This week, we explore new therapies to reduce pancreatitis risk in severe hypertriglyceridemia, advances in breast cancer treatment, and long-term results of gene therapy for hemophilia B. We discuss vision-threatening vascular emergencies, the mental health effects of firearm injury on families, and care for peripheral artery disease. We also follow a revealing diagnostic case in an older woman with respiratory failure. Perspectives reflect on hypertension control, immunization access, chronic disease policy, and on the inherited risk of disease.