Spyridon Fortis, MD, from the division of pulmonary, critical care, and occupational medicine at the University of Iowa Hospital and Clinics.

Why Bronchodilator Response Matters in COPD Risk, With Spyridon Fortis, MD

Bronchodilator responsiveness may offer clinicians a more clinically actionable signal of 

chronic obstructive pulmonary disease (COPD)

 risk than genetic profiling, according to recent findings from the COPDGene study.

“Bronchodilator Response includes every type of pathology, while genetic risk scores only this one genetically predisposed to have 

decline or obstruction,” Spyridon Fortis, MD, from the division of pulmonary, critical care, and occupational medicine at the University of Iowa Hospital and Clinics, told 

. “Bronchodilator Response is used in clinical practice…only to help you to diagnose asthma. It does have prognostic values in COPD…almost every single study that has studied bronchodilator response shows that it is associated with 

decline, so that's very well established.”

COPD remains underdiagnosed in its early stages, particularly among smokers whose spirometry appears normal. Identifying individuals at heightened risk before irreversible lung damage occurs is a persistent challenge. These results suggest that bronchodilator responsiveness, a readily available clinical measure, may help fill that gap by identifying subclinical airway disease that genetics alone may miss.

While bronchodilator responsiveness has established prognostic value, its role in guiding treatment decisions remains limited. Fortis and colleagues conducted a cross-sectional analysis of 4824 adults aged 45 to 80 years enrolled in the multicenter COPDGene study. All participants had a smoking history of at least 10 pack-years and normal spirometry at baseline. The cohort included both non-Hispanic White (n = 3378) and African American (n = 1446) participants. Bronchodilator responsiveness was defined by the percent change in forced expiratory volume in 1 second (FEV₁) following bronchodilator administration, while polygenic risk scores were used to estimate inherited COPD risk.

The study suggests that airway responsiveness better predicts lung function decline and progression to COPD than polygenic risk scores, even among individuals with preserved spirometry. Across models, bronchodilator responsiveness consistently outperformed genetic risk in predicting FEV₁ decline.

The analysis found that genetic risk was not correlated with bronchodilator response in African American individuals (P =.82) but had a slight, weak correlation in non-Hispanic White participants (P <.001). Non-Hispanic White participants with a bronchodilator response versus those without displayed greater polygenic risk scores.

“This is a limitation of the polygenic risk score that we use because the polygenic risk score that we use was primarily developed [using] people of European ancestry,” Fortis said. “I don't know for sure, but I believe that polygenic score that [was] developed or derived using…African American or African ancestry population will show us the same results. This is just a limitation of this specific polygenic risk score that we used.

Disclosures for Fortis include AstraZeneca Pharmaceuticals LP and GlaxoSmithKline, LLC..

Derman C. Bronchodilator Response Outperforms Genetic Risk in Predicting COPD Progression. HCPLive. Published on January 14, 2026. Accessed on January 22, 2026. 

https://www.hcplive.com/view/bronchodilator-response-outperforms-genetic-risk-predicting-copd-progression 

Fortis S, Comellas AP, Bowler RP, et al. Relationships between bronchodilator responsiveness, a COPD polygenic risk score, and COPD progression. Respir Med. Published online January 9, 2026. 

Videos

COPDGene data show bronchodilator response more accurately predicts FEV₁ decline and disease progression than polygenic risk scores, including among smokers with preserved spirometry.

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Pulmonology

Infectious Disease condition center page is a comprehensive resource for clinical news and insights on respiratory health. This page consists of interviews, articles, podcasts, and videos on the research, treatment and development of therapies for asthma, COPD, interstitial lung disease, COVID-19, and more.

COPD

COPD condition center page, resources on the topics of medical news and expert insight into chronic obstructive pulmonary disease can be found. Content includes articles, interviews, videos, podcasts, and breaking news on COPD research, treatment, and drug development.

Latha Palaniappan, MD, MS, is the associate dean for research at Stanford University.

