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Non-Invasive CT Coronary Angiography Detects Low- to Moderate-Risk Coronary Artery Disease too

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Can Non-Invasive CT Coronary Angiography Detect Low- to Moderate-Risk Coronary Artery Disease?

September 12, 2025

TOPLINE:

CT coronary angiography (CTCA) was found to be safe and effective for evaluating coronary artery disease in patients with a low-to-intermediate pretest probability of the disease. It demonstrated a high negative predictive value and good sensitivity and specificity and led to a significant reduction in the diagnosis time compared with invasive CA.

METHODOLOGY:

  • Researchers conducted a single-centre non-randomised trial involving 100 patients (67% men) with a low-to-intermediate pretest probability of coronary artery disease in Germany between November 2019 and April 2022.
  • Patients were randomly assigned in a 1:2 ratio to undergo either CTCA (n = 30; mean age, 63 years) or invasive CA (n = 70; mean age, 65 years). Both groups underwent follow-up stress echocardiography after a minimum interval of 6 months.
  • Across both groups, patients demonstrated similar distributions of cardiac risk factors, including hypertension, which was most prevalent; diabetes; and smoking.
  • The primary outcome was the change in the Wall Motion Score Index (WMSI) from stress testing to resting conditions, with a threshold score > 0.37 indicating a significant risk for cardiac mortality during long-term follow-up.
  • Secondary outcomes included mortality, myocardial infarction, hospital admissions for angina, and myocardial revascularisation procedures.

TAKEAWAY:

  • Among 63 patients who completed follow-up (median time, 10 months), none of them in the CTCA or invasive CA group showed a change in the WMSI score > 0.37.
  • At the follow-up, one patient in the invasive CA group died, and one patient in the CTCA group experienced angina; no instances of myocardial infarction or revascularisation were recorded in any of the groups.
  • Diagnostic performance metrics of CTCA showed a sensitivity of 75% and a specificity of 77.27%, with a high negative predictive value of 89% for ruling out coronary artery disease.
  • Compared with invasive CA, CTCA significantly reduced the diagnostic time (20.2 vs 4.7 hours; P < .0001); however, it had a higher mean radiation dose (1.5 vs 2.3 mSv; P = .03).

IN PRACTICE:

“Our study supports the assertion that CT coronary angiography (CTCA) is a safe and reliable non-invasive modality for the diagnosis or exclusion of coronary artery disease (CAD) when appropriate clinical indications are met,” the authors wrote, suggesting a promising future of non-invasive diagnostics for CTCA, “especially with the emergence of photon-counting CTCA technology, enabling a substantially higher image resolution.”

SOURCE:

This study was led by Migena Disha, Department of General and Interventional Cardiology/Angiology, Heart and Diabetes Center NRW, Ruhr University Bochum, Bochum, Germany. It was published online on September 03, 2025, in the Journal of Clinical Medicine.

LIMITATIONS:

The small sample size limited the study’s ability to identify significant differences between the two groups. The COVID-19 pandemic resulted in 37 patients being lost to follow-up. Additionally, the non-randomised design may have introduced selection bias, and patient self-selection created additional bias.

DISCLOSURES:

This study did not receive any external funding, and the authors declared having no relevant conflicts of interest.

International expert consensus recommends faster, more targeted MRI scans in prostate cancer screening

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NEWS RELEASE

Research presented at international urology conference in London shows how far prostate cancer screening has come

Reports and Proceedings

EUROPEAN ASSOCIATION OF UROLOGY

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Research presented at international urology conference in London shows how far prostate cancer screening has come

Nearly 300 abstracts on prostate cancer research from around the world will be presented at the European Association of Urology Congress (EAU26), taking place in London from 13–16 March 2026.

Highlights of some of the key advances in the prostate cancer screening field are detailed below.

Tobias Nordström is a clinical urologist and Associate Professor at the Karolinska Institute, Sweden and a member of the EAU Scientific Congress Office. He said: “The field of prostate cancer screening is advancing all the time. EAU26 provides us with a snapshot of where things are going.

“We know that screening can save lives. This year we have that confirmed with 30-year data from the longest running prostate cancer screening trial, led by a pioneer in the field, Jonas Hugosson. In the last ten years, research has focused on reducing overdiagnosis and unnecessary harms while maintaining the benefits in saving lives.  A key tool for this is MRI, and we are now seeing research to evaluate how we can make best use of it in real world, clinical practice. But for all the buzz around new data, biomarkers or imaging, we must never forget that this is ultimately about people, about the men at risk of prostate cancer, about their lives and wellbeing. This is why research that confirms minimal harms from screening is also vital as we move forward.”

Positive impact of screening on mortality increases over time, 30-year results show

Results from the longest-running European prostate cancer screening study confirm that screening leads to a reduction in mortality from prostate cancer, which becomes more pronounced over time.

The randomised controlled Gothenburg 1 study began in 1994 and involved 20,000 men aged 50–64. Half were invited every two years for PSA-testing until aged 70 and referred directly for systematic biopsy when their PSA was 3ng/ml or over. The other half were not invited to screening. Screening helped to avert one death for every 311 men invited to screening after 15 years, and for every 161 men after 30 years. Screening helped to avert one death for every 13 men diagnosed after 15 years and for every 6 men diagnosed after 30 years.

However, the study also registered a higher incidence of prostate cancer in the screening group compared to what would normally be expected.

Dr Jonas Hugosson, a senior researcher in the Department of Urology at the University of Gothenburg said: “This is the longest follow-up of any screening study and shows that the beneficial effect of screening on prostate cancer mortality continues to increase with time. However, it’s also clear that screening detects cancers which would otherwise remain undetected and not be a cause for concern. This overdiagnosis may be due to the diagnostic pathway followed in the study, which has now been overtaken by the use of MRI and risk-stratification to reduce the number of insignificant cancers identified.”

