Lancet

Seung-Jung Park and colleagues1 report an important proof-of-concept study of precision medicine for so-called vulnerable plaques, which could represent a first step towards a shift in current indications for percutaneous coronary intervention with stenting.

We read with great interest the study by Seung-Jung Park and colleagues,1 regarding preventive percutaneous coronary intervention in patients with high-risk, but fractional flow reserve-negative, lesions. The results are of particular interest; however, several implications arise.

We commend the authors, Seung-Jung Park and colleagues, of the PREVENT trial1 for testing a bold hypothesis; stenting vulnerable non-flow-limiting plaques. Although the treatment effect of the primary outcome was impressive, the event rates were low. The authors assumed a major adverse cardiac event (MACE) rate of 8·5% in the intervention group and 12·0% in the medical therapy group. Actual event rates were substantially lower at 0·4% in the intervention group and 3·5% in the medical therapy group.

The necessity of additional intervention for non-flow-limiting high-risk plaques remains uncertain.1 Seung-Jung Park and colleagues’ PREVENT Trial2 offers compelling insights into the comparison of preventive percutaneous coronary intervention with optimal medical therapy for patients with non-flow-limiting vulnerable plaques. The findings unequivocally establish the superior advantages of preventive percutaneous coronary intervention, as the primary outcome at 2 years was notably lower in the percutaneous coronary intervention group.

Prevention of acute myocardial infarction in stable coronary disease has been the so-called holy grail in interventional cardiology. Numerous large randomised clinical trials, including the COURAGE1 and ISCHAEMIA2 trials, showed that percutaneous coronary intervention does not offer incremental prognostic benefit above optimal medical therapy in patients with stable angina. It is in this context we read, with great interest, Seung-Jung Park and colleagues’ PREVENT trial.3 It is the first trial, powered for clinical outcomes, which attributes prognostic benefit to percutaneous coronary intervention in addition to optimal medical therapy in patients with stable angina (84% of patients had stable angina).

We thank the authors for their interest in our trial.1

Hickey M, Hunter MS, Crandall CJ, et al. Reflections on The Lancet menopause Series. Lancet 2024; 404: 1307–08—In this Correspondence, the order of the author list and Hadine Joffe's name were incorrect. These corrections have been made to the online version as of Nov 7, 2024.

An 81-year-old woman with a 2-day history of vomiting and abdominal distension attended our hospital. The patient reported no fever, recent travel abroad, or change of bowel habit. She had a 3-year history of dementia—diagnosed as Alzheimer's because she had presented with gradually declining short-term memory—and hysteromyoma resection at age 40 years; she was prescribed rivastigmine.

Almost 40 000 people died alone at home in Japan this year—many unnoticed for months—prompting much concern, and new policy. Megan Tatum reports.

Pluripotent stem cells, such as embryonic stem cells, are characterised by their capacity for self-renewal and differentiation into nearly every cell type within the human body. In 2006, Shinya Yamanaka pioneered the development of induced pluripotent stem cells (iPSCs) by introducing specific genes, now known as Yamanaka factors, into somatic cells.1 iPSC technology enables the generation of autologous or HLA-matched cells and tissues, and iPSCs quickly emerged as a promising source for cell-based regenerative medicine.

iCEPS transplantation for LSCD was found to be safe throughout the study period. A larger clinical trial is planned to further investigate the efficacy of the procedure.

We respond to a Correspondence by Rasha Khatib and colleagues.1

We are outraged that a prestigious journal such as The Lancet has published a non-peer-reviewed Correspondence1 by Rasha Khatib and colleagues that makes entirely unsubstantiated claims regarding the death toll in Gaza.

A decade ago, 194 member states endorsed WHO's Every Newborn Action Plan (ENAP) to end preventable stillbirths, committing to reach the target of 12 or fewer late-gestation stillbirths (≥28 weeks) in every country by 2030 and to close equity gaps.1 Despite the preventability of most stillbirths through timely access to high-quality antenatal and intrapartum care, millions of babies continue to be stillborn annually, leaving lasting impacts on affected women, families, health-care providers, and wider society.

We are writing regarding the Correspondence by Rasha Khatib and colleagues.1

We agree with Rafael Beyar and Karl Skorecki that every death matters. There have been too many deaths on both sides of this conflict. As physicians trained in clinical medicine and epidemiology, we believe that discussing the challenges of counting them lies within our expertise. We also agree that culpability, responsibility, and accountability matter, but argue that resolving these contested issues does not. Rather, they are a matter for those with the expertise to examine the competing arguments.

Despite the gradual global decline in stillbirths between 1990 and 2021, the overall number of stillbirths remains substantially high. Counting all stillbirths is paramount to progress, as nearly a third—close to 1 million in total—are left uncounted at the 28 weeks or longer threshold. Our findings draw attention to the differential progress in reducing stillbirths, with a high burden concentrated in countries with low development status. Scarce data availability and poor data quality constrain our capacity to precisely account for stillbirths in many locations.

Advocates for action on rare diseases are having a moment. Oct 28 saw the launch of the European Rare Diseases Research Alliance, an ambitious initiative with a substantial budget of €380 million that unites more than 170 organisations to drive research in prevention, diagnosis, and treatment of rare diseases. This development follows the 2021 UN Resolution on Addressing the Challenges of Persons Living with a Rare Disease and their Families, which put addressing the needs of people with rare diseases—in terms of health, employment, education, poverty, and gender equity—on the highest political agenda.

“Our knowledge being limited means we need to limit our actions”, said Ali Hossaini at the launch of The Work of Art in the Age of Planetary Destruction. Hossaini is a biochemist turned artist. While our knowledge may be limited, our creativity is unlimited. And that unbounded space for imaginative exploration enables him to pursue his goals of “beauty, truth, and the good”. Instead of seeking to control nature, the signature style of 21st-century life, Hossaini's wish is simply to be a participant in nature's full experience.

Aside from abortion, health issues have largely been neglected in the run-up to the Nov 5 election. What have the candidates proposed to improve health? Susan Jaffe reports.