AHA 2026 Heart Disease and Stroke Statistics: Progress and Pitfalls, With Latha Palaniappan, MD, MS

-related mortality has declined in the wake of a 5-year upward trend during the COVID-19 pandemic, these conditions still kill more Americans annually than any other cause, according to the 2026 Heart Disease and Stroke Statistics from the American Heart Association (AHA).

Heart failure, long since the leading cause of death in the US and representing 22% of all deaths, and stroke, which has replaced COVID as the 4th leading cause of death at 5.3%, accounted for >25% of all deaths in 2023. The statistics committee has attributed this significant toll to overall declines in core health behaviors, including smoking, physical activity, nutrition, sleep, and 

, as well as health factors like cholesterol, blood pressure, glucose control, and cardio-kidney-metabolic syndrome (CKM).

“In terms of younger adults, we’re seeing a real signal of rising incidence in the Southeast, sometimes referred to as the ‘stroke belt’, and broader evidence suggests stroke incidence trends are diverging by age, with less favorable trends at younger ages,” Latha Palaniappan, MD, MS, associate dean for research at Stanford University and chair of the statistics committee, told 

 in an exclusive interview. “These are likely due to more severe exposure to high blood pressure, obesity, 

, prediabetes, high cholesterol, and tobacco and nicotine, along with sedentary behavior.”

, key statistics from the report include the following:

A total of 915,973 deaths from cardiovascular disease, including stroke, 

, heart failure, and heart disease, occurred in 2023, which was down from 941,652 in 2022. The age-adjusted rate of cardiovascular disease deaths in 2023 was 218.3 per 100,000 individuals, versus 224.3 per 100,000 in 2022.

Coronary heart disease was the underlying cause for 349,470 deaths in 2023, down from 371,506 in 2022.

Stroke was the underlying cause for 162,639 deaths in 2023, down from 165,393 in 2022.

Additionally, the document includes a new chapter on CKM syndrome, which includes patients both at risk for and with existing cardiovascular disease due to the presence of metabolic risk factors, CKD, or both. CKM is categorized into stages 0 to 4 to mark different degrees of cardiovascular risk. This new chapter highlights a substantial prevalence of CKM among adolescents 12-18 years old. The prevalence of stages 0, 1, and 2 were 56.3% (95% CI, 52.4-60.2%), 26.7% (95% CI, 33-40.4%), and 6.9% (95% CI, 5.3-8.5%, respectively. The prevalence was much lower in adults and did not display any significant temporal changes over the study period for the guidelines.

The document also emphasizes the importance of monitoring Life’s Essential 8, a construct developed to comprehensively and operationally define cardiovascular health. Life’s Essential 8 includes the AHA’s 8 major components of cardiovascular health, including a healthy diet, participation on physical activity, avoidance of nicotine, healthy sleep, healthy weight, and healthy levels of blood lipids, blood glucose, and blood pressure.

The report’s findings on Life’s Essential 8 include the following:

Optimal Life’s Essential 8 scores could prevent <40% of annual all-cause and cardiovascular disease deaths in the US.

Better cardiovascular health was associated with better brain health, including less subclinical vascular disease, slower cognitive decline, and reduced dementia risk.

Individuals with ideal cardiovascular health had a 74% lower risk of cardiovascular events compared to those with poor health.

However, adherence to the measures is still low, as only 1 in 4 of US adults meet national physical activity guidelines. Additionally, diet scores are the lowest of all 8 measures among both adults and youth, and <50% of Americans being treated for type 2 diabetes have their condition under control.

“The most important thing is to focus on the Life’s Essential 8 health behaviors and pick 1 or 2 actions that can improve multiple downstream risks,” Palaniappan said. “For instance, focusing on excess weight by improving nutrition, improving caloric intake, and exercise. Improving this can help with cholesterol and diabetes, and focusing on lifestyle can help improve clinical risk factors.”

Editor’s Note: Palaniappan reports no relevant disclosures.