International expert consensus recommends faster, more targeted MRI scans in prostate cancer screening

Twenty-one experts including urologists, radiologists and pathologists from across Europe and North America have agreed an expert consensus on a smarter way to use MRI in prostate cancer screening.

Using MRI in accordance with the PRISM recommendations could detect significant prostate cancers while reducing overdiagnosis and unnecessary biopsies. The study, led by Imperial College London researchers, analysed existing research to draw up over 300 statements detailing when and how to best use MRI in prostate cancer screening, how the MRI should be interpreted, triggers for biopsy and when further screening MRIs are needed. Recommendations were drawn up based on the consensus view of the experts.

Nikhil Mayor, NIHR doctoral fellow at Imperial College London, is presenting the research at  EAU26. He said: “MRI is key to diagnosing prostate cancer but there’s no agreement as to how it should be used in population-level screening. We hope that the PRISM recommendations, backed by international expert consensus, will be widely adopted so that protocols are standardised for future screening pilots, studies and programmes. The recommendations will be applied in the landmark TRANSFORM prostate cancer screening trial which will use 10-minute, non-contrast ‘Prostagram’ MRI scans to screen up to 300,000 men.”

Risk-based approach reduces MRI referrals for prostate cancer by up to 60%

MRI referrals can be reduced by 40–60% when risk stratification is used in addition to PSA alone, according to preliminary data from the PRAISE-U study. Previous studies have shown that up to 70% of MRIs may be unnecessary when PSA is used without additional risk stratification. Within the PRAISE‑U study, five European pilot sites are implementing a risk‑stratified prostate cancer screening algorithm for men aged 50–69 yrs.

Pilot sites use either PSA-density or the Rotterdam Prostate Cancer Risk calculator (RPCRC) to risk stratify following PSA, with various methods used to assess prostate volume (digital rectal examination, transrectal ultrasound, and transabdominal ultrasound). All risk stratification methods reduced the absolute number of MRI referrals. Centres using the RPCRC with transrectal ultrasound saw the greatest reduction in unnecessary MRIs.

Meike van Harten, PhD student at Erasmus MC Cancer Institute University Medical Centre in Rotterdam, The Netherlands, is presenting the data at EAU26. She said: “The implementation of population-based prostate cancer screening programs in Europe could result in around 5 million men being referred for MRI scans based on PSA solely. We need to find ways to reduce demand on MRI so that fewer men have unnecessary tests and those that need it get timely access to a diagnosis. PRAISE-U is showing how to identify a lower risk group of men who can safely avoid further tests, so only those most likely to have prostate cancer are referred for MRI.”

Stockholm3 biomarker-based blood test reduces unnecessary MRI and biopsies 

An advanced testing strategy designed to accurately detect aggressive prostate cancers can reduce the need for MRI referrals by 67% and biopsies by 40%.

A Sweden-based trial compared standard PSA test-based screening with PSA plus the Stockholm3 blood test, which uses an algorithm that combines protein and genetic biomarkers with clinical information. A total of 17,801 men were invited to organised prostate testing in 2023 and 30,556 in 2024. Of these, 13,733 men aged 50–52 yrs were included in the trial. It found that performing the Stockholm3 test before MRI in men with PSA 2 ng/ml or over led to 67% fewer MRI scans.

Professor Ugo Falagario, Professor of Urology at the University of Foggia, Italy, a co-investigator on the trial, is presenting the data at EAU26. He said: “Since rolling out prostate cancer screening programmes across most Swedish regions, the call on MRI scans is very high. Stockholm3 has already been shown as a beneficial approach in detecting prostate cancer. We now demonstrate it can be implemented in population-based organised prostate testing to identify only those with potentially higher-risk cancers who require a referral for an MRI scan and a biopsy – significantly reducing the demand on imaging services.”

Worry is common in prostate cancer screening, but severe anxiety is rare

Around a quarter of men who have a high PSA during prostate cancer screening feel worried in the run-up to biopsy, but very few have more severe anxiety, new research has found.

692 men with an elevated PSA value were questioned about their levels of anxiety, depression, distress and worry during the Göteborg-2 prostate cancer screening trial in Sweden. 3.8–4.8% of men reported moderate to severe anxiety after referral for MRI and biopsy. The greatest impact was just before biopsy, when 9.7% of men reported distress and 26% said they felt worried, with 4.2% saying it affected their daily life.

Dr Linda Svensson, specialist nurse in oncology at the Department of Urology, Sahlgrenska University Hospital, Sweden, is presenting the research at EAU26. She said: “One of the concerns around prostate cancer screening is the balance between benefits and harms for men taking part, including psychological harm. It’s natural for men to feel worried if they have a high PSA and are referred for diagnostic investigation, but our study shows that severe anxiety symptoms are rare. This shows that there is a low risk of psychological harm from modern prostate cancer screening programmes.”

SUBJECT OF RESEARCH

People

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Global breast cancer cases expected to rise to 3.5m by 2050 – Lancet

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Global breast cancer cases expected to rise to 3.5m by 2050 – Lancet

Photo: iStock

Breast cancer is the most diagnosed cancer among women globally, and the number of cases worldwide is estimated to reach more than 3.5m by 2050, recent research has found.

CNN reports that in high-income countries, decades of investment in screening, early detection and treatment drove a nearly 30% decline in breast cancer mortality between 1990 and 2023.

But in the world’s lowest-income countries, the trend is moving in the opposite direction: deaths from breast cancer have nearly doubled over the same period, according to a study published in The Lancet Oncology.

The findings, drawn from an analysis of breast cancer trends across 204 countries and territories for more than three decades, show a deepening global divide between who lives and who dies from the most common cancer among women worldwide.

“There were improvements in mortality rates over time in higher-income settings, but there were really inequities in progress and increasing mortality in some lower-income settings,” said senior study author Dr Lisa Force, an assistant Professor at the University of Washington School of Medicine’s Institute for Health Metrics and Evaluation.

An estimated 2.3m women were diagnosed with breast cancer globally in 2023, resulting in 764 000 deaths, according to the study.

Nearly one in four cancers diagnosed in women worldwide that year was breast cancer.

While the death rate, adjusted to account for differences in population age across countries, dropped by nearly 30% in high-income nations between 1990 and 2023, it increased by roughly 99% in low-income countries over the same period.

Meanwhile, the diagnosis rate in low-income countries rose by 147% over the same period.

For women living in sub-Saharan Africa, which includes some of the highest mortality rates worldwide, the numbers are especially alarming.

Mortality rates in central and western sub-Saharan Africa are now more than double the global average, with roughly 35 deaths for every 100 000 people each year after adjusting for age.

“People’s outcomes from cancer depend on what country they live in,” said Dr Kamal Menghrajani, an oncologist at Massachusetts General Hospital who wasn’t involved in the study. “And that shouldn’t be the case.”

Gap in infrastructure

The divergence reflects a fundamental mismatch between rising diagnosis rates and the infrastructure needed to treat the disease.

Cancer awareness and screening are not enough, said Menghrajani, former assistant director for Cancer Innovation and Public Health in the Biden administration. “We need to have strong infrastructure in place to be able to treat people with cancer and support them all the way through so that they can be cured.”

Treating breast cancer requires a carefully co-ordinated system, she said: surgery, radiation therapy, and chemotherapy or targeted treatments. In the United States, all three are generally available and covered by insurance.

In much of sub-Saharan Africa, though, the picture is dramatically different. As of 2020, only about half of African countries had any external beam radiotherapy service – the most common form of radiation therapy for breast cancer – and none had sufficient capacity to meet their populations’ needs, according to the study.

Where radiation is unavailable, mastectomy often becomes the default treatment, the study noted, but without the surrounding infrastructure of post-operative care and systemic therapy, even surgery has limited effectiveness.

The cost of some treatments compounds the problem. The authors wrote that a standard course of trastuzumab, a targeted therapy for a common subtype of breast cancer, combined with chemotherapy, can cost the equivalent of a decade’s average income in some lower-income countries.

“In low-income countries, people are being left behind,” Menghrajani said. “They’re finding cancer more frequently, and when they find it, they may not have the resources to offer the best treatment.”

Addressing the disparity will require “both political will and investment in strategies that really target the entire cancer care continuum”, Force said. She added that services need to be both accessible and affordable, and strategies should be integrated with broader non-communicable disease efforts.

Force noted that the World Health Organisation’s Global Breast Cancer Initiative recommends three pillars to reduce mortality: ensuring cancers are identified early, ensuring timely diagnosis after symptoms are noticed, and ensuring patients have access to comprehensive management.

“The most effective interventions are really going to include all of those things,” she said.

Without a meaningful approach, the study’s authors warn that many countries will fall short of the WHO’s Global Breast Cancer Initiative target of achieving a 2.5% annual reduction in mortality worldwide.

However, the study noted that even in the US, black women have a death rate from breast cancer that is 40% higher than that of white women, a disparity that persists despite the country’s world-class treatment infrastructure.

Force said the reasons are complex with multiple factors and mirrored patterns seen across countries: potentially more delayed diagnoses, treatment access gaps and biases in the care patients receive.

“Disparities within countries are sometimes similar to disparities between countries,” she said. “If you’re diagnosed later with breast cancer, the outcomes are generally poor.”

While the study is primarily a call to action for global health change, it also offers guidance for individuals aiming to reduce their risk of breast cancer.

Menghrajani warned that lifestyle changes alone can’t fully eliminate the risk of breast cancer, while Force noted that the majority of breast cancer causes are not attributable to lifestyle at all.

 

CNN article – Global breast cancer cases expected to reach over 3.5 million by 2050 (Open access)

Heart Disease Risk in Young Women Projected to Spike Over Next 25 Years

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Heart Disease Risk in Young Women Projected to Spike Over Next 25 Years

Lois Anzelowitz Levine, MA

February 26, 2026

Risk for heart disease is projected to spike over the next 25 years among younger women — typically considered a low-risk group — according to a new scientific statement from the American Heart Association (AHA).

The statement, published in Circulation, found that women aged 20-44 years and women of color face disproportionate risk and that among all US women, 6 in 10 will develop at least one type of cardiovascular disease by 2050.

photo of Karen Joynt Maddox
Karen E. Joynt Maddox, MD, MPH

“The sheer magnitude of this epidemic is really striking, no matter how many times you see it,” Karen E. Joynt Maddox, MD, MPH, the volunteer chair of the writing group told Medscape Medical News.

“It should be a real wake-up call for everyone who sees these numbers,” said Joynt Maddox, who is a professor of medicine and public health at Washington University School of Medicine in St. Louis.

Projections were based on National Health and Nutrition Examination Survey data (2015-2020) for baseline prevalence, the Medical Expenditure Panel Survey (2015-2019) for atrial fibrillation, and US Census population projections through 2050.

Climbing Risk Factors

Among all women, type 2 diabetes is projected to increase from 14.9% to 25.3% and obesity from 43.9% to 61.2% — an absolute increase of 17.3 percentage points. Hypertension is expected to rise from 48.6% to 59.1%.

Clinical cardiovascular conditions are also projected to increase: coronary disease by nearly 20%, heart failure by 46.9%, stroke by 62.8%, and atrial fibrillation by 46.2%.

Adverse trends are projected to be more pronounced among women and girls identifying as American Indian/Alaska Native, multiracial, Black, or Hispanic.

Among Black women, hypertension is projected to rise from about 56% in 2020 to about 72% in 2050, diabetes from roughly 18% to about 26%, and obesity from approximately 48% to nearly 63%.

For Hispanic women, hypertension is projected to increase from about 38% to roughly 60%, diabetes from approximately 17% to about 27%, and obesity from around 44% to nearly 60% by 2050. Similar trends are seen among American Indian/Alaska Native and multiracial women.

The projections underscore the persistence of social determinants of health. The authors wrote, “Despite decades of knowledge of these health inequities, major gaps remain.”

Impact on Young Women

The most striking finding may be among women aged 20-44 years. In this group, total cardiovascular disease, excluding hypertension, is expected to increase by approximately 50% by 2050. Stroke prevalence is expected to nearly double, from about 1% to 2%.

While absolute disease burden remains highest among women aged 80 years or older, the fastest growth has occurred in younger women — a red flag for earlier-onset disease.

One positive trend: Hypercholesterolemia is projected to decline from 42.1% to 22.3%, which the authors attribute to improved lipid management and broader statin uptake.

Joynt Maddox attributes the trend to two forces: demographics (more women living into their eighties and nineties, increasing the number of cardiovascular events and demands for hospital and long-term care) and rising risk factors in younger generations.

“We are setting up a generation of young people to have early-onset cardiovascular disease if we don’t make significant changes, and soon,” she warns.

AHA surveys show that awareness about the risk for cardiovascular disease peaked around 2010 and has since declined, particularly among young women and women of color. Younger women may be less likely to perceive themselves at risk or receive routine cardiovascular counseling.

photo of Stacey E. Rosen
Stacey E. Rosen, MD

Stacey E. Rosen, MD, the volunteer president of the AHA and executive director of the Katz Institute for Women’s Health at Northwell Health in New Hyde Park, New York, noted that diminished awareness must be addressed to reverse these trends.

“The growing reliance on episodic care models rather than a continuous primary care relationship — where prevention is more likely to be discussed — has also contributed,” she said.

Changing the Trajectory

With rising hypertension in women of reproductive age, more hypertensive disorders of pregnancy, and underrecognition of cardiovascular risk in 20- to 44-year-olds, both clinicians call for an urgent rethinking of prevention tactics with respect to cardiovascular risk.

“Our healthcare system hasn’t prioritized prevention historically, but it’s imperative that we do so now,” said Joynt Maddox.

Rosen highlighted key windows of opportunity, including a reduction of siloed care. “As most young women see a gynecologist as their primary care clinician, prioritizing alignment between ob/gyn and internists, family medicine, and cardiology will enhance a ‘whole person’ approach and allow cross-disciplinary education and support.”

Joynt Maddox and Rosen reported having no relevant financial disclosures.

Lois Anzelowitz Levine is a medical and lifestyle writer in Dallas.

Credits

Lead image: Maskot/Getty Images

Image 1: WashU Medicine
Image 2: American Heart Association
Medscape Medical News © 2026 WebMD, LLC
Send comments and news tips to news@medscape.net.

Cite this: Heart Disease Risk in Young Women Projected to Spike Over Next 25 Years – Medscape – February 26, 2026.

Rising Lung Cancer Burden Among Women

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Rising Lung Cancer Burden Among Women

Caroline Guignot

March 04, 2026

While the incidence of lung cancer is decreasing in men, it continues to rise in women. With more than 19,000 new cases in France each year, lung cancer is now the third most commonly diagnosed cancer among women. This trend is also seen in other European countries but appears to be region-specific because other continents report a decline in incidence among women. Moreover, although overall prognosis remains better in the female population, the trend is worrying: Mortality associated with the disease is increasing in women, unlike in men with lung cancer. A session at the French-Language Pneumology Congress held from January 30 to February 1, 2026, in Lille, France, provided an opportunity to review the situation.

Efficacy and Toxicity

Lung tumors in women have a distinct tumor profile: Women have a higher proportion of adenocarcinomas than men and a higher frequency of somatic mutations (EGFR, BRAF, or HER2), including in nonsmokers. In addition, 65% of lung cancers in women are associated with smoking compared with 87% of those in men.

The role of estrogens is central because they interact directly with tumor growth signaling pathways. Moreover, “sex is the second leading factor of variability in drug pharmacokinetics after weight and accounts for 28% of anticancer drug kinetics,” emphasized Julien Mazières, pulmonologist, Toulouse University Hospital, Toulouse, France. Also involved in this equation are a higher body fat percentage, lower gastric acidity, and, above all, reduced renal and hepatic clearance.

As a result, exposure to drugs — represented by the area under the curve — is often greater in women and translates into not only improved progression-free survival with targeted therapies and chemotherapy but also increased toxicity. Carboplatin and paclitaxel are among the drugs whose kinetics are most affected by clearance. There are differences in clearance of more than 20% for these drugs in women vs men, though dosages are not systematically adjusted except for weight-based dosing. This vulnerability to adverse effects is particularly pronounced with targeted therapies, with more neuropsychiatric and gastrointestinal disorders. Data on the efficacy of immunotherapy in lung cancer by sex are contradictory. However, endocrine-related adverse effects and pneumonitis are more frequent in women, especially before menopause.

Women remain underrepresented in clinical trials, and sex-specific analyses of results are too rarely performed, which limits understanding of mechanisms and prevents tailoring management recommendations according to sex.

