Dear Aventine Readers,

Cardiovascular health has been improving for decades in the US (with the exception of the Covid years) thanks to new drugs and treatments. So it was alarming when a recent study found increased mortality from heart attacks among young adults, especially among women. We wanted to understand why, so in this week’s newsletter we dive into that study and other new research. The results paint a new picture of heart attack risk among Americans that is changing the way doctors treat younger patients.

Also in this issue:

Do you have a burning question about AI, technology or health you’d like us to address? Let us know by responding to this email. We’d love to hear from you. 

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Danielle Mattoon
Executive Director, Aventine

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The ability to treat cardiac disease is one of the great successes of modern medicine. Medications like statins, which control cholesterol, the use of stents to increase blood flow and public health campaigns to reduce smoking have all helped to control heart disease; deaths from heart attacks dropped by almost 90 percent between 1970 and 2022. 

So it came as a surprise when a recent study found an increase in the rate of in-hospital deaths among what researchers characterized as “young adults” — people aged 18 to 54 — having their first heart attack. The study, published in the Journal of the American Heart Association in late February, looked at a category of severe heart attacks called STEMI (for ST-elevation myocardial infarction) where a coronary artery is fully blocked. They found that between 2011 to 2021, deaths from those heart attacks among people under 55 increased by 1.2 percent. 

There was another surprise: The study also found that, while over 77 percent of young adults hospitalized with their first heart attack were men, young women in the group fared worse. Over three percent of women in that age group died from their first heart attack versus only 2.6 percent of men.

While the increases in mortality may seem small, they are occurring at a time of vastly improved outcomes for cardiac disease patients overall. Younger individuals also typically have healthier blood vessels and better general fitness, so they are usually assumed not to be high-risk. The peak ages for cardiac disease are 65 for men and 72 for women. 

So what’s behind these increases? Previous studies have shown that young adults represent about a fifth of all patients suffering heart attacks, both fatal and nonfatal, and that percentage has been increasing. Not surprisingly, these patients often exhibit the same traditional risk factors — high blood pressure and cholesterol, obesity and smoking — as older adults. But recent studies also show an increasing appearance of nontraditional risk factors among this group. These factors include some autoimmune diseases, the effects of low incomes and of sedentary childhoods and — surprisingly — being female, all of which can also contribute to cardiac disease. This confluence of factors has startled the medical community, prompting a reevaluation of how to think about heart attacks and what can be done to address the growing risks for young adults. 

Dennis Ko, a cardiologist at the Institute for Clinical Evaluative Sciences in Toronto, argued that the classic image of the heart-attack victim is changing. “When you have a lot more risk factors, you're going to have heart disease at an earlier stage,” he said. 

A heart attack, also called a myocardial infarction, occurs when blood flow, carrying essential oxygen to the heart muscle, becomes severely reduced or blocked. That blockage is often caused by atherosclerosis, an inflammatory condition in which plaque — composed of fat, cholesterol and calcium—builds up inside coronary arteries. 

Recent studies have found that other kinds of inflammation can also contribute to heart attack risk. A study published in The Lancet found that autoimmune diseases like systemic sclerosis, Addison’s disease and lupus, play a bigger role than was previously thought. The study examined 22 million patients and found that those with autoimmune disorders have a higher risk of developing heart disease — between 1.4 to 3.6 times higher — than people who don’t have them. That risk is particularly high for people under 45. 

Another study published in the American Heart Association Journal found that other autoimmune conditions like rheumatoid arthritis, psoriasis, ulcerative colitis and Crohn's disease can also increase the risk of a heart attack. 

The incidence of autoimmune diseases has been increasing in the past few decades. Michael J. Wilkinson, a cardiologist at the University of California San Diego and a co-author of the study, said that a continuous inflammatory state can make atherosclerosis worse. “Diseases like lupus or rheumatoid arthritis [develop] earlier in life,” he said. “You're exposed to higher levels of systemic inflammation in your body over a longer period of time, so that becomes a premature risk factor for you.”

It’s long been known that adult obesity, along with diabetes, is a well-known risk factor for heart disease. What new studies have shown is that long before those conditions take hold, sedentary time during childhood can affect how the heart develops. 