American Heart Association. Heart disease, stroke deaths down, yet still kill more in US than any other cause. 

 January 21, 2026. Accessed January 22, 2026. 

https://www.eurekalert.org/news-releases/1113054

Palaniappan LP, Allen NB, Almarzooq ZI, et al. 2026 heart disease and stroke statistics: A report of US and Global Data from the American Heart Association. 

Lloyd-Jones DM, Allen NB, Anderson CAM, et al. Life’s essential 8: Updating and enhancing the American Heart Association’s construct of Cardiovascular Health: A presidential advisory from the American Heart Association. 

Palaniappan explains what steps to take in managing cardiovascular disease risk among a population that does not adhere to the Life’s Essential 8 guidelines.

Cardiology

Cardiology condition center page is a comprehensive resource for clinical news and insights on cardiovascular and cardiometabolic diseases. This page consists of interviews, articles, podcasts, and videos on the research, treatment and development of therapies for heart disease and cardiovascular events, as well as associated diabetes, renal failure, and more...

Heart Failure

The HCPLive heart failure page is a resource for medical news and expert insights on HF. This page features expert-led coverage, articles, videos and research on the therapies and development of treatments for heart disease, reduced and preserved ejection fraction, and more.

Stroke

On the HCPLive stroke page, resources on the topics of medical news and expert insight into CVA can be found. Content includes articles, interviews, videos, podcasts, and breaking news on stroke medicine, and more.

Hypertension

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Frances Lee, MD, is an assistant professor of medicine in the division of liver diseases at Mount Sinai.

A. Sidney Barritt, MD, is a tenured associate professor and the director of hepatology in the UNC liver center at the University of North Carolina.

Closing Gaps in PBC Care With Emerging and Established Second-Line Treatments

 has undergone a meaningful transformation in recent years, offering new optimism for a disease long defined by limited treatment options.

While ursodeoxycholic acid remains the cornerstone of first-line therapy, a substantial proportion of patients fail to achieve an adequate biochemical response, placing them at continued risk for disease progression. In an interview with HCPLive, A. Sidney Barritt, MD, a tenured associate professor and the director of hepatology in the UNC liver center at the University of North Carolina, and Frances Lee, MD, an assistant professor of medicine in the division of liver diseases at Mount Sinai, discuss how the arrival of multiple second-line agents is reshaping PBC management, redefining treatment goals, and prompting clinicians to think more broadly about both outcomes and quality of life.

Barritt emphasized that for decades, the 20% to 30% of patients who did not respond adequately to ursodeoxycholic acid represented a critical unmet need. The availability of second-line therapies has changed that equation, with the introduction of seladelpar (Livdelzi) and elafibranor (Iqirvo) allowing clinicians to help more patients achieve normalization of alkaline phosphatase and meaningful reductions in bilirubin. These biochemical improvements, he noted, are closely linked to reduced risks of cirrhosis, hepatic decompensation, and liver transplantation. With better tools now available, he says there is a real opportunity to slow the pace of disease progression for many patients.

Lee echoed this perspective, underscoring the significance of having multiple second-line options for patients with an incomplete response to first-line therapy. She framed these advances as a source of renewed hope, not only for controlling disease activity but also for improving patients’ day-to-day lives.

Despite this progress, both experts highlighted persistent gaps in PBC care. Barritt pointed to delays in diagnosis as a major issue, noting that abnormal alkaline phosphatase levels are often present for years before PBC is recognized. Earlier identification, followed by prompt initiation and optimization of therapy, remains essential to improving outcomes.

Lee focused on the importance of addressing quality-of-life concerns, such as pruritus and fatigue, which can be profoundly disabling yet are frequently underrecognized. She also noted that careful symptom assessment may uncover concomitant autoimmune conditions that warrant targeted management.

