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Leif Andersson and colleagues report the genome sequence of the ruff, a bird species with three male morphs with different reproductive strategies. Satellite and faeder morphs differ from the common independent morph by a 4.5-Mb inversion that occurred approximately 3.8 million years ago, and multiple genetic changes within this inverted region are associated with the satellite and faeder morphs.

Successful social interaction relies on predicting others’ behavior. Buergi et al. combined computational modeling and brain imaging to show how humans adjust to changing strategies, revealing a neural signature of adaptive belief updating.

Longitudinal metatranscriptomics in a prospective cohort of 1,164 adults hospitalized for COVID-19 reveals that azithromycin offered no apparent anti-inflammatory benefit but enriched the respiratory microbiome with potential pathogens and antimicrobial resistance genes.

Multi-ancestry genome-wide and transcriptome-wide association studies of aortic stenosis identify more than 200 independent risk loci and provide insights into its genetic architecture.

A cross-ancestry meta-analysis of genome-wide association studies identifies association signals for stroke and its subtypes at 89 (61 new) independent loci, reveals putative causal genes, highlighting F11, KLKB1, PROC, GP1BA, LAMC2 and VCAM1 as potential drug targets, and provides cross-ancestry integrative risk prediction.

Antiphospholipid antibodies (aPL) are associated with an elevated risk of thromboembolic events in patients with antiphospholipid syndrome and, increasingly, in those without previous thrombosis. In this Review, Bikdeli and colleagues discuss the clinical relevance of aPL seropositivity in predicting the risk of thrombotic cardiovascular events, summarize potential management strategies and identify key knowledge gaps that warrant further research.

A meta-analysis of genome-wide association studies of type 2 diabetes (T2D) identifies more than 600 T2D-associated loci; integrating physiological trait and single-cell chromatin accessibility data at these loci sheds light on heterogeneity within the T2D phenotype.

Here the authors provide an explanation for 95% of examined predicted loss of function variants found in disease-associated haploinsufficient genes in the Genome Aggregation Database (gnomAD), underscoring the power of the presented analysis to minimize false assignments of disease risk.

Genome-wide association analyses identify new risk loci for heart failure and its subtypes, extending understanding of the underlying biological pathways and disease mechanisms.

Maier, Raja Beharelle et al. provide a computational model of the decision process that quantifies the temporal dynamics of weighing different attributes. Their time-varying drift diffusion model reveals latent individual differences in decision-making.

From an analysis of participants in lipid-lowering trials for primary and secondary prevention of coronary artery disease, a polygenic risk score comprising 35 single nucleotide variants with predicted effects on endothelial cell function identified patients who benefited most from aggressive lipid-lowering therapy.

In an analysis of five large randomized clinical trials testing established therapies for cardiovascular disease, individuals with clonal hematopoiesis had an increased risk for first but not recurrent myocardial infarction as compared to individuals without clonal hematopoiesis, and did not show increased benefit from any of the therapies tested.

Analyses of genome and exome sequencing data identify rare coding and structural variants associated with atrial fibrillation and highlight genetic links between atrial fibrillation and cardiomyopathies.

Genome-wide association meta-analyses identify more than 350 loci associated with atrial fibrillation. A polygenic score derived from these results improves atrial fibrillation risk prediction compared to published clinical and polygenic scores.

Individuals vary considerably in how they are affected by stress. Here, the authors show that the severity of psychopathological symptoms triggered by prolonged real-life stress relate to fMRI-measured responsivity of the human brainstem arousal system and associated pupil responses.

Recent studies suggest that value-based choices involve communication between parietal and prefrontal cortices. Here the authors use a novel, non-invasive cortical manipulation technique to demonstrate a causal role for such communication in mediating accurate value-based, but not perceptual, choices.

Using modelling and experimental data, the authors provide evidence that risk aversion may arise from relative underestimation of larger monetary payoffs, a perceptual bias rooted in the noisy logarithmic coding of numerical magnitudes.

Dorsomedial prefrontal regions are known to contribute to observational learning. Here, the authors specify this role computationally by showing that these regions control learning about the predictability of the demonstrator.

Polanía et al. show that, similarly to sensory signals, subjective preferences guiding choice are represented by the brain in a manner that accounts for regularities of the environment, thereby optimizing use of limited neural processing resources.

The prevalence of coronary artery disease, and its manifestation as acute coronary syndromes (ACS), has reached a pandemic level as a consequence of modernization of the developing world. Drs. Ruff and Braunwald discuss the evolving demographics of ACS, including the impact of the introduction of troponin testing and the change in the definition of myocardial infarction. They also highlight the importance of modifiable risk factors and adherence to guideline-recommended therapy.

The authors show that transcranial magnetic disruption of the right temporoparietal junction decreases strategic behavior during competitive interactions. The altered behavior relates to neural activity changes both locally and in interconnected prefrontal areas. These brain networks may causally underlie the ability to predict the behavior of other agents.

Genome-wide association analyses, functionally informed fine-mapping and complementary gene prioritization approaches identify new risk loci and candidate effector genes for CAD.

Aydogan and colleagues investigate the association between polygenic risk scores for risky behaviour with variation in grey-matter volume across multiple brain areas.

Metacognitive insight into economic preferences has been suggested to enable the consideration of long-term action-consequences. Here, the authors provide a neural link between these phenomena by showing that enhancing frontopolar theta oscillations affects both metacognition and prospective decision making.

Accurate classification of genetic variants is critical for research and patient care. Here, the authors report that population-based associations between rare variants and quantitative endophenotypes for monogenic diseases can provide support for variant pathogenicity.

In patients with type 2 diabetes and at risk for atherosclerotic cardiovascular disease, the FREEDOM Cardiovascular Outcomes study showed that a continuous subcutaneous infusion of exenatide via an osmotic mini-pump was non-inferior compared to placebo in terms of cardiovascular safety outcomes.

In a one-shot prisoner’s dilemma game, manipulating the location of payout information on computer screens changed participants’ gaze pattern sequences and resulted in greater cooperation when more focus was given to others’ outcomes.

Meine, McPherson et al. assess risk and resilience factors in Swiss medical interns predicting skills improvement, burnout, wellbeing and career motivation. Based on quantitative and qualitative analyses, three important factors emerge: work dissatisfaction, social and team factors and degree of practical involvement.

A prospective meta-analysis supports the cardiovascular safety of the dual incretin receptor agonist tirzepatide, after promising clinical outcomes in the SURPASS-4 study.

Inhibition of factor XI has emerged as a promising strategy to mitigate bleeding while potentially preserving antithrombotic efficacy. In this Review, the authors comprehensively discuss the rationale, pharmacology, evidence and future directions for factor XI inhibitors across various clinical settings.

Transcranial electrical stimulation (tES) can be used in combination with functional MRI (fMRI) to study brain functions. This Consensus Statement provides a checklist for reporting concurrent tES-fMRI research.

GestaltMatcher uses a deep convolutional neural network to improve recognition of rare disorders based on facial morphology. The framework detects similarities among patients with previously unseen syndromes, aiding discovery of new disease genes.