Review Articles in 2007

Pulmonary arterial hypertension (PAH) was once a lethal condition. As the number of therapeutic options available has risen, however, the treatment of PAH has evolved considerably. In this Review, Aniket Puri, Michael McGoon and Sudhir Kushwaha consider the current knowledge of the pathogenesis of PAH in relation to presently available and novel emerging therapies, including combination therapy, that hold promise for treatment as well as disease modification.

In light of advances in imaging technology, awareness of the clinical significance of thoracic aortic aneurismal disease has increased in recent years and allowed earlier diagnosis. In this Surgery Insight, James Davies and Thoralf Sundt examine the indications for surgical intervention on the dilated aorta, particularly the ascending segment. They discuss the management options currently available and provide their clinical recommendations for follow-up.

Despite the growing prevalence and high morbidity and mortality associated with calcific aortic stenosis, until recently little was known about the cellular mechanism of this condition. Recent studies have demonstrated that the pathophysiology of aortic valve disease and vascular atherosclerosis is similar. Here, Nalini Rajamannan, Robert Bonow and Shahbudin Rahimtoola discuss the etiology and mechanisms of calcific aortic stenosis, its diagnosis and future medical therapies in the context of recent developments.

L-Arginine, the substrate for nitric oxide synthase, is the precursor for nitric oxide synthesis in the vascular endothelium. Experimental and preliminary clinical studies have indicated that intra-arterial or intravenous infusion ofL-arginine could improve nitric oxide bioavailability in the coronary arteries. Here, Tousoulis et al. examine the literature on the role of L-arginine in the prevention of atherosclerosis from a clinical perspective.

Vasculogenic erectile dysfunction has assumed center stage as a powerful risk-marker for cardiovascular disease. A readily treatable disorder, erectile dysfunction could potentially independently predict cardiovascular risk. Here, Watts et al. review the linked pathogenesis of endothelial and erectile dysfunction, and the relationship between and the clinical management of erectile dysfunction and cardiovascular disease.

Endovascular stent-graft repair of abdominal aortic aneurysms is a less-invasive alternative to open repair. Since the first description of the technique in 1990, the technology used has developed rapidly. In this Surgery Insight, Donald Baril, Tikva Jacobs and Michael Marin summarize the history of endovascular stent-graft development and discuss recent data on patients treated with this technique, and outline some new advances in stent-graft repairs.

The beneficial effects of statins in the treatment and prevention of ischemic coronary artery disease are well-established; their value in the treatment of heart failure is, however, still being investigated. Here, Lipinskiet al. discuss how the pleiotropic effects of statins could improve survival in the setting of ischemic and nonischemic heart failure.

Familial hypercholesterolemia (FH) is an inherited disorder characterized by raised serum LDL cholesterol, which leads to accelerated atherosclerosis and a steep rise in the risk of premature coronary heart disease. Here, Anne Soutar and Rossi Naoumova examine the genetic mechanisms behind FH and discuss what effect new discoveries will have on the clinical management of FH.

Individuals with diabetes mellitus have worse outcomes, and particularly a higher rate of restenosis, following revascularization than those without diabetes. The advent of drug-eluting stents has, however, reignited enthusiasm for percutaneous coronary intervention in individuals with diabetes. In this Review, Victor Legrand evaluates drug-eluting stents as an alternative revascularization strategy to surgery in diabetic patients.

In this instructive Review, Skelding et al. explain how the recently published Haplotype Genetic Map (HapMap) has the potential to revolutionize our genetic discoveries. By cataloguing common haplotypes in the human genome, the HapMap will help elucidate the multiple genetic variants underlying common complex processes, such as in-stent restenosis. Jargon-free and informative, this Review provides insight into the relevance of HapMap to cardiovascular practice.

Approximately one-third of patients with diabetes have peripheral arterial disease (PAD) and concomitant diabetes amplifies the already high risk of atherothrombotic events present in those with PAD. Here, Emile R Mohler III discusses atherothrombosis and PAD in patients with diabetes in the context of the 2006 American College of Cardiology/American Heart Association guidelines for PAD management.

Despite aggressive lipid-lowering therapy, coronary heart disease event rates remain unacceptably high, indicating the need for additional therapeutic approaches. Notably, low HDL-cholesterol levels remain an independent risk factor for adverse coronary events even in patients with naturally low or therapeutically lowered LDL-cholesterol levels. Here, Daniel Rader examines the current status of the development of novel therapies aimed at raising HDL-cholesterol levels or improving the function of HDL.

Over the past year there have been major advances in the rapidly evolving field of atherothrombosis study, in both basic and experimental research, and in clinical studies. In this Review, Javier Sanz, Pedro Moreno and Valentin Fuster provide an update of such advances for physicians and scientists with an interest in the study of atherothrombotic disease.

Conceptually and in practice cardiac dyssynchrony is complex. In this Review, Cleland et al. discuss the results of atrio-biventricular pacing trials, and examine how this pacing can improve cardiac synchrony in many patients and whether cardiac resynchronization is indeed the mechanism by which atrio-biventricular pacing exerts its effects.

In addition to morphological structures resembling bone, cartilage and bone marrow being found in calcified vascular structures, several studies have indicated that vascular calcification develops along with coronary artery disease. Hence, mechanisms resembling bone remodeling could be relevant to the development of vascular disease. Here, Raggi et al. review some of the mechanisms that could underlie the parallel development of vascular and bone disease.

Given the obesogenic environment in which we live, characterized by the abundance of energy-dense, processed and highly convenient foods, and sedentary lifestyle, overweight and obesity have become an epidemic. Concomitant with this increase has been the rise in the number of weight-loss diets. In this Review, Vasanti Malik and Frank Hu discuss the current evidence on the efficacy of low-fat, low-carbohydrate and Mediterranean-style dietary patterns for weight loss, their potential mechanisms of action and clinical utility.

Variability seems to exist in patients' responsiveness to aspirin, to the point of producing no measurable response at all. The characteristics of aspirin resistance differ, however, from those traditionally associated with drug resistance. Here, Patrono and Rocca discuss why aspirin resistance is thought to occur and how to manage it.