Looking ahead, both experts expressed enthusiasm for ongoing research and emerging therapies, including additional PPAR agonists, FXR-targeting agents, and treatments aimed specifically at symptom relief. Both stressed that clinicians should adopt more ambitious biochemical targets, striving for alkaline phosphatase levels as close to normal as possible and aggressive use of second-line therapies when goals are not met. With an expanding therapeutic arsenal, they say the focus in PBC is shifting toward true disease optimization rather than acceptance of partial control.

Editors’ Note: Barritt reports relevant disclosures with Mirum, Madrigal, Target RWE, Boehringer Ingelheim, Merck, and Mallinckrodt. Lee reports no relevant disclosures.

Brooks A. FDA Grants Accelerated Approval to Elafibranor (Iqirvo) for PBC. HCPLive. June 10, 2024. Accessed January 22, 2026. 

https://www.hcplive.com/view/fda-grants-accelerated-approval-to-elafibranor-iqirvo-for-pbc

Brooks A. FDA Grants Accelerated Approval to Seladelpar (Livdelzi) for Primary Biliary Cholangitis. HCPLive. August 14, 2024. Accessed January 22, 2026. 

https://www.hcplive.com/view/fda-grants-accelerated-approval-to-seladelpar-livdelzi-for-primary-biliary-cholangitis

A pair of hepatology experts discuss the shifting therapeutic landscape in PBC, lingering unmet needs, and where the field may be heading next.

Hepatology

Cholangitis

cholangitis page, resources on the topics of medical news and expert insight into cholangitis can be found. Content includes articles, interviews, videos, podcasts, and breaking news on research, treatment, and drug development in PBC, PSC, and more!

Ahmad Masri, MD, MS, is the director of the Hypertrophic Cardiomyopathy Center at Oregon Health and Science University. 

To close the discussion, Dr Maron and Dr Masri address how surgical myectomy and alcohol septal ablation fit into a therapeutic ecosystem that now includes potent sarcomere-directed drugs. Masri stresses that clinicians have an obligation to present all reasonable options—medical and invasive—and to individualize decisions through shared decision-making. Although cardiac myosin inhibitors offer a noninvasive, reversible approach that can be maintained long term, patients must understand that therapy is generally chronic, and gradients and symptoms recur when treatment is discontinued. By contrast, septal reduction, particularly surgical myectomy, can offer a more definitive “one-and-done” solution, albeit with higher upfront procedural risk and recovery.

Integrating Myosin Inhibitors With Septal Reduction and Future Directions in Nonobstructive HCM

Maron underscores that a subset of patients with complex LVOT and mitral valve anatomy may have residual obstruction and symptoms despite optimal myosin inhibition. For these individuals, structural intervention remains essential to address anatomic contributors that pharmacologic modulation cannot fully overcome. Younger patients, women planning pregnancy, and individuals strongly averse to lifelong pharmacotherapy and monitoring may also reasonably favor septal reduction, provided they understand and accept procedural risks. The experts agree that myosin inhibitors are unlikely to obviate the need for expert septal reduction centers but will instead complement and refine referral patterns.

Finally, the discussion looks ahead to nonobstructive HCM. Masri cites the neutral ODYSSEY-HCM trial of mavacamten in nonobstructive disease but expresses optimism regarding the ongoing ACACIA-HCM trial evaluating aficamten in this population. Both clinicians regard nonobstructive HCM as a major remaining unmet need, given the lack of targeted therapies that reliably improve exercise capacity and symptoms. Maron concludes that results from trials like ACACIA-HCM will be pivotal in determining whether the benefits of myosin inhibition can extend beyond obstructive physiology, potentially redefining care for an even broader spectrum of patients with HCM.

Maron and Masri define the ongoing role of surgical myectomy and alcohol septal ablation in the myosin inhibitor era and preview emerging trials of aficamten in nonobstructive HCM.