A longitudinal study led by Andrew Agbaje at the University of Eastern Finland followed 1682 children for 13 years (62.7 percent girls and 33.3 percent boys) to examine the link between activity and cardiac changes. The study found that, between ages 11 and 24, their sedentary time grew from one-third to more than a half of their waking time. 

Agbaje’s study found that sedentary time was associated with an increase in size of the heart’s left chamber that occurs between 17 to 24 years of age, the result of the heart working too hard. Such enlargement of the heart’s left chamber raises the risk of heart disease, stroke and death by two-fold.

Maybe the most unexpected finding in recent studies is that women were more likely to die from first heart attacks than men. The reasons go far beyond the traditional risks.

Women, for example, are four times more likely to develop autoimmune diseases than men, and these conditions mean elevated cardiovascular risk. One study found that women with rheumatoid arthritis, lupus or systemic sclerosis — a chronic autoimmune connective tissue disease that leads to scarring and blood vessel damage — died from heart-related issues at a rate 50 percent higher than men with these conditions. 

Another reason that women might be dying at a higher rate is that their heart attack symptoms differ from men’s, said Nieca Goldberg, cardiologist and clinical associate professor at NYU Grossman School of Medicine. In addition to the classic symptoms — chest tightness or pressure radiating to the arm, neck or jaw — women may also experience shortness of breath “like they’ve just ran a marathon” and discomfort below the chest. As a result, women can mistake the signs of a heart attack for a stomachache. 

Younger women also have pregnancy-related heart threats, including preeclampsia and eclampsia — conditions in which blood pressure rises to dangerous levels. Doctors prescribe blood pressure medications for these complications, but women sometimes stop taking them after giving birth because they think about these conditions as pregnancy complications, according to Dr. Goldberg, and not as signs of cardiac distress.

“Women often drop out of the health care system after they have their babies, because they're taking care of the baby, so they don't make regular doctor's visits for themselves to check their blood pressure,” Goldberg says. “And some of those women have persistently elevated blood pressures.”

And there is another mystery about women and heart attacks. Young adults also suffer from different types of heart attacks, such as myocardial infarction with nonobstructive coronary arteries (MINOCA), in which arteries aren’t blocked but the blood flow is restricted by a sudden spasm or tear in the arterial wall. 

According to Dr. Ko, the cardiologist in Canada, young women are more susceptible to these nontraditional heart attacks than men, but we don’t know why. “There's still a lot that needs to be learned in those patients,” he said.

What do these studies mean for doctors and their younger patients? GLP-1 drugs like Ozempic and Zepbound have become the frontline treatment for obesity and diabetes, and ongoing studies are looking at whether these drugs could act as anti-inflammatories for people with Crohn’s disease, psoriasis and arthritis.

Beyond individual treatments, Dr. Ko argues that we need to revisit our ideas of the traditional signs – and the traditional victims – of heart attacks. In particular, he said that health authorities need to educate young adults not to dismiss symptoms like chest pain, shortness of breath or dizziness or, in the case of women, stomach pain. And patients need to heed these warnings and not simply chalk up intense or atypical symptoms to stress. 

“Obviously, people don't want to go to the emergency room and do an assessment,” he said. “I think people really should.” 

Hantavirus, the disease that has killed three people aboard the cruise ship MV Hondius, is a serious illness. But it is not the next pandemic.

Hantaviruses are a family of viruses, spread mainly by rodents. Some strains cause a severe respiratory illness known as hantavirus cardiopulmonary syndrome (HCPS); others cause haemorrhagic fever with renal syndrome (HFRS). The Andes virus, responsible for the infections aboard MV Hondius, is the only hantavirus known to spread person-to-person. Even then, transmission tends to require close, prolonged contact, such as between household members or intimate partners. Infection is much more likely via contact with the urine, droppings or saliva of infected rodents. The current working hypothesis for the infections aboard MV Hondius is that at least one passenger was exposed to the virus while spending time in Argentina or Chile, and subsequently transmitted it to other passengers on board.

