Review Articles in 2011

Cardiac ischemia causes release of a diverse range of immune-modulating molecules known as 'danger-associated molecular patterns' (DAMPs). Acting through Toll-like receptors on cardiomyocytes and circulating cells, DAMPs mediate ischemia–reperfusion injury, but can also contribute to the cardiac repair response. In this Review, Arslan and colleagues explain how the innate immune system responds to cardiac ischemia, and discuss whether DAMPs can be exploited therapeutically.

Patients with type 1 or type 2 diabetes mellitus are at increased risk of cardiovascular disease (CVD). In this Review, the author discusses available data from randomized controlled trials of statins and other dyslipidemia-management agents that provide a framework to guide primary and secondary prevention of CVD in these populations.

The wide spectrum of abnormal cardiac rhythms collectively known as 'ventricular arrhythmias' cause substantial morbidity and are the most common cause of sudden cardiac death. These arrhythmias have widely differing mechanisms, prognoses, and appropriate therapies, which can be determined by evaluation of the underlying disease substrate. In this Review, Dr. Roberts-Thomson and colleagues focus on the mechanisms, diagnosis, and management of monomorphic ventricular arrhythmias.

The relationship between an elevated level of LDL cholesterol (LDL-C) and increased risk of cardiovascular disease is well established. National and international guidelines are continuously being revised to recommend increasingly lower LDL-C targets for cardiovascular disease prevention. In this Review, Drs. Brautbar and Ballantyne examine the evidence and recommendations for optimal LDL-C levels and the agents currently available or under development to achieve these levels.

Genetic testing is an attractive tool for CHD risk prediction; however, the process of harnessing genetic information to improve population health is in its infancy. In this article, Dr Holmes and colleagues discuss the numerous challenges faced by researchers and clinicians, and suggest a change of focus to better exploit the opportunities offered by the unique properties of genetic information.

Although high levels of HDL seem to be protective against clinical events from atherosclerosis, assessing the composition and function of HDL is a more-accurate approach to determine cardiovascular risk. The authors of this Review describe the atheroprotective effects of HDL, which have been attributed to its anti-inflammatory properties and role in cholesterol efflux. The relationship between impaired HDL function and cardiovascular disease is also discussed, as well as approaches to evaluate HDL functionality.

Abdominal aortic aneurysm (AAA) is a common condition that can result in aortic rupture and death. AAA-related mortality continues to rise, highlighting the growing need for effective management strategies. In this Review, the authors discuss the current and future diagnostic and therapeutic strategies for the management of AAA, including the potential of new imaging techniques and novel pharmacological agents.

Patent foramen ovale (PFO) is a failure of the atrial septa to fuse postpartum, potentially leading to right-to-left shunting, which may increase the risk of cerebrovascular events. The authors of this Review outline the embryology and anatomy of PFO, and discuss the indications for PFO closure on the basis of available data from clinical trials and other studies. Devices for PFO closure, as well as the procedure itself, are also reviewed.

The benefits of lowering LDL-cholesterol levels to prevent clinical events are well-recognized. However, other parameters of the lipoprotein–lipid profile are likely to contribute to cardiovascular risk and should be used in addition to the traditional lipid profile for improved assessment of cardiovascular risk. The authors of this Review discuss alternative and emerging lipid parameters associated with cardiovascular disease that could identify patients at high risk and those who will benefit most from lipid-lowering therapy.

The epidemiology of valvular heart disease in the industrialized world has evolved since the 1950s, with a rising prevalence of degenerative etiologies and a reduction in rheumatic heart disease (RHD). In developing countries, however, RHD remains the primary cause of valve dysfunction. Professors Iung and Vahanian discuss the epidemiology of the various manifestations of valvular heart disease in adults, together with insights from studies that reflect developments in valvular intervention.

The early detection of 'vulnerable' plaque segments is a key goal of coronary imaging. In this Review, Puri et al. highlight some of the advances in coronary imaging that have provided insights into the morphology of atherosclerosis and the identification of surrogates of plaque instability. The authors suggest that the fusion of these imaging technologies will allow for enhanced detection of early disease.

Novel atheroprotective therapies are needed to address the residual risk associated with atherothrombotic cardiovascular disease. In this Review, Drs deGoma and Rader discuss the mechanisms of HDL-targeted drugs, including agents that enhance or mimic apolipoprotein A-I activity, and summarize the development of these pharmacotherapies in preclinical and clinical studies.