Video Series

In this segment, Dr Maron poses a key practical question: in newly presenting, treatment-naive patients with symptomatic obstructive HCM, should clinicians still begin with traditional beta-blockers or calcium channel blockers, or has the evidence base matured sufficiently to justify first-line use of cardiac myosin inhibitors? Dr Masri responds by highlighting the MAPLE-HCM trial, in which aficamten, used as first-line monotherapy, outperformed metoprolol in terms of LVOT gradient reduction and symptomatic improvement. Notably, metoprolol was associated with worsening exercise capacity, higher N-terminal pro–brain natriuretic peptide levels, and increased left atrial volume index.

Positioning Cardiac Myosin Inhibitors as First-Line Therapy: Evidence Versus Beta-blockers

Both faculty members emphasize that, while formal head-to-head comparisons of beta-blockers with mavacamten are lacking, the limited and largely nonrandomized evidence for beta-blockers contrasts sharply with the robust phase 3 data for myosin inhibitors. Given the magnitude and consistency of gradient reduction and symptom improvement, Masri explains that in his practice, he moves rapidly toward myosin inhibition in highly symptomatic, markedly obstructed patients rather than spending prolonged periods titrating conventional agents to maximal tolerated doses. Maron argues that, based on current data, it is reasonable to consider aficamten as initial monotherapy in suitable patients.

The clinicians also acknowledge real-world constraints, including payer requirements that may still mandate a trial of traditional negative inotropes before authorizing myosin inhibitors. Maron clarifies that this first-line positioning pertains specifically to treatment of obstruction-related symptoms and does not supersede beta-blocker use when indicated for other conditions such as atrial fibrillation or hypertension. Nonetheless, both experts concur that the totality of evidence now supports consideration of aficamten as a legitimate first-line option for symptomatic obstructive HCM, reflecting a substantial evolution in standard of care.

Maron and Masri discuss whether myosin inhibitors, particularly aficamten, should be considered first-line therapy for symptomatic obstructive HCM in treatment-naive patients, in light of data from trials like MAPLE-HCM.

Ozan Unlu, MD, is a fellow in interventional cardiology at Brigham and Women’s Hospital and Harvard University.

Despite being considered superior to in-clinic measurements, a substantial number of patients do not follow the HBPM guideline recommendations of 12 readings per week.

Home Blood Pressure Monitoring Engagement Suboptimal Among Most Patients, With Ozan Unlu, MD

Nancy Reau, MD, is Professor of Internal Medicine, Richard B. Capps Chair of Hepatology, Associate Director of Solid Organ Transplantation, and Section Chief of Hepatology at Rush University Medical Center.

This segment of Liver Lineup features an in-depth discussion on hepatocellular carcinoma screening in patients with cirrhosis.

Understanding Missed HCC Screening in Patients With Cirrhosis: Barriers to Care

Tim Pflederer, MD, is the chief medical officer at Evergreen Nephrology

Tim Pflederer, explains how nephrologists can help patients with CKD and ESKD navigate the 2025–2030 Dietary Guidelines, including managing protein, potassium, and phosphorus intake.

Nephrology

The HCPLive nephrology page is a resource for medical news and expert insights on kidney disease. This page features expert-led coverage, articles, videos and research on the therapies and development of treatments in nephrology, and more.

Chronic Kidney Disease

Guiding CKD Care Through Updated Dietary Guidelines, With Tim Pflederer, MD

Diana Isaacs, PharmD, is an endocrine clinical pharmacist, director of Education and Training in Diabetes Technology, and codirector of Endocrine Disorders in Pregnancy at the Cleveland Clinic.

This segment of Diabetes Dialogue spotlights the FDA clearance of the MiniMed Go and its collaborative capacity with various other devices.

Endocrinology

The HCPLive endocrinology page is a comprehensive resource for clinical news and insights on endocrine system conditions. This page consists of interviews, articles, podcasts, and videos on the research, treatment and development of therapies for diabetes, hormonal disease, and more.

Type 1 Diabetes

Type 2 Diabetes

Podcasts

podcasts page features a feed of medical news and interview podcast series, including DocTalk, Lungcast, Derm Discussions, and Heart Trials.