The virus has proven deadly aboard the ship: three of seven confirmed cases so far have died. That is roughly in line with what's seen in the Americas, where the Andes virus and related New World hantaviruses cause HCPS and can kill up to half of those infected. But Andes-virus cases are rare: Only a few hundred are recorded each year, almost all in Argentina and Chile. The global estimate of 10,000 to 100,000 annual hantavirus infections is dominated by milder HFRS cases in Asia and Europe, caused by different viruses in the same family, with fatality rates typically in the low single digits.

Maria Van Kerkhove, an infectious disease epidemiologist at the World Health Organization, was emphatic last week that this is not the start of a global outbreak. "I want to be unequivocal here," she said. "This is not SARS-CoV-2, this is not the start of a COVID pandemic." Other experts broadly agree that, with self-isolation and monitoring in place, the risk to the broader public is very low. The deaths aboard MV Hondius are tragic, but they are not a reason to fear a new pandemic.

Deaf children can hear again thanks to gene therapy. In late April, the US Food and Drug Administration granted accelerated approval to Otarmeni, a gene therapy designed by Regeneron to reverse severe hearing loss caused by mutations in a gene called OTOF. In a video released by researchers at Mass Eye and Ear in Boston and Eye and ENT Hospital of Fudan University in China, a toddler initially shows no response to sound; six weeks later, after receiving a single injection of the therapy, the same child turns toward tones and reacts when his grandfather calls his name. In results from a small trial, published in The New England Journal of Medicine in late 2025, 80 percent of the 12 treated patients showed measurable improvements in hearing, while 42 percent achieved hearing levels sensitive enough to detect whispers. Ninety percent of patients retain hearing improvements two and a half years later. The OTOF gene targeted by the therapy is crucial in helping tiny hairs in the inner ear to transmit sound signals to the brain. Otarmeni delivers a functional copy of the gene directly into cells in the inner ear. But there are obstacles to treatment. Children with hearing loss are not routinely screened for the relevant genetic mutations, meaning many eligible patients may never discover the therapy could help them. And while patients in the US who qualify will receive the treatment free of charge as part of an agreement between Regeneron and the US government, those in other countries won’t be so lucky. They will need to “pay their fair share,” according to the company’s CEO, Leonard Schleifer — and historically, gene therapies have cost millions of dollars per patient.

America’s nuclear renaissance starts here, with small modular reactors. For 718 days after Plant Vogtle entered service in 2024 — years late and massively over budget — no new nuclear power facility was constructed in the United States. That has now changed. In April, Kairos Power broke ground in Oak Ridge, Tennessee, on a 50-megawatt demonstration version of its next-generation small modular reactor, or SMR. Soon after, TerraPower began construction in Kemmerer, Wyoming, on its full-size SMR. According to analysis from the think tank Third Way, at least three more SMR projects are moving through the pipeline with financing and licensing plans in place but still awaiting a building permit. Those include Holtec International’s proposal to add SMRs to the Palisades plant in Michigan that it’s restarting, as well as projects from GE Vernova Hitachi at Clinch River, Tennessee, and X-energy in Seadrift, Texas. Small modular reactors have been trumpeted for years as a path to making nuclear power cheaper and faster to build. Rather than constructing enormous bespoke plants, the idea is that companies would manufacture smaller reactors in a more standardized, modular way. These  typically produce about a third of the power of conventional facilities. So far, no commercial SMR has come online in the US — but with all these projects in the works, that may finally be changing. 

Cheap submersibles could transform deep-sea science (and mining). A fluorescent orange block of foam with stubby legs is an unlikely looking path to better understanding of the oceans. But that describes a new autonomous underwater vehicle developed by Orpheus Ocean, designed to make deep-sea investigation affordable. The company, spun out of Woods Hole Oceanographic Institution in 2024, has built low-cost robotic submersibles capable of diving 36,000 feet beneath the surface. While traditional deep-sea submersibles can cost as much as $10 million, Orpheus’s systems cost only a few hundred thousand dollars each. Despite that, they can capture imagery, collect samples, measure temperature and detect chemical signatures in the deep ocean. As MIT Technology Review reports, the vehicles are undergoing their largest deployment yet as part of a National Oceanic and Atmospheric Administration project in the Pacific, where they are helping map more than 8,000 square nautical miles of seafloor at depths of 20,000 feet. Researchers are excited because lower costs could allow fleets of these robots to explore far larger areas than has previously been practical. Defense firms, energy companies and even seabed mining companies are also interested — with the latter group emboldened by recent US policy to accelerate domestic access to critical minerals. Orpheus positions itself as a service provider that is agnostic about the end use, and argues that all oceanic exploration will raise the bar on what regulators permit in the seas. But it’s unclear if better understanding of the seabed might strengthen environmental oversight or simply accelerate extraction.

