Volume 10 Issue 12, December 2013

The effect of a fixed-dose combination drug strategy ('polypill') on patients' adherence to medication was analysed in a series of 2,004 individuals with, or at high risk of, cardiovascular disease in the UMPIRE study. The polypill improved adherence by >20%, but the reduction in blood-pressure and cholesterol levels was modest.

Transcatheter aortic valve replacement (TAVR) is an effective treatment for patients with severe aortic stenosis who are not suitable candidates for surgery. However, serious complications such as myocardial infarction, cerebrovascular events, vascular complications, bleeding, acute kidney injury, valve regurgitation, valve malpositioning, coronary obstruction, and conduction disturbances and arrhythmias, can occur. In this Review, Alec Vahanian and colleagues describe TAVR-related complications, the mechanisms that cause these events, and methods of preventing them.

Silent cerebral infarcts frequently occur in association with cardiovascular disease and cardiac interventional procedures, but their prognostic importance is unknown. In this Review, Hassell and colleagues assess the incidence and detection of silent cerebral infarcts, and their possible association with adverse neurological outcomes, such as stroke, depression, cognitive decline, and dementia.

Percutaneous transcatheter mechanical occlusion of the left atrial appendage (LAA) is a nonpharmacological treatment option for stroke prevention in patients with atrial fibrillation who cannot receive anticoagulant drugs. In this Review, Cheuk-Man Yu and colleagues present the rationale for LAA occlusion in patients with AF, the available occlusion devices and the clinical evidence for their use, and discuss the role of imaging techniques in device implantation and the management of procedural complications.

Cardiologists and intensivists often regard death as failure, continuing to pursue active treatment while potentially denying patients access to alternatives such as symptom control and end-of-life care. In this Review, Price and Haxby describe how decision-making should be shared between the patient, their family, and the physician, to ensure that high-quality, patient-centred care is provided to critically ill patients with cardiac disease.

Opium is a widely abused substance throughout the Middle East and Asia. In this Perspectives article, Dr Masoudkabir and colleagues dispel the commonly held misconception in these regions that opium has beneficial effects on cardiovascular health, and summarize the available evidence showing that, conversely, opium use is a risk factor for cardiometabolic diseases.