Reviews & Analysis

The coronary microvasculature cannot be directly imagedin vivo, but parameters that depend directly on coronary microvascular function are routinely assessed by a number of invasive and noninvasive procedures. In this Review, Camici and colleagues explore available imaging techniques that allow novel insights into the pathophysiological role of coronary microvascular dysfunction.

In conditions of prolonged stress valvular cells can contribute to valve disease progression. In this Review, Wang and colleagues describe how the biophysical and biochemical properties of the extracellular matrix can regulate valve cell function in the context of calcific valvular diseases. The authors also describe how new cell culture approaches can be employed to better understand the pathophysiology of valve diseases.

Dual antiplatelet therapy (DAPT) with aspirin and the P2Y purinoceptor 12 (P2Y₁₂)-receptor inhibitor clopidogrel has been considered the gold standard of care in patients with acute coronary syndrome (ACS). The FDA approval of the novel P2Y₁₂-receptor antagonists prasugrel and ticagrelor, which are faster-acting and more potent than clopidogrel, in the past 5 years have improved clinical outcomes in patients with ACS. Even with these newer compounds, many patients continue to experience adverse ischaemic events. This Review will provide an overview of the antiplatelet agents currently used to treat patients with ACS. Furthermore, emerging antiplatelet therapies, including intravenous P2Y₁₂antagonists, oral PAR-1 antagonists and thromboxane-receptor inhibitors will be discussed.

Clinical trials published during the past decade have had substantial effects on the treatment of peripheral vascular diseases. In this article, I discuss ten important trials that have influenced treatment for common vascular disorders, including peripheral artery disease, abdominal aortic aneurysm, renal artery disease, extracranial carotid artery disease, and venous thromboembolism.

Since Wallace Brigden first used the term 'cardiomyopathy' in 1952, this group of diseases has continued to attract the interest of clinicians, researchers, and importantly, patients. The past decade has seen a substantial accumulation of knowledge relating to various cardiomyopathies, which has partially lifted the mystery surrounding this topic.

The global epidemic of cardiovascular disease is being fuelled by the spread of a Western lifestyle characterized by a high prevalence of cardiovascular risk factors. In this Perspectives article, Valentin Fuster highlights 10 therapies and interventions that, in his opinion, will be most useful in combating cardiovascular disease and promoting cardiovascular health over the next decade.

Tremendous advances in the understanding and treatment of structural heart valve disease have been made in the past decade, including widespread utilization of minimally-invasive surgical procedures and the invention and evolution of numerous interventional techniques. These innovations will become the norm in therapy for valvular disease in the future.

Risk models to predict outcomes in cardiac surgery are increasingly being used to identify patients who might be better treated using percutaneous techniques than by surgical intervention. In this Review, Thalji and colleagues critically evaluate how the databases from which these models are derived might influence risk prediction in clinical practice, particularly for selecting patients to undergo transcatheter aortic valve implantation.

To mark the 10^th anniversary of Nature Reviews Cardiology, five of our Advisory Board members were invited to consider a topic within cardiology about which we know too little. The key opinion leaders from around the globe also suggest ways in which future research could be targeted to address the deficits in our understanding, with the aim of preventing cardiovascular disease, improving patient care, and reducing morbidity and mortality.

Over the past decade, we have witnessed the unparalleled success of statins to treat dyslipidaemia. Target identification by Mendelian randomization, human monoclonal antibodies, gene therapy, RNA-based targets, and atherogenic lipoproteins other than LDL cholesterol have fuelled intense development efforts that might bear fruit in the very near future.

Cardiac rhythm disorders, or 'arrhythmias', are major sources of morbidity and mortality, and have been challenging to treat because classic pharmacological therapies are often ineffective and sometimes dangerous. In the past decade, groundbreaking developments have revolutionized the management of arrhythmias and prepared the groundwork for new advances in the future.

During stress or injury-induced cardiac remodelling, fibroblasts increase production of extracellular matrix proteins, which leads to fibrosis formation, and consequently, heart failure. In this Review, Thomas Thum describes the contribution of noncoding RNAs to this process, with a specific focus on microRNAs that might be used as future therapeutic targets or biomarkers for cardiac fibrosis.

The Hispanic population will grow to represent nearly one-third of residents in the USA by mid-century. A new AHA Science Advisory paper provides an overview of current evidence on cardiovascular disease in this population, including prevailing risk factors and specific clinical approaches for treatment, and predicts what insights future research might reveal.

The association between HDL cholesterol and cardiovascular events, and the potential antiatherogenic effects of HDL particles, are altered in patients with established coronary heart disease. HDL particle composition has, therefore, gained attention after trials of therapies to increase HDL-cholesterol levels did not reduce the risk of an adverse cardiovascular event.

In this Decade in Review article, I highlight the top 10 advances in heart failure (HF) over the past decade, including new pharmacological therapies and expanded indications for devices in HF with reduced ejection fraction. The poor progress in acute HF and HF with preserved ejection fraction is emphasised. Biomarkers and devices that help prevent, detect, and guide treatment represent the future of HF management.

Hypertension research in the past decade has been a mixture of hope and hype. In the absence of new drug developments, clinical intervention procedures such as renal nerve ablation and baroreflex activation therapy have dominated the research, but the results have not yet fulfilled the great expectations.

The past decade has seen considerable advances in the treatment of acute coronary syndromes (ACS), particularly in the search for improved antithrombotic therapies. Despite these successes, however, renewed efforts are needed to improve long-term outcomes after ACS by reducing recurrent ischaemic events and lowering the risk of bleeding complications.

East Asian patients are known to have differing risks of thrombophilia and bleeding compared with white patients, but few have been included in phase III trials of P2Y₁₂inhibitors. Therefore, the World Heart Federation has produced this evidence-based review and expert consensus statement to determine the antiplatelet treatment strategies that are most appropriate for East Asian patients with acute coronary syndrome or undergoing percutaneous coronary intervention.

Early detection of signs of heart failure can allow fast therapeutic intervention, potentially improving a patient's prognosis and avoiding unnecessary hospitalizations. Implantable monitoring devices have been suggested as useful tools in detecting early changes in cardiac parameters, but clinical trials aimed at studying their efficacy and safety have unique problems. In this Review, Abraham et al. identify the major hurdles in trials of implantable monitoring devices, and discuss the approaches used to overcome the challenges arising during trial design.

The prevalence of atrial fibrillation (AF) is estimated to increase worldwide, mainly as a consequence of generalized population ageing. Even though the rise in AF prevalence is a global trend, data from Africa, Asia, and South America are limited and might underestimate the true frequency of AF. In this Review, the authors discuss the available epidemiological data on AF and highlight the widespread inadequacy of its treatment.