Medical research articles within Nature Reviews Cardiology

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  • Review Article |

    Physiological responses to stress are thought to increase the risk of cardiovascular disease via haemodynamic, vascular and immune perturbations. In this Review, Vaccarino and Bremner focus on issues with the measurement of psychological stress and the underlying pathobiology connecting stress to the risk of cardiovascular disease.

    • Viola Vaccarino
    •  & J. Douglas Bremner

  • Comment |

    The under-representation of women in cardiovascular clinical trials persists across participant, clinician and research roles. This gap perpetuates health inequity and hampers the generation, translation and implementation of optimal evidence-based care. Urgent action is needed to address barriers, promote diversity, and ensure inclusive trial design and health-care delivery and dissemination, for more equitable cardiovascular health.

    • Julie Sanders
    • , Tim Clayton
    •  & Rochelle Wynne

  • Review Article |

    Patients with cardiovascular disease (CVD) have an increased risk of cancer, and patients with cancer have an increased risk of CVD. In this Review, the authors discuss the shared modifiable risk factors and the shared pathophysiological mechanisms underlying the bidirectional relationship between these two prevalent diseases.

    • Nicholas S. Wilcox
    • , Uri Amit
    •  & Bonnie Ky

  • Comment |

    Representation of Black patients in cardiovascular clinical trials remains dismally low, reflective of systemic and structural barriers, which can lead to missed opportunities to meet community-identified needs, understand responses to medical therapies and improve cardiovascular care. Innovative, multilevel strategies focused on Black communities are warranted to increase enrolment of this population into clinical research.

    • LaPrincess C. Brewer
    •  & Joshua J. Joseph

  • Review Article |

    In this Review, Tsimikas and co-workers re-examine the role of lipoprotein(a) in the regulation of platelet function and propose areas for future research to define its clinical relevance for cardiovascular disease.

    • Harpreet S. Bhatia
    • , Richard C. Becker
    •  & Sotirios Tsimikas

  • Clinical Outlook |

    The link between migraine and cardiovascular disease is complex and involves overlapping mechanisms, such as endovascular disturbances. Challenges in measuring migraine, in distinguishing between causation and prediction, and in the understanding of clinical implications highlight the need for further research to guide treatment and cardiovascular risk assessment for the millions of individuals living with migraine.

    • Tobias Kurth
    •  & Pamela M. Rist

  • Review Article |

    Acute coronary syndromes (ACS) are a major contributor to death from cardiovascular disease. In this Review, Timmis and colleagues present data on mortality from ACS for 122 countries and examine the regional and temporal changes in the epidemiology of ACS over the past 20 years.

    • Adam Timmis
    • , Denis Kazakiewicz
    •  & Panos Vardas

  • Review Article |

    In this Review, Münzel and colleagues describe the exposome concept with a focus on environmental physical and chemical exposures and their effects on the burden of cardiovascular disease. Additionally, they discuss selected exposome studies and the relevance of the exposome concept for future health research and preventive medicine.

    • Thomas Münzel
    • , Mette Sørensen
    •  & Andreas Daiber

  • Comment |

    Low plasma levels of HDL cholesterol are a risk factor for infection and hospitalization for infectious disease. Recent work suggests that inadequate levels of HDL particles of specific sizes — small and medium — account for this risk. In this Comment, we discuss the mechanistic implications of these observations and the methodologies used to quantify HDL size.

    • Jay W. Heinecke
    •  & W. Sean Davidson

  • Comment |

    While there is understandable excitement about the development of new cardiovascular drugs, an unmet and equally important need is to perform new clinical trials of old drugs, including to determine their longer-term effects and if and when they should be discontinued after years of use. New trials of old drugs can inform clinical practice and are much needed.

    • Christopher B. Granger
    • , Stuart J. Pocock
    •  & Bernard J. Gersh

  • Review Article |

    In this Review, Lutsey and Zakai describe the epidemiology of venous thromboembolism, including incidence, risk factors and outcomes; summarize opportunities for primordial, primary and secondary prevention; and highlight the importance of reducing disparities in venous thromboembolism incidence and management, and opportunities to reduce them.

    • Pamela L. Lutsey
    •  & Neil A. Zakai

  • Review Article |

    In this Review, Khan and colleagues discuss the benefits and challenges of including pragmatism in the design, conduct and interpretation of randomized controlled trials (RCTs) for cardiovascular disease and highlight selected ongoing and completed cardiovascular RCTs that incorporate a pragmatic design.

    • Muhammad Shariq Usman
    • , Harriette G. C. Van Spall
    •  & Muhammad Shahzeb Khan

  • Roadmap |

    Cardiovascular researchers face a range of challenges, including reduced grant funding, job insecurity and a lack of diversity in leadership roles. In this Roadmap article, Marques and colleagues propose strategies to overcome these challenges, focusing on three key areas: capacity building, research funding and fostering diversity and equity.

    • Niamh Chapman
    • , Emma E. Thomas
    •  & Francine Z. Marques

  • Research Highlight |

    A model generated using proteomics and machine learning that included 27 proteins was able to predict the 4-year risk of myocardial infarction, heart failure, stroke or all-cause death better than a clinical model and was sensitive to the adverse and beneficial changes in outcome.