Reality Check, from Science
4,500 words, or about 19 minutes

There’s a corner of Reddit called “Is This AI?” where users post suspicious images and videos and ask strangers to judge whether they’re real. Its 3.5 million weekly visitors are a sign of just how pervasive AI-generated media has become. But fake images are almost as old as photography itself, and researchers like Hany Farid, a UC Berkeley computer scientist profiled in this piece, have long been working out how to tell the real from the fake. Farid is one of the world’s leading experts in digital forensics. For more than two decades, he has developed techniques for detecting manipulated images and video, adapting as the technology behind fakes has evolved. Early on, that meant looking for statistical traces left behind by tools like Photoshop. Today, modern generative AI systems can create images from scratch, leaving fewer obvious fingerprints. So Farid increasingly looks instead for something more fundamental: violations of physics. Perspective lines that fail to converge correctly, shadows that could not physically exist, explosions whose sound delays do not match the apparent distance from the camera — tiny inconsistencies like these can help reveal that an image or video is fake. The looming concern is what happens if AI systems eventually learn those rules of physics properly. For now, Farid is still one step ahead.

He Couldn’t Land a Job Interview. Was AI to Blame? from Wired
4,000 words, or about 17 minutes 

Chad Markey was a Dartmouth medical student with glowing references and Lancet publications to his name. So why couldn’t he get the residency interviews he wanted? That question sent Markey down a rabbit hole: He began to suspect that an AI screening system might be part of the problem. Specifically, he was focused on Cortex, an AI-powered tool reportedly used by roughly 30 percent of US residency programs. He believed the system may have interpreted wording in his records negatively — particularly a medically related leave of absence that had been described vaguely as “voluntary” and for “personal reasons.” So, over six months, he built synthetic datasets, tested alternative wording, and even reverse-engineered a system described in a patent held by Medicratic, which had been acquired by Thalamus, the maker of Cortex. His analysis suggested that medically explicit language describing his leave performed significantly better in AI screening. At the same time, Cortex itself faced documented technical issues, including reports of inaccurate grades, and research showing scores fluctuating during review. Thalamus disputed the severity of those problems, and Wired ultimately confirmed that Cortex itself was not algorithmically ranking or scoring applicants during Markey’s admissions cycle. Yet the story highlights how the more institutions rely on opaque AI screening tools, the harder it will become for individuals to understand — or challenge — the decisions shaping their lives.

The Old Guard, from Harper’s Magazine 
5,300 words, or about 22 minutes

We often hear that the needs of aging populations will strain economies. But this essay by Samuel Moyn argues that something else is also happening: Modern societies, especially the United States, are increasingly dominated — politically, economically and culturally — by older people. Adapted from Moyn’s forthcoming book, “Gerontocracy in America,” the piece argues that longer lifespans, falling birth rates and decades of policy choices have combined to concentrate power in older generations in ways that are only becoming more entrenched. In Congress, the median age of politicians is now over 60, compared to the early 50s in the 1970s and ’80s. Mandatory retirement has largely disappeared, allowing senior executives and professionals to remain in top roles far longer than before: The average age of a newly hired CEO has climbed by 9 years over the past two decades. And this isn’t limited to elites; the broader aging population perpetuates the trend. Politically, older voters vote at much higher rates than younger ones, giving their preferences outsize influence over elections and policymaking, a trend that continues to develop. Economically, Americans under 40 control only 5 percent of national wealth, while those over 54 hold 72 percent. Moyn’s proposed remedies include age limits in politics, stronger intergenerational redistribution and policies designed to encourage succession rather than indefinite incumbency. At the same time, he argues that societies should guarantee dignity and economic security in old age, reducing the fear that drives some people to cling to wealth and power.