This week, join author Makoto Hibino and editorialist Christoph Nienaber as they discuss the article "Blood Pressure, Hypertension, and the Risk of Aortic Dissection Incidence and Mortality: Results From the J-SCH Study, the UK Biobank Study, and a Meta-Analysis of Cohort Studies" and accompanying editorial "Taming Hypertension to Prevent Aortic Dissection: Universal Recognition of a "New Normal" Blood Pressure?" Dr. Carolyn Lam: Welcome to Circulation on the Run, your weekly podcast summary and backstage pass to the journal and its editors. We're your co-hosts. I'm Dr. Carolyn Lam, associate editor from the National Heart Center and Duke National University of Singapore. Dr. Greg Hundley: And I'm Dr. Greg Hundley, associate editor, director of the Poly Heart Center at VCU Health in Richmond, Virginia. Well, Carolyn this week's feature discussion. Oh, very interesting. We are going to delve into results from the Japan specific health checkup study, as well as the UK Bio bank study and also a meta-analysis of several cohorts and investigate the relationship between hypertension and the future risk of aortic dissection. Well, Carolyn, but first, how about we grab a cup of coffee and delve into some of the other articles in this issue, and I'll go first? Dr. Carolyn Lam: Please do. Dr. Greg Hundley: I'm going to discuss with you the AVATAR trial. Dr. Carolyn Lam: Hold on, Greg, remind us, the AVATAR trial? Dr. Greg Hundley: Right, Carolyn. So the aortic valve replacement versus conservative treatment in asymptomatic, severe aortic stenosis or the AVATAR trial is an investigator initiated international prospective randomized control trial that evaluated the safety and efficacy of early SAVR or surgical aortic valve replacement in the treatment of asymptomatic patients with severe aortic stenosis, according to common criteria. Dr. Greg Hundley: So for example, the valve area is less than one centimeter squared with an aortic jet velocity of greater than four meters per second, or a mean trans aortic gradient of greater than 40 millimeters of mercury. They also, all of the patients had normal LV function and negative exercise testing was mandatory for inclusion. Dr. Greg Hundley: And so these authors, led by professor Marco Banovic from the University Clinical Center of Serbia, tested the primary hypothesis that early SAVR would reduce the primary composite endpoint of all cause death, acute myocardial infarction, stroke, or unplanned hospitalization for heart failure as compared to a conservative strategy, according to guidelines. And the trial was designed as event driven to reach a minimum of 35 pre-specified events. The study was performed across nine centers in seven European countries. Dr. Carolyn Lam: Wow. A big important study. What did they find? Dr. Greg Hundley: Right, Carolyn? So they had 157 patients and they age average, 67 years and 57% were men and they were randomly allocated to early surgery, so 78 were in that group, or conservative treatment, and 79 were in that group. The follow-up was completed in May of 2021 and the overall medium follow was 32 months, 28 months in the early surgery group and 35 months in the conservative treatment group. Dr. Greg Hundley: There was a total of 39 events, 13 in early surgery and 26 in the conservative treatment arm. So Carolyn, in asymptomatic patients with severe aortic stenosis, early surgery reduced the primary composite all cause death, acute myocardial infarction, stroke, or unplanned hospitalization for heart failure compared to the conservative treatment. And so, Carolyn, this randomized trial provides preliminary support for early SAVR once aortic stenosis becomes severe, regardless of symptoms. Dr. Carolyn Lam: Wow. Interesting. Well, this next paper that I'm looking at describes a novel therapeutic target that, listen up, can lower plasma cholesterol and prevent thrombosis simultaneously. Dr. Greg Hundley: What? Are you sure about this? All right, Carolyn. All right.