What's next in internal medicine — October 12, 2026

This edition covers what is coming in internal medicine between November and December 2026: three late-breaking blocks at the American Heart Association Scientific Sessions (Chicago, November 7 and 9), a pending FDA decision in obesity, and the yearly update of the ADA diabetes standards. For each item we give the official source and whether the date is confirmed or estimated.

1. Lp(a) and inflammation: full results of Lp(a)HORIZON and ZEUS

[Congress] [United States / international] [Confirmed date: November 7, 2026]
What it is: AHA session LBS.01 will present the primary results and extended analyses of Lp(a)HORIZON (pelacarsen, an antisense oligonucleotide against Lp(a), vs placebo in established cardiovascular disease), which according to Novartis did not reduce the composite of CV death, non-fatal MI, non-fatal stroke or urgent hospitalized coronary revascularization despite lowering Lp(a) (8,323 participants, per the Novartis release of September 4, 2026); and ZEUS (once-monthly subcutaneous ziltivekimab 15 mg, anti-IL-6, vs placebo in >6,300 patients with atherosclerotic disease, CKD and hsCRP ≥2 mg/L), which per Novo Nordisk (July 31, 2026) also failed to reduce 3-point MACE (HR 0.99; 95% CI 0.88–1.11), with more serious infections.
What problem it solves: There is no specific therapy for elevated Lp(a) or for residual inflammatory risk; today we treat LDL, blood pressure and other factors, and Lp(a) is used only for risk stratification.
Critical take: Both trials are industry-sponsored and already announced as negative; any subgroups and "extended analyses" presented are hypothesis-generating, not indications.
https://sessions.hub.heart.org/home/article/22975212/scientificsessions26-latebreaking-science-announced
https://www.novartis.com/news/media-releases/novartis-announces-lpahorizon-phase-iii-topline-results-pelacarsen-patients-elevated-lpa-and-established-cardiovascular-disease-cvd
https://www.novonordisk.com/news-and-media/news-and-ir-materials/news-details.html?id=916587

2. STREAM: stopping statins in multimorbid older adults without cardiovascular disease?

[Ongoing trial] [Switzerland, France, Netherlands] [Confirmed date: November 7, 2026]
What it is: Randomized, open-label (with blinded outcome adjudication), non-inferiority trial, with 1,800 participants planned in the protocol, in people ≥70 years with at least two chronic conditions besides dyslipidemia taking a statin for primary prevention, assigned to stop or continue it; primary outcome: composite of non-fatal MI, non-fatal ischemic stroke and all-cause death, analyzed over 24 months. Presented in AHA session LBS.03.
What problem it solves: Statin deprescribing in frail or multimorbid older patients is decided today without randomized evidence, based on clinical judgment and patient preference.
Critical take: Publicly funded (Swiss National Science Foundation), which is a plus, but the non-inferiority margin (5% absolute at 24 months) is wide and the design is open-label; "non-inferior" does not mean "risk-free."
https://clinicaltrials.gov/study/NCT05178420
https://www.biham.unibe.ch/research/research_projects/stream/index_eng.html
https://sessions.hub.heart.org/home/article/22975212/scientificsessions26-latebreaking-science-announced

3. SYNCHRONIZE-CVOT: cardiovascular safety of survodutide in obesity

[Ongoing trial] [International] [Confirmed date: November 9, 2026]
What it is: Phase 3, randomized, double-blind, event-driven trial of once-weekly survodutide (3.6 mg or 6.0 mg; dual glucagon/GLP-1 receptor agonist, Boehringer Ingelheim) vs placebo in adults with BMI ≥27 kg/m² and established CV or kidney disease and/or ≥2 weight-related complications or risk factors (5,531 randomized, versus an initial target of 4,935); primary outcome: time to first adjudicated 5-point MACE (non-inferiority analysis). Presented in AHA session LBS.05.
What problem it solves: Before wide use of new incretin agonists with a glucagon component, we need to know they are safe for the heart; semaglutide has shown CV benefit in people with overweight or obesity and established CV disease without diabetes (SELECT), but each new molecule must prove its own case.
Critical take: Primarily a company-sponsored safety study; a neutral result would be a regulatory success but would not prove cardiovascular benefit.
https://clinicaltrials.gov/study/NCT06077864
https://sessions.hub.heart.org/home/article/22975212/scientificsessions26-latebreaking-science-announced