    • Irene Fernández-Ruiz

  • News & Views |

    Cardiovascular disease is both a risk factor and potential outcome of the direct, indirect and long-term effects of COVID-19. A recent analysis in >150,000 survivors of COVID-19 demonstrates an increased 1-year risk of numerous cardiovascular diseases. Preventing and managing this new disease burden presents challenges to health systems and requires a learning health system approach.

    • Mohamed O. Mohamed
    •  & Amitava Banerjee

  • Comment |

    Precision medicine envisages a changed paradigm for health care through better understanding of individual disease susceptibility and prognosis, enabling more personalized treatment. Enabling technologies such as the health digital twin are rapidly evolving, presenting important challenges and opportunities to be tackled within local contexts.

    • Genevieve Coorey
    • , Gemma A. Figtree
    •  & Julie Redfern

  • Review Article |

    Valvular heart disease (VHD) is a major contributor to loss of physical function, quality of life and longevity. In this Review, Prendergast and colleagues discuss the global burden of VHD, geographical variation in the presentation and clinical management, and temporal trends in disease burden.

    • Sean Coffey
    • , Ross Roberts-Thomson
    •  & Bernard D. Prendergast

  • Comment |

    The homogeneity of cardiovascular clinical trial populations limits the generalizability of results and compounds health inequities faced by women, older adults and people of colour. This Comment highlights the importance of diversity in clinical trial populations and describes multifaceted interventions that might help to close the diversity gap in trial enrolment.

    • Erin D. Michos
    •  & Harriette G. C. Van Spall

  • Review Article |

    Dyslipidaemias, particularly hypercholesterolaemia, are major risk factors for cardiovascular disease. In this Review, Catapano and colleagues summarize the latest data on plasma lipid levels and associated deaths and trends in these parameters over the past four decades in different regions of the world.

    • Angela Pirillo
    • , Manuela Casula
    •  & Alberico L. Catapano

  • Research Highlight |

    Biological sex is increasingly being recognized as an important variable in cardiovascular health and disease and, consequently, in cardiovascular research. Three new studies highlight the influence of sex hormones in pulmonary arterial hypertension, arterial senescence and abdominal aortic aneurysms.

    • Gregory B. Lim

  • Review Article |

    In this Review, Díez and colleagues summarize the mechanisms of diffuse myocardial fibrosis in heart failure, discuss imaging techniques and circulating biomarkers to characterize the variability of this lesion in patients, and highlight the available and potential future therapeutic strategies for personalizing the prevention and reversal of diffuse myocardial fibrosis.

    • Begoña López
    • , Susana Ravassa
    •  & Javier Díez

  • Research Highlight |

    A new study shows that exosomes secreted by cardiac cells derived from human induced pluripotent stem cells improve myocardial recovery without arrhythmogenic complications and might provide an acellular therapeutic option for myocardial infarction.

    • Andrew Robson

  • Research Highlight |

    A study in an in vitro model of RBM20-deficient dilated cardiomyopathy suggests that pharmacological upregulation of RBM20 with all-trans retinoic acid is a potential therapeutic strategy in patients with a heterozygous RBM20 mutation.

    • Irene Fernández-Ruiz

  • Review Article |

    Current estimates of the prevalence of hypertrophic, dilated and arrhythmogenic cardiomyopathies are probably conservative because of the overlapping phenotypes, incomplete and age-related expression, and variable penetrance of these conditions. In this Review, McKenna and Judge discuss the clinical and genetic diagnosis of the inherited cardiomyopathies, with the aim of better defining the epidemiology of these diseases.

    • William J. McKenna
    •  & Daniel P. Judge

  • Comment |

    The COVID-19 pandemic has provided the vital stepping stones to improve how clinical trials are conducted. We provide an overview of the major changes to the clinical trial process instigated by the pandemic and suggest ways to make these changes sustainable.

    • Prakriti Gaba
    •  & Deepak L. Bhatt

  • Research Highlight |

    A new clinical trial in a dish study sheds light on a new mechanism that restores endothelial dysfunction with lovastatin in induced pluripotent stem cells that are derived from patients with dilated cardiomyopathy.

    • Andrew Robson

  • Review Article |

    In this Review, Gerd Heusch revisits the pathophysiology of myocardial ischaemia–reperfusion injury, discusses the latest developments in cardioprotective interventions and the signalling pathways involved, identifies the challenges for their clinical translation and advocates the use of additive cardioprotective interventions and a focus on patients with severe haemodynamic alterations.

    • Gerd Heusch

  • Review Article |

    Novel strategies to improve blood pressure control and treat drug-resistant hypertension are needed despite the efficacy and widespread availability of current antihypertensive drugs. In this Review, Mahfoud and colleagues summarize the pathophysiological rationale and available clinical evidence for device-based therapies for hypertension, including renal sympathetic denervation.

    • Lucas Lauder
    • , Michel Azizi
    •  & Felix Mahfoud

  • Review Article |

    Single-cell RNA sequencing (scRNA-seq) technologies have helped to identify rare cell populations and allowed the comparison of healthy and diseased tissues at single-cell resolution. This Review discusses the available scRNA-seq tools and summarizes the scRNA-seq findings that have contributed to our understanding of cardiovascular development and disease.

    • David T. Paik
    • , Sangkyun Cho
    •  & Joseph C. Wu

  • Research Highlight |

    A somatic gene editing therapy for the treatment of Duchenne muscular dystrophy (DMD) improