Vascular aging is a central determinant of healthy life span, not only influencing the susceptibility to cardiovascular diseases but also shaping the risk of systemic decline across multiple organs. It is driven by a variety of age-related factors, including cellular senescence, chronic inflammation, loss of proteostasis, mitochondrial dysfunction, genomic instability, epigenetic remodeling, and stem cell exhaustion. These processes interact with the unique mechanical and metabolic environment of the vasculature to create a distinctive pathological trajectory, manifested in part as arterial stiffening, impaired barrier integrity, and dysregulated vasomotor control. Recent advances in single-cell omics and cross-organ molecular clocks have revealed the heterogeneity and organ specificity of aging, underscoring the need for integrative frameworks that connect vascular biology with overall health. Meanwhile, the development of diverse therapeutic strategies-ranging from senolytic and immune-mediated clearance to metabolic and mitochondrial interventions-highlights the translational potential of targeting the aging vasculature. Looking ahead, multimodal biomarkers and precision medicine may transform vascular aging from an inevitable process into a modifiable determinant of health span.

Bias in clinical research affects not only the internal validity of studies but also the equitable distribution of health benefits derived from studies. Among the most impactful forms are selection bias, attrition bias, and algorithmic bias, each of which is capable of distorting participant representation, treatment effect estimates, and model performance across important subgroups. This scientific statement provides a reference for cardiovascular researchers and clinicians, integrating detection, correction, and prevention strategies to address these biases. Selection bias may be mitigated through approaches such as inverse probability weighting and adjustment for sociodemographic imbalances; attrition bias can be addressed using intention-to-treat analyses and multiple imputation for missing data that are missing at random; algorithmic bias requires fairness-aware modeling, diverse training data sets, and explainable artificial intelligence techniques. These 3 forms of bias are not exhaustive, but their careful management is essential to achieving scientific rigor, fairness, and real-world applicability, and requires multidisciplinary collaboration to embed equity and validity throughout the research lifecycle.

Although global myocardial flow reserve (MFR) is a powerful prognostic factor, it may overlook segmental abnormalities and does not differentiate focal from diffuse perfusion impairments. Therefore, we sought to assess whether integrated MFR provides incremental prognostic value beyond global MFR.

Although ambulatory ECG (AECG) monitoring has been assessed after transcatheter aortic valve replacement (TAVR), its impact on life-threatening cardiovascular events remains unclear. This study aimed to evaluate whether systematic AECG monitoring after TAVR reduces life-threatening cardiovascular events during the first year of follow-up.

Drug-coated balloons (DCBs) are increasingly adopted in percutaneous coronary intervention. Bail-out drug-eluting stent (DES) implantation due to suboptimal immediate results after DCB angioplasty is not infrequent, and the clinical outcomes of percutaneous coronary intervention with DCB angioplasty followed by bail-out DES implantation remain unexplored. The aim of this study was to evaluate the safety of bail-out DES implantation following DCB angioplasty in percutaneous coronary intervention.

The ideal timing for complete revascularization (CR) in patients with ST-segment-elevation myocardial infarction and multivessel disease is uncertain. This meta-analysis examined outcomes of immediate CR (ICR) versus staged CR (SCR).

The United States is facing a growing health care affordability crisis. In 2024, national health expenditures totalled $5.3 trillion, or $15 474 per person, accounting for 18.0% of the U.S. economy. Spending on health care continues to rise, propelled by high prices for services, drugs, and devices; growing administrative complexity; chronic underinvestment in prevention, primary care, and public health; and the mounting burden of chronic conditions such as cardiovascular disease. Patients, even those with insurance, frequently face financial hardship, delayed or foregone care, and medical debt because of gaps in coverage and inadequate consumer protections. Addressing this crisis will require coordinated action across the health care system, guided by evidence and a commitment to shared responsibility among key stakeholders. This Presidential Advisory from the American Heart Association draws on interviews and listening sessions with patients, clinicians, payers, employers, health system leaders, and public health experts to examine the many dimensions of affordability and offer a practical framework for action. The Advisory presents 5 core principles to guide efforts to address the affordability crisis: ensuring access to high-quality care without financial hardship; minimizing cost sharing for high-value services; creating shared accountability across the health care system; investing in the workforce, infrastructure, and data systems needed to support progress; and addressing the social and structural factors that make care less affordable for many communities. The evidence, tools, and expertise to combat the health care affordability crisis already exist. What is needed now is the collective will to act.

RBM20 (RNA binding motif protein 20) is a cardiac splicing factor responsible for the splicing of several cardiac genes such as titin (TTN), triadin (TRDN), ryanodine receptor 2 (RYR2), PDZ and LIM domain protein 1 (PDLIM1), and calcium/calmodulin-dependent protein kinase II (CAMK2D). Pathogenic variants in RBM20 are a major cause of familial dilated cardiomyopathy, and lead to missplicing of RBM20 target genes.