4. FDA decision on CagriSema (cagrilintide + semaglutide)

[Pending regulatory decision] [United States] [Estimated date: before the end of 2026, per Novo Nordisk ("The FDA is expected to review the CagriSema application in 2026"); no official PDUFA date published]
What it is: Application filed December 18, 2025 for chronic weight management with the once-weekly combination of cagrilintide 2.4 mg (an amylin analogue) and semaglutide 2.4 mg; in REDEFINE 1 (3,417 adults with obesity, or overweight with at least one complication, without diabetes; 68 weeks) weight loss was 20.4% vs 3.0% with placebo (treatment-policy estimand).
What problem it solves: It broadens drug options for obesity, today centered on semaglutide, tirzepatide and orforglipron, by adding a different mechanism (amylin).
Critical take: Sponsor data; no cardiovascular outcomes results yet, and cost and gastrointestinal tolerability will shape its use in our setting.
https://www.prnewswire.com/news-releases/novo-nordisk-files-for-fda-approval-of-cagrisema-the-first-once-weekly-combination-of-glp1-and-amylin-analogues-for-weight-management-302645862.html
https://www.novonordisk.com/content/nncorp/global/en/news-and-media/news-and-ir-materials/news-details.html?id=916470

5. ADA Standards of Care in Diabetes—2027

[Guideline in preparation] [United States] [Estimated date: December 2026, per the ADA's annual schedule (2025 and 2026 editions published on December 9, 2024 and December 8, 2025)]
What it is: Yearly update of the American Diabetes Association recommendations, published as a Diabetes Care supplement, with "living" updates during the year.
What problem it solves: It is the practical reference for many internists on diagnosis, targets and drug choice in diabetes, obesity and related kidney disease; the 2026 edition applies today.
Critical take: The date has not been officially announced; check the committee's conflict-of-interest disclosures, and some recommendations for high-cost drugs do not transfer as-is to our setting.
https://professional.diabetes.org/standards-of-care
https://diabetes.org/newsroom/press-releases/american-diabetes-association-releases-standards-care-diabetes-2026
https://diabetes.org/newsroom/press-releases/american-diabetes-association-releases-standards-care-diabetes-2025

*What's next in internal medicine — October 12, 2026*
1. Lp(a)HORIZON and ZEUS: full results of two negative trials (Lp(a) and IL-6) — AHA, Nov 7, 2026
2. STREAM: stopping statins in multimorbid adults ≥70 without CVD? — AHA, Nov 7, 2026
3. SYNCHRONIZE-CVOT: CV safety of survodutide in obesity — AHA, Nov 9, 2026
4. FDA on CagriSema (cagrilintide + semaglutide) — estimated before end of 2026, no official date
5. ADA Standards of Care 2027 — estimated December 2026
Full text and audio: https://boletinesmedicos.com/en/internal-medicine/2026-10-12-viene.html
MedBulletins · boletinesmedicos.com/en/

What's next in internal medicine (November–December 2026), with official sources and confirmed or estimated dates:

• Nov 7: full results of Lp(a)HORIZON (pelacarsen) and ZEUS (ziltivekimab), both already announced as negative. Watch the subgroups with caution.
• Nov 7: STREAM, a randomized trial of stopping vs continuing primary-prevention statins in multimorbid adults ≥70. Everyday clinic question; wide non-inferiority margin.
• Nov 9: SYNCHRONIZE-CVOT, cardiovascular safety of survodutide in obesity.
• FDA decision on CagriSema, estimated before the end of 2026 (no official date).
• ADA Standards of Care 2027, expected in December.

Full text and audio: https://boletinesmedicos.com/en/internal-medicine/2026-10-12-viene.html

#InternalMedicine #Cardiometabolic #Obesity #Diabetes #EvidenceBasedMedicine

What's next in internal medicine: Lp(a)HORIZON & ZEUS (Nov 7), STREAM on stopping statins at ≥70 (Nov 7), SYNCHRONIZE-CVOT (Nov 9), FDA on CagriSema, ADA 2027 standards. https://boletinesmedicos.com/en/internal-medicine/2026-10-12-viene.html