Consuming ultraprocessed foods (UPFs) was associated with an increased risk for atherosclerotic cardiovascular disease (ASCVD), and a higher risk among Black Americans, according to findings from the multiethnic MESA study presented during ACC.26 and published in JACC: Advances.

Researchers examined whether associations between UPFs and ASCVD differed by race/ethnicity, sex or socioeconomic status among 6,531 adults without known heart disease. Of the participants, 52% were women, 39% were White, 27% Black, 22% Hispanic and 12% Chinese.

Using food questionnaires, researchers assessed each participant's daily intake of UPFs based on the NOVA classification system. Participants in the highest quintile for UPF intake consumed 9.3 servings of such foods per day on average, while participants in the lowest quintile averaged 1.1 servings per day. Compared with the lowest quintile, participants in the highest quintile were 67% more likely to die from coronary heart disease or stroke or to experience a nonfatal heart attack, stroke or resuscitated cardiac arrest.

Researchers also observed the risk of ASCVD events increased by more than 5% with each additional serving. Stratified by race, the increased risk for ASCVD events per every serving of UPF was 6.1% for Black Americans vs. 3.2% for non-Black Americans.

"These findings contribute to the growing body of evidence linking UPF intake with adverse cardiometabolic health outcomes and underscore the need for targeted public health interventions and dietary guidelines aimed at reducing UPF consumption, particularly in vulnerable populations," write Amier Haidar, MD, et al.

In an accompanying editorial comment, Kim Allan Williams Sr., MD, MACC, says the "stronger UPF-ASCVD associations among Black Americans" highlights the urgency of structural solutions including the transparent front-of-packaging labels that provide "concise, biologically meaningful information at the point of purchase."'

Haidar A, Rikhi R, Watson KE, et al. JACC Adv. 2026;March 17. doi:102516.

Despite being critical to comprehensive cardiovascular care, many clinicians report being unprepared when it comes to providing palliative care. In an effort to close this gap, a national modified Delphi consensus study, presented at ACC.26 in New Orleans and simultaneously published in JACC: Advances, identifies a core set of 14 palliative care competencies for cardiovascular trainees.

A panel of 120 experts in cardiovascular disease, palliative care and medical education participated in a series of surveys to evaluate a list of 35 potential competencies and gain consensus on a core set. From the surveys, 14 competencies were ultimately deemed as "core," spanning six domains covering needs assessment; prognostic awareness; patient-centered treatment recommendations; physical, psychosocial and spiritual symptoms; when to consult specialty palliative care; and end-of-life care. A separate set of 14 competencies were identified as "desirable."

"Standardized education that prepares fellows to address the [palliative care] needs of patients and their families throughout their care is essential," write Sarah Godfrey, MD, MPH, FACC, et al. She and colleagues note the competencies "should prompt future study" and highlight the development of COCATS 5 as an opportunity to "standardize the incorporation of these essential skills into the expectations for [cardiovascular disease] fellowship training programs."

Godfrey S, Pawlow PC, Chuzi S, et al. JACC Adv 2026;4:102514.

• Access ACC's free on-demand Palliative Care for the Cardiovascular Clinician course.

Current pretest probability (PTP) tools for identifying patients at risk for coronary artery disease (CAD) were largely developed in White Western populations and have limited utility in Asian and other non‑Western regions, where CAD deaths are projected to rise sharply by 2050. To address this gap, investigators have launched the Global Pretest Probability Study of CAD (GPS‑CAD), a large international effort to examine how race, ethnicity and environment relate to three CAD phenotypes.

The design and rationale for the retrospective, cross‑sectional study of more than 60,000 patients referred for CT for suspected CAD was presented at ACC.26 and published in JACC: Asia. With enrollment spanning 19 countries across six continents and a target of 100,000 participants, the study aims to support development of a more globally relevant PTP tool by characterizing CAD phenotypes across diverse populations and geographies.

"GPS‑CAD is a remarkable international collaboration powered by Lohendran Baskaran, MBBS, BS, FACC, at Duke NUS in Singapore," says co‑author and past ACC president Pamela S. Douglas, MD, MACC. "By using CCTA to provide detailed information on the anatomy of CAD in different countries and among people identifying with different races and ethnicities, it will substantially enlarge our understanding of the differences – and similarities – of the #1 killer worldwide."

Baskaran L, Selva JJ, Mantri AVI, Douglas PS, et al. JACC Asia 2026;March 28.

The quality of a low-carbohydrate or low-fat diet may matter more to reduce heart disease risk than the amount of carbohydrates or fat consumed, according to a study published in JACC.

Zhiyuan Wu, PhD, et al., analyzed data from 198,473 participants across three large-scale cohort studies and participants were followed for a combined total of more than 5.2 million person-years, during which 20,033 cases of coronary heart disease (CHD) were documented.

Overall findings showed that versions of both diets emphasizing macronutrients from healthy foods were associated with a lower risk of CHD, while versions high in refined carbohydrates and animal products were linked to higher risk and adverse metabolic profiles.

"These results suggest that healthy low-carbohydrate and low-fat diets may share common biological pathways that improve cardiovascular health," Wu said. "Focusing on overall diet quality may offer flexibility for individuals to choose eating patterns that align with their preferences while still supporting heart health."

Wu Z, Liu B, Wang X, et al. JACC. 2026;Feb. 11: doi: 10.1016/j.jacc.2025.12.038.