Impaired Quality of Life

Lung cancer most severely impairs physical functioning in women. “In the absence of sex-stratified studies, psycho-oncologists’ experience suggests that women have more cognitive disorders, anxiety, and depression associated with this disease. Its impact on quality of life is major, with deterioration of social relationships and reduced treatment adherence,” summarized Céline Mascaux, MD, PhD, pulmonologist, Strasbourg University Hospital, Strasbourg, France. Women also face social and family pressure — a mental burden that pushes them to “hold on” for their loved ones. Regarding sexual health, women with lung cancer who are sexually active often report dissatisfaction with the quality of their sexual relations because of fatigue, lack of energy, sadness, and shortness of breath, not to mention treatment-related sexual dysfunction. These problems are often not given sufficient attention by physicians.

Finally, fertility requires greater attention from the medical community: According to the VICAN study conducted by France’s National Health Insurance Fund, a discussion about fertility preservation did not take place at the time of cancer diagnosis for 60% of men and 67% of women of childbearing age. “In lung cancer specifically, the desire for children nevertheless exists in nearly 40% of patients of childbearing age,” regretted Jacques Cadranel, pulmonologist, Tenon Hospital, Paris, France. This desire does not appear to have influenced therapeutic strategy, and fertility preservation was ultimately proposed in only a third of cases and was carried out in only 3% of women compared with21% of men.

This story has been translated from Univadis France, part of the Medscape Professional Network.

 

Credits

Lead image: iStock / Getty Images

Medscape News Europe © 2026 WebMD, LLC
Cite this: Rising Lung Cancer Burden Among Women – Medscape – March 04, 2026.

Lower Arterial Plaque May Not Protect Women From Chest Pain or Heart Attack

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Lower Arterial Plaque May Not Protect Women From Chest Pain or Heart Attack

Catherine Shaffer

February 25, 2026

Standard methods for calculating heart attack risk based on arterial plaque may be underestimating risks for women, according to a new study.

In the study, published Monday in Circulation: Cardiovascular Imaging, women had a similar risk for nonfatal heart attack, hospitalization for chest pain, or death from any cause as men, despite having less plaque in their arteries.

Women also faced elevated risk at lower levels of plaque than men, with risk beginning to rise at a 20% vs 28% plaque burden in women vs men. As plaque levels increased, women’s risk rose more sharply than men’s.

photo of Jan Brendel, MD
Jan Brendel, MD

“Cardiovascular disease remains the leading cause of death in women, yet much of our risk prediction framework has historically been derived from predominantly male populations,” said Jan Brendel, MD, postdoctoral research fellow at Massachusetts General Hospital in Boston and lead author of the study. “Women have less coronary plaque overall, which can lead to the perception that they are lower risk.”

A Quantitative Approach

Following prior studies suggesting women may experience cardiovascular risk events even without large obstructive lesions, Brendel’s team became interested in whether quantitative imaging biomarkers, specifically plaque burden measured by coronary CT angiography, might reveal subtle, sex-related differences in how atherosclerosis translates into clinical risk.

The researchers analyzed data from 4267 patients enrolled in the PROMISE trial, a study comparing diagnostic strategies in stable outpatients with chest pain and no prior history of coronary artery disease. The patients were randomly assigned to coronary CT angiography.

Rather than simply assessing the degree of artery blockage, Brendel’s group measured each patient’s plaque volume and plaque burden. They then followed patients for a mean of 26 months to assess major adverse cardiovascular events (MACE).

“Quantitative plaque assessment is shifting the field toward imaging-based phenotyping and more individualized cardiovascular risk stratification, rather than binary obstructive versus nonobstructive classification of coronary plaque,” Brendel said.

While MACE incidence did not differ markedly between men and women, there was a difference in the pattern of the risk. In women, MACE risk rose steeply at low plaque levels and then leveled off, whereas men had a more delayed, gradual increase in risk with increasing plaque.

Interpreting Plaque Burden

One challenge Brendel and his collaborators faced was ensuring appropriate interpretation of subtle sex differences without overstating findings.

“We observed substantial overlap between women and men, particularly at higher levels of plaque burden, where statistical precision is more limited,” Brendel said. “Rather than indicating a dramatic divergence, the results point to nuanced differences in how coronary plaque relates to risk — with risk in women appearing to emerge at lower plaque levels.”

The findings suggest plaque measurements in women should be interpreted with nuance, and that those with low-to-moderate plaque burden should not automatically be assumed to be at low risk,” Brendel said.

“Integrating quantitative plaque assessment into cardiovascular risk stratification, with attention to sex, may help refine prevention strategies,” he added.

Outdated Practice Guidelines

Armin Arbab-Zadeh, MD, MPH, director of cardiac computed tomography in the Division of Cardiology at Johns Hopkins Hospital in Baltimore, published an editorial Monday in Circulation: Cardiovascular Imaging discussing the results of the study.

“I disagree with the authors’ interpretation of the study results because of the many potential confounding factors,” Arbab-Zadeh, who was not involved with the study, told Medscape Medical News. “I am not saying their conclusions are false but rather that the information is insufficient to draw these conclusions.”

Arbab-Zadeh emphasized it’s important that women with suspected coronary artery disease receive adequate testing and treatment.

“This is a much bigger concern than the minor differences outlined in the study,” he said. “Practice guidelines still focus on detecting obstructive rather than nonobstructive coronary artery disease, while the latter actually accounts for more myocardial infarctions, as shown in the PROMISE trial. Since women tend to have more nonobstructive [disease] compared to age- and risk-matched men, women are disproportionately affected by this outdated practice, which should be changed.”

“This study should raise awareness for evaluation and diagnosis for all women who present with symptoms of chest pain or symptoms concerning for angina,” said Sadiya Khan, MD, director of the Center for Population Science and Aging at Northwestern University Feinberg School of Medicine in Chicago. “The critical piece is that symptoms should not be dismissed.”

photo of Sadiya Sana Khan
Sadiya Khan, MD

Khan, who also was not involved in the PROMISE trial analysis, added that in the future, use of the American Heart Association’s PREVENT risk score would be helpful because it is a more contemporary model for how plaque correlates with risk.

The study was funded by the National Institutes of Health and the National Heart, Lung, and Blood Institute. Some authors reported receiving funding from other research institutes and receiving consulting fees from pharmaceutical and device manufacturers. Borek Foldyna reported receiving institutional research support from AstraZeneca, MedImmune, Cleerly Health, and MedTrace.

Catherine Shaffer is a freelance science and medical writer with a background in molecular biology and pharmaceutical research. Her work has appeared extensively in scientific trade and mainstream publications and on public radio.

Pancreatic Cancer: Top 10 Triggers for an Often-Silent Disease

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Pancreatic Cancer: Top 10 Triggers for an Often-Silent Disease

Grace E. Kim, MD

February 13, 2026

Pancreatic cancer incidence has doubled over the past two decades. Rates are highest in North America and Europe, and within the United States, pancreatic cancer occurs more frequently in Black individuals than in White or Asian populations.

photo of Grace Kim
Grace E. Kim, MD

Diagnosing this increasingly prevalent cancer is notoriously difficult, making it essential to identify the key risk factors that contribute to its development. Fortunately, in recent years there has been extensive research into the causes of pancreatic cancer, including many of the studies linked below, which are well worth reading in full.

Here are the top 10 risk factors for pancreatic cancer that are consistently reported across the literature. Clinicians should keep these in mind during routine patient care and provide education about lowering risk.

Smoking

As one of the strongest modifiable risk factors, smoking is associated with an odds ratio of 1.74, meaning that smokers are nearly twice as likely to develop pancreatic cancer than nonsmokers. However, smoking cessation lowers this risk over time. After 10-20 years of abstinence, the risk approaches that of never-smokers.

Alcohol Consumption

Heavy alcohol use (defined as more than three drinks per day) has been associated with an increased risk for pancreatic cancer in multiple studies and meta-analyses. Although light or moderate drinking has not consistently shown a statistically significant association, alcohol is a well-established cause of pancreatitis, which itself markedly increases pancreatic cancer risk. Thus, it is always advisable to limit alcohol intake.

High BMI

Obesity (BMI >30 kg/m2) is an independent risk factor for pancreatic cancer, even after controlling for smoking status, diabetes, and age.

Diabetes

Diabetes is a risk factor worth being mindful of, especially in patients with new-onset diabetes or a sudden worsening of glycemic control later in life. Although the overall risk of developing pancreatic cancer in the setting of new onset diabetes remains low (0.3%-1%), such clinical changes warrant further evaluation.

Dietary Patterns (Red Meat and Sugary Beverages)

Data on red meat and sugar-sweetened beverages are mixed, in part because of confounding factors such as BMI. For example, some studies suggest increased risk in those consuming more than two sugary beverages per day, while others do not. Conversely, healthy diets rich in plant-based foods, nuts, and Mediterranean-style eating patterns have been shown to decrease the risk for pancreatic cancer and should be encouraged.

Pancreatitis

Pancreatitis can both be the cause and a consequence of pancreatic cancer. The risk is particularly elevated within the first year after an episode of pancreatitis, with reported odds ratios of up to 21.35. Although pancreatitis is relatively uncommon, it is important for clinicians to keep this in mind when evaluating for pancreatic cancer or evaluating patients with a history of pancreatitis, and to counsel patients to avoid known triggers of pancreatitis such as alcohol.

Age

Pancreatic cancer risk increases after age 40 and rises with advancing age, with more than 80% of cases developing between age 60 to 80 years. However, the disease is rare in younger individuals.

Family History of Pancreatic Cancer

As with many other cancers, having a close family relative with pancreatic cancer increases the risk. Individuals with family history of pancreatic cancer are recommended to undergo screening magnetic resonance cholangiopancreatography (MRCP) or endoscopic ultrasound (EUS).

Genetic Predisposition

Pathogenic variants in genes such as BRCA2 and ATM are associated with a higher risk of developing pancreatic cancer. Individuals with known hereditary cancer syndromes should undergo pancreatic cancer screening with MRCP or EUS. For more detailed information on high-risk genes, please refer to my previous commentary on pancreatic cancer screening.

Premalignant Pancreatic Lesions

Mucinous pancreatic cysts, including mucinous cystic neoplasia (MCN) and intraductal papillary mucinous neoplasm (IPMN), are considered premalignant lesions that may progress to pancreatic cancer. Management depends on the lesion size, growth, and other features, with options ranging from surgical resection to surveillance with MRCP or EUS.

Pancreatic cancer is often considered one of the deadliest malignancies because it is often discovered at an advanced stage. Rather than reacting to the disease after it develops, clinicians should take a proactive approach by focusing on prevention, educating patients about risk factors, and maintaining vigilance with appropriate pancreatic cancer screening.

Credits

Lead image: Stepan Popov/Dreamstime

Image 1: Grace Kim
Medscape Gastroenterology © 2026 WebMD, LLC
Any views expressed above are the author’s own and do not necessarily reflect the views of WebMD/Medscape or its affiliates.

Cite this: Pancreatic Cancer: Top 10 Triggers for an Often-Silent Disease – Medscape – February 13, 2026.

Photon Counting ultra-high resolution CT coronary artery scans sparing patients from unnecessary intervention.