Diabetes Dialogue

Diabetes Dialogue: Technology, Therapeutics, & Real-World Perspectives is a monthly podcast hosted by Diana Isaacs, PharmD, and Natalie Bellini, DNP, aimed at providing a regular roundup of the latest clinically applicable insights across diabetes and metabolic diseases, with a focus on leveraging technology to improve care.

Integrating Every Facet of Insulin Delivery With Medtronic’s MiniMed Go

Michael E. Thase, MD, of the University of Pennsylvania

Adjunctive lumateperone 42 mg improves remission, relieves anxiety and sleep symptoms, and shows sustained safety in patients with treatment-resistant MDD.

Psychiatry

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Major Depressive Disorder

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Lumateperone Shows Broad Symptom Benefit for MDD, With Michael E. Thase, MD

Tim Smith joined the MJH Life Sciences team in 2022 and is currently an associate editor for HCPLive. He is also the executive producer of two podcasts: Skin of Color Savvy and The Medical Sisterhood. Previously, he was the producer of the Lungcast podcast. He graduated from UC Berkeley and worked in multimedia journalism as a staff writer prior to joining MJH. You can contact him at tsmith@mjhlifesciences.com.

Articles

This survey highlights several key findings related to patient concerns and caregiver concerns over topical steroids (TCS).

Plaque Psoriasis

The HCPLive plaque psoriasis page is a resource for medical news and expert insights on psoriasis. This page features expert-led coverage, articles, videos and research on the therapies and development of treatments for psoriatic disease, and more.

Topical Steroid Concerns in Dermatology Highlighted in Nationwide Survey

Sayna Norouzi, MD, is an assistant professor of medicine, clinical nephrologist, and founder and director of the glomerular disease and polycystic kidney disease clinics at Loma Linda University Medical Center.

In the closing discussion, the panel looks ahead to how IgA nephropathy treatment may continue to evolve.

Future Directions in IgAN

Courtney Balentine, MD, MPH, is an associate professor in the department of surgery at the University of Wisconsin School of Medicine and Public Health and director of the Wisconsin Surgical Outcomes Research Program.

Balentine explains the unique challenges of AI implementation in surgery and reviews his research on current barriers to real-world uptake.

Hospital Medicine

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Surgery

The HCPLive surgery page is a resource for medical news and expert insights on invasive medicine. This page features expert-led coverage, articles, videos and research on the therapies and development of treatments for surgery, and more.

Bringing AI to the OR: Real-World Challenges And What’s Next, With Courtney Balentine, MD, MPH

Updated federal guidelines highlight protein intake, with Tim Pflederer emphasizing the importance of individualized nutrition strategies for CKD patients


New Federal Dietary Guidelines Impact on Chronic Kidney Disease Management, With Tim Pflederer, MD

Andrew Vissing, MD, an attending physician and assistant professor at Northwestern University Feinberg School of Medicine.

Andrew Vissing shares his clinical perspective and strategies to mitigate gaps in care and management for young adults with glomerular disease.


IgA Nephropathy

The HCPLive Berger disease page is a resource for medical news and expert insights on IgA nephropathy. This page features expert-led coverage, articles, videos and research on the therapies and development of treatments in Berger disease, and more.

Focal Segmental Glomerulosclerosis

The HCPLive focal segmental glomerulosclerosis page is a resource for medical news and expert insights on FSGS. This page features expert-led coverage, articles, videos and research on the therapies and development of treatments in FSGS, and more. 

Latest News

Why Bronchodilator Response Matters in COPD Risk, With Spyridon Fortis, MD

AHA 2026 Heart Disease and Stroke Statistics: Progress and Pitfalls, With Latha Palaniappan, MD, MS

Closing Gaps in PBC Care With Emerging and Established Second-Line Treatments

Integrating Myosin Inhibitors With Septal Reduction and Future Directions in Nonobstructive HCM

Positioning Cardiac Myosin Inhibitors as First-Line Therapy: Evidence Versus Beta-blockers