Not the same for everyone: ageing, liver fat and stroke in 4 stories

Aspirin did not prevent loss of capacity in older adults and was linked to slightly faster decline in women

On 29 October 2026, GeroScience published a secondary analysis of a randomised, placebo-controlled trial of daily aspirin in community-dwelling people aged 65 and over. The researchers built a four-domain intrinsic capacity score covering cognition, locomotion, vitality and psychological well-being, and calculated it every year for five years in 18,581 participants.

The score behaved like a measure of ageing. It fell with calendar age and tracked a deficit-accumulation index and epigenetic clocks such as PhenoAge, GrimAge and DunedinPACE, more closely in women. People in the lowest fifth of the score at the start were much more likely to lose dementia- and disability-free survival during the trial than those in the highest fifth: hazard ratio 4.62 in women and 4.32 in men. Women started with lower scores and declined faster than men.

In this post-hoc analysis, aspirin did not prevent the decline in either sex. In women it was associated with a small but statistically significant additional decline (β −0.006; 95% CI −0.01 to −0.001), while in men there was no effect; the formal test for a difference between the sexes was borderline (p = 0.06). The trial was designed for other outcomes, so the signal in women needs confirmation. One author reports patents and paid consulting linked to epigenetic clocks.

Strength training lowered liver fat in fatty liver disease even when BMI barely moved

A systematic review and meta-analysis published in the European Journal of Gastroenterology & Hepatology on 30 October 2026 looked only at supervised exercise on its own in people with metabolic dysfunction-associated steatotic liver disease (MASLD): studies that combined exercise with diet or medicines were excluded. It included 41 randomised and non-randomised studies with 1,517 participants and pooled 24 of them.

Compared with control groups, resistance training was associated with the largest drop in liver fat (standardised mean difference −0.77; 95% CI −1.14 to −0.39), followed by moderate-intensity aerobic exercise (−0.50; −0.95 to −0.04). High-intensity interval training showed no clear effect. Moderate aerobic exercise also improved transaminases and triglycerides, and resistance training improved fasting glucose and HDL cholesterol, but changes in liver enzymes were inconsistent overall. Effects on BMI, body fat and HbA1c were negligible.

Liver fat is an intermediate measure: the review looked at liver fat, blood tests and body measures, not at cirrhosis, liver complications or deaths. The authors rated the certainty of the evidence as low to very low and say it is not precise enough for detailed exercise prescriptions. A training plan for fatty liver is worth discussing with your doctor.

After thrombectomy, a clot-dissolving drug in the artery was linked to better recovery only when reopening was partial

On 29 October 2026, Stroke published a prespecified secondary analysis of the ANGEL-TNK trial from China. It enrolled 253 people with a blocked large artery in the front of the brain whose vessel had been reopened by thrombectomy, the mechanical removal of the clot. They were randomly assigned to tenecteplase, a clot-dissolving drug, injected directly into the artery, or to standard medical management. The analysis split them by how complete the reopening was on the expanded TICI (eTICI) scale.

In this subgroup analysis, among the 164 patients with partial reperfusion (eTICI 2b50–67), 44.8% of those given tenecteplase were living without significant disability at 90 days (modified Rankin score 0–1), against 19.5% with standard care (relative risk 2.08; 95% CI 1.35–3.21). Among the 89 patients with near-complete or complete reperfusion (eTICI 2c–3) there was no such difference (30.8% versus 38.0%), and any brain bleeding within 48 hours was more frequent with the drug (33.3% versus 20.0%). Symptomatic bleeding and death within 90 days did not differ in either group.

The trial was open-label with blinded outcome assessment, and this is a subgroup analysis, so the better recovery after partial reperfusion still needs confirmation in a trial designed for that group.

PET-guided treatment let some women with HER2-positive early breast cancer skip chemotherapy: five-year data

On 29 October 2026, Nature Medicine published five-year results of the randomised phase 2 PHERGain trial. Women with operable HER2-positive breast cancer, stages I–IIIA and tumours of at least 1.5 cm, received either chemotherapy plus the antibodies trastuzumab and pertuzumab, or the two antibodies with or without endocrine therapy. In the second group treatment was adapted: a PET scan after two cycles and the result of surgery decided who still needed chemotherapy. Women whose tumours did not respond on PET, or did not disappear completely by the time of surgery (pathological complete response, pCR), received it.

After a median follow-up of 5.6 years, 89.5% (95% CI 85.7–93.4) of the 267 women in the adapted group were free of invasive disease at five years. Among the 86 women who responded on PET and reached pCR without any chemotherapy, the figure was 92.4% (86.7–98.5), with one distant recurrence. Tumour DNA detectable in the blood at baseline or during treatment went with worse outcomes, and its clearance went with higher pCR rates.

The trial was not designed to compare the two strategies, and the 86 women form a subgroup defined after randomisation, so the authors call that figure descriptive, not proof that omitting chemotherapy is as effective. The blood DNA findings are exploratory. The non-comparative phase 2 design does not establish that omitting chemotherapy is equally effective. The trial was funded by Roche, and the blood DNA analyses by Guardant Health.

This material 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.

Sources

• Ryan J, Phyo AZZ, Wieczorek M, et al. Validation of an intrinsic capacity index and the effects of aspirin in older males and females: secondary analysis of a randomized controlled trial. GeroScience. 2026. PMID 42955660, doi:10.1007/s11357-026-02624-x

• Pinheiro Dos Santos EE, Cappato de Araújo R, Antunes Guijo J, et al. Exercise-only interventions for metabolic dysfunction-associated steatotic liver disease: a systematic review and meta-analysis. Eur J Gastroenterol Hepatol. 2026. PMID 42960563, doi:10.1097/MEG.0000000000003315

• Zhang X, Tong X, Luo G, et al. Relationship Between the eTICI Score Before Randomization and 90-Day Outcome: A Post Hoc Analysis of ANGEL-TNK Trial. Stroke. 2026. PMID 42953960, doi:10.1161/STROKEAHA.126.057260, NCT05624190

• Pérez-García JM, Cortés J, Ruiz-Borrego M, et al. 5-year outcomes of chemotherapy de-escalation in HER2-positive early breast cancer and exploratory circulating tumor DNA analyses from the randomized phase 2 PHERGain trial. Nat Med. 2026. doi:10.1038/s41591-026-04723-w, NCT03161353