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Coronary artery stenosis quantification in patients with dense calcifications using ultra-high-resolution photon-counting-detector computed tomography

a,b ∙ a ∙ a ∙ … ∙ c ∙ a ∙ a leng.shuai@mayo.edu … Show more
Cover Image - Journal of Cardiovascular Computed Tomography, Volume 18, Issue 1
Corrigendum to “Coronary artery stenosis quantification in patients with dense calcifications using ultra-high-resolution photon-counting-detector computed tomography” [J Cardiovasc Comput Tomogr 18 (2024) 56–61]
Emily K. Koons, Prabhakar Shantha Rajiah, Jamison E. Thorne …
May 20, 2024

Abstract

Background

To quantify differences in coronary artery stenosis severity in patients with calcified lesions between conventional energy-integrating detector (EID) CT and ultra-high-resolution (UHR) photon-counting-detector (PCD) CT.

Methods

Patients undergoing clinically indicated coronary CT angiography were prospectively recruited and scanned first on an EID-CT (SOMATOM Force, Siemens Healthineers) and then a PCD-CT (NAEOTOM Alpha, Siemens Healthineers) on the same day. EID-CT was performed with standard mode (192 ​× ​0.6 ​mm detector collimation) following our clinical protocol. PCD-CT scans were performed under UHR mode (120 ​× ​0.2 ​mm detector collimation). For each patient, left main, left anterior descending, right coronary artery, and circumflex were reviewed and the most severe stenosis from dense calcification for each coronary was quantified using commercial software. Additionally, each measured stenosis was assigned a severity category based on percent diameter stenosis, and changes in severity category across EID-CT and PCD-CT were assessed.

Results

A total of 23 patients were enrolled, with 34 coronary artery stenoses analyzed. Stenosis was significantly reduced in PCD-CT compared to EID-CT (p ​< ​0.001), resulting in an average of 11% (SD ​= ​11%) reduction in percent diameter stenosis. Among the 34 lesions, 15 changed in stenosis severity category: 3 went from moderate to minimal, 1 from moderate to mild, 9 from mild to minimal, and 2 from minimal to mild with the use of PCD-CT compared to EID-CT.

Conclusion

Use of UHR PCD-CT decreased percent diameter stenosis by an average of 11% relative to EID-CT, resulting in 13 of 34 stenoses being downgraded in stenosis severity category, potentially sparing patients from unnecessary intervention.

Keywords

  1. Computed tomography
  2. Coronary artery disease
  3. Stenosis
  4. Photon-counting-detector CT
  5. Ultra-high-resolution

Abbreviations

  1. CAD (coronary artery disease)
  2. cCTA (Coronary computed tomography angiography)
  3. EID (energy-integrating-detector)
  4. PCD (photon-counting-detector)
  5. UHR (ultra-high-resolution)
  6. ECG (electrocardiogram)
  7. VMI (virtual mono-energetic image)
  8. LM (left main)
  9. LAD (left anterior descending)
  10. RCA (right coronary artery)
  11. CX (circumflex)

Men’s heart attack risk speeds up in their 30s

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Men’s heart attack risk speeds up in their 30s – US study

Photo: iStock

Experts have recommended that screening for heart attack risk in men should start earlier than for women, warning that cardiovascular disease (CVD) starts climbing when men are in their mid-30s.

For their recent study, which was published in the Journal of the American Heart Association, the US-based researchers followed the health of 5 112 people for an average of around 34 years. As the participants were healthy and aged 18-30 when the study started in the mid-1980s, the study team could chart cases of CVD (including strokes and heart failure) over time.

According to the data, 35 is the critical age when disparities between male and female CVD risk start to appear. Most of the difference is driven by coronary heart disease (CHD), the most common cause of heart attacks, where fatty deposits clog up arteries, blocking blood flow.

“That timing may seem early, but heart disease develops over decades, with early markers detectable in young adulthood,” said epidemiologist Alexa Freedman from America’s Northwestern University.

“Screening at an earlier age can help identify risk factors sooner, enabling preventive strategies that reduce long-term risk.”

After accounting for other contributory factors, including blood pressure, cholesterol, blood sugar levels, smoking status, physical activity, and body weight, the gap was lessened – but it didn’t disappear, suggesting there’s more to the story.

The data showed that men reach a 5% incidence level of cardiovascular disease about seven years earlier than women, or 50.5 years versus 57.5 years, on average. For CHD specifically, a 2% incidence is reached in men a decade before women.

For stroke risk, there was little difference between men and women, and the gap for heart failure (where the heart isn’t pumping as well as it should be) started to emerge later in life, findings upon which future studies may be able to build.

“This was still a relatively young sample – everyone was under 65 at last follow-up – and stroke and heart failure tend to develop later in life,” Freedman said.

While the study didn’t go into the reasons for the discrepancy between men and women in much detail, differences in sex hormones and cholesterol levels may be partly responsible.

The 10-year difference in CHD risk between the sexes has been reported before, but this new study analysed more recent data and expanded upon previous analyses to include multiple kinds of cardiovascular disease.

Given that women are more likely to regularly visit health professionals for check-ups, and men have such a significant head start when it comes to heart attack risk, the researchers are hoping to see more done to encourage men to get their heart health assessed at an earlier age.

“Our findings suggest that encouraging preventive care visits among young men could be an important opportunity to improve heart health and lower cardiovascular disease risk,” said Freedman.

Study details

Sex Differences in Age of Onset of Premature Cardiovascular Disease and Subtypes: The Coronary Artery Risk Development in Young Adults Study

Alexa Freedman, Laura. Colangelo, Hongyan Ning et al.

Published in Journal of the American Heart Association on 28 January 2026

Abstract

Background
Historical data indicate men develop coronary heart disease (CHD) 10 years before women. However, whether this sex gap persists in a contemporary sample amid changing cardiometabolic risk profiles, and whether differences exist for other cardiovascular disease (CVD) subtypes (ie, stroke, heart failure), is not known.

Methods
Data are from the CARDIA (Coronary Artery Risk Development in Young Adults) study, a prospective multicentre cohort study. US adults aged 18 to 30 years enrolled in 1985 to 1986 and were followed through August 2020. Sex differences in the cumulative incidence functions of premature CVD (onset <65 years), overall and for each subtype (CHD, heart failure, stroke), were compared using Gray’s test.

