, those undergoing revascularization were more likely to experience rapid and complete symptom relief. However, the benefit was not uniform—patients with frequent baseline angina saw the greatest improvement, and some had persistent symptoms regardless of treatment. These findings underscore the importance of personalized, shared decision-making based on a patient's likely symptom trajectory rather than a binary treatment choice.