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Early artery procedures added no years, lifting saved muscle: four studies

ResearchDigest · 4 storiesMedicine and treatment

4 stories this week: stable coronary disease, keeping muscle while losing weight on medication, fatty liver with scarring and high triglycerides. What each trial measured, and where its evidence stops.

In 5,179 people with stable coronary disease, routine early procedures did not change survival over 11 years

An empty hospital corridor at dusk with warm stripes of window light on a polished floor

On 7 November 2026 JAMA published online ISCHEMIA-EXTEND, the long-term follow-up of the international ISCHEMIA trial. Between 2012 and its end, 5,179 people with stable coronary disease and moderate or severe ischaemia on stress testing were randomised at 320 sites in 37 countries: one group received medicines plus coronary angiography and revascularisation (a stent or bypass) where feasible, the other medicines alone, with a procedure only if medical therapy failed. People with left main disease, unacceptable angina, a recent heart attack or an ejection fraction below 35% were not included. The median age was 64.

Over a median of 9 years, with follow-up to December 2025, 1,071 people died. All-cause mortality at 11 years was 25.8% in the invasive group and 26.9% in the conservative group, a difference of 1.0 percentage point (95% CI −4.2 to 2.1). Cardiovascular deaths were 15.8% versus 17.1%, also not significantly different, and the 11-year restricted mean survival differed by 14 days.

The result applies to people like those enrolled: stable disease, an ejection fraction of at least 35% and no recent acute coronary syndrome. This report assessed deaths only, not heart attacks or chest pain, and only 23% of participants were women.

In 120 adults on tirzepatide, strength training three times a week kept about 1 kg more lean mass and raised strength

A pair of iron dumbbells and a coiled resistance band on a light wooden gym floor by a window

On 9 November 2026 Nature Medicine published a randomised trial in 120 adults with overweight or obesity, all treated with tirzepatide, a weekly injection approved in the US for chronic weight management in adults with obesity, or overweight plus a weight-related condition. Half were assigned supervised resistance training three times a week for 40 weeks, half kept their usual activity. Attendance at training was 91%.

Both groups lost about 22.5 kg and about 17–18 kg of fat. The difference was in lean tissue: 4.67 kg lost without training versus 3.57 kg with it, a difference of 1.09 kg (95% CI 0.43 to 1.75). Strength moved in opposite directions: without training, bench press, lat pulldown and knee extension fell by about 4 kg each; with training, they rose by 4.7 to 8.6 kg.

The trial was small and lasted 40 weeks; the abstract reports lean tissue and strength, not falls, fractures or disability, and lean soft tissue on a body scan does not by itself show muscle quality. Still, it is randomised evidence that loading muscles changes what the scale does not show. Anyone starting such a medicine can discuss a training plan with their doctor.

In a phase 2b trial in 381 adults with fatty liver inflammation and scarring, an experimental weekly injection resolved the inflammation in about 60%

A translucent glass model of a human liver on a white laboratory bench beside a microscope

On 9 November 2026 The Lancet published a phase 2b trial of efinopegdutide, an investigational weekly injection that acts on both GLP-1 and glucagon receptors. It randomised 386 adults, 381 of whom were treated and analysed, all with biopsy-proven metabolic dysfunction-associated steatohepatitis (MASH, fatty liver with inflammation) and moderate or advanced fibrosis (stage 2–3), at 176 centres in 26 countries. They received one of three doses, placebo or open-label semaglutide for comparison.

After 52 weeks, a repeat biopsy showed MASH resolution without worsening of fibrosis in 56–63% across the three doses versus 13% on placebo; 53% of the semaglutide group met it as well. Fibrosis improved by at least one stage in 52% at the middle dose versus 21% on placebo; at the highest dose the difference was not significant, and 11% of that group stopped treatment because of adverse events. Gastrointestinal events were the most common.

This is a one-year biopsy result in a mid-stage trial, not an outcome such as cirrhosis or liver failure. The semaglutide arm, a medicine the FDA approved in 2025 for this liver disease with moderate to advanced fibrosis, was open-label and not formally compared. Efinopegdutide remains investigational; the trial was funded by Merck Sharp & Dohme.

In 236 adults, an experimental antibody against ANGPTL4 lowered triglycerides by 39–45 points more than placebo

A rack of test tubes with separated blood and cloudy milky-yellow plasma on a laboratory bench

On 9 November 2026 the New England Journal of Medicine published part A of TYDAL-TIMI 78, a phase 2b trial of MAR001, an investigational monoclonal antibody against ANGPTL4, a protein that slows the enzyme clearing triglyceride-rich particles from the blood. It enrolled 236 adults with fasting triglycerides of at least 150 mg/dL and raised remnant cholesterol; the median triglyceride level was about 250 mg/dL and the mean age 60.

Participants received one of three doses or placebo by injection every four weeks for 24 weeks. At week 12, fasting triglycerides fell by 39 to 45 percentage points more than with placebo, depending on dose. Adverse events occurred in 69% on the antibody and 78% on placebo.

Lower triglycerides are a blood marker, not proof of fewer heart attacks: the main result was measured at 12 weeks, and the report gives no cardiovascular outcomes. MAR001 remains investigational; the trial was funded by Marea Therapeutics.

This article is for information only and does not replace a consultation with a doctor. Nothing in it is a recommendation to start, stop or change treatment.

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Articles in this section are educational and are not medical advice, a diagnosis, or a prescription. Consult a qualified professional before acting on anything you read here.

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