Results
Among 5112 participants (54.5% female, 51.6% Black) with a mean age of 24.8 years (SD: 3.7) at enrolment and a median follow‐up of 34.1 years (interquartile range, 33.8–35.7), men had a significantly higher cumulative incidence of CVD, CHD, and heart failure (P<0.05 for all), with no difference in stroke (P=0.63). Men reached 5% incidence of CVD 7.0 years earlier than women (50.5 versus 57.5 years, P<0.001). CHD was the most frequent CVD subtype, and men reached 2% incidence 10.1 years earlier than women (P<0.001). Men and women reached 2% stroke and 1% heart failure incidence at similar ages. Ten‐year CVD event rates diverged at an index age of 35.

Conclusions
Men developed CVD earlier than women, with the greatest difference observed for CHD. Sex differences in CVD risk emerged at 35, persisted through midlife, and were not attenuated by accounting for cardiovascular health.

CT Coronary scans – First for Chest Pain: The Anatomical Truth Machine

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CT-First for Chest Pain: The Anatomical Truth Machine

Jonathon A. Leipsic, MD

January 09, 2026

photo of Jonathon Leipsic
Jonathon A. Leipsic, MD

By 2050, the prevalence of total cardiovascular disease in the United States is projected to grow from 11% to 15%. That growth is already felt by doctors, as nearly 8 million patients annually show up to emergency departments with acute chest pain. When those patients present, we need a quicker, more effective way to test for cardiovascular disease.

Currently, the two tests most often performed are stress testing and cardiac catheterization.

While effective, these tests cost time, money, and effort — sometimes, only to find out they were unnecessary. Too many patients endure slow, costly, invasive pathways before we even confirm that they have coronary artery disease(CAD).

That is why I believe that the first step should be coronary CT angiography(CCTA).

A New Standard of Care

We can do better than relying on stress testing and symptom-based referrals as a first line of defense. Chest pain alone is an imperfect indicator of CAD, and sending patients for catheterizations on the basis of this symptom may end up putting them through unnecessary duress. Right now, we’re seeing 1 million cardiac catheterizations performed annually. We could avoid a fair amount of those if we prioritize a CCTA-first approach.

For over two decades, I’ve been passionate about cardiac CT. This advanced imaging technique uses a lower dose of radiation with imaging conducted within a single heartbeat that scans the entire heart. We receive a real picture of what goes on inside the coronary arteries, quickly revealing what we’re treating. This allows us to proactively identify problems and provide patients with the treatment they need.

Noninvasive and fast, CCTA allows for the confident diagnosis of atherosclerosis and anatomical stenoses, enabling more effective titration of medical therapy and referral to invasive angiography, leading to improved revascularization. It opens a door to the entire picture of a patient’s condition instead of just cracking open a window, helping us diagnose CAD, informing us of any patient risks, and improving medical management.

Why CT?

I’ve seen the effectiveness of a CT-first approach firsthand. Back in 2019, we installed a dedicated, small-footprint CT from Arineta at the University of British Columbia. To this day, I’m amazed when I walk into our CT scan room and, instead of a vast unit, see a much smaller piece of equipment on hand to provide the answers.

photo of a CT scanner
Arineta CT Scanner

At the time, I believed that we’d see a rapid adoption of CCTA, but it wasn’t until the 2021 ACC/AHA chest pain guidelines were released that we saw it take off.

Published jointly by a number of professional societies, including the American Heart Association (AHA) and the American College of Cardiology (ACC), the guidelines are used by a wide range of healthcare professionals and organizations, such as the Centers for Medicare & Medicaid Services. Cardiac CT received a Class I, Level A recommendation, validating it as a frontline strategy for diagnosing CAD, supported by evidence from clinical trials.

This top-tier recommendation for cardiac CT as the preferred initial strategy for patients with chest pain and no known CAD is all the more reason to embrace a CT-first approach.

Looking to the Future

We can improve on the current method of sending patients for stress testing or waiting on cath lab appointments; just look at the 50% of patients we’ve seen incompletely revascularized in the ISCHEMIA trial. By implementing a CT-first approach, we can enhance patient outcomes and experiences, while saving them time and money.

The recent position paper  from the Society for Cardiovascular Angiography & Interventions and the Society of Cardiovascular Computed Tomography, which I co-chaired, highlights opportunities to integrate noninvasive physiology, such as fractional flow reserve (FFR-CT) and AI-enabled quantitative atherosclerosis measures into CCTA. We are also seeing growing integration of quantitative plaque assessment in prevention clinics. This broader application through the integration of advanced analytic tools should drive further improvements in clinical outcomes.

I’m confident that cardiac CT will be a standard in cath labs and prevention clinics within the next 10 years.

Jonathon A. Leipsic, MD, is a professor and chair of radiology and a professor of cardiology at the University of British Columbia, and previously served as Canada Research Chair of Cardiac Imaging. Dr Leipsic has over 900 peer-reviewed manuscripts in press or in print. He is also past president of the Society of Cardiovascular Computed Tomography and was awarded its Gold Medal in 2019. Dr Leipsic has received the prestigious top 1% most impactful scientists designation by the Web of Science for the past 6 years. 

Credits

Lead image: Tyler Olson/Dreamstime

Image 1: Credit Society of Cardiovascular Computed Tomography
Image 2: Arineta
theheart.org on Medscape © 2026 WebMD, LLC
Any views expressed above are the author’s own and do not necessarily reflect the views of WebMD/Medscape or its affiliates.

Cite this: CT-First for Chest Pain: The Anatomical Truth Machine – Medscape – January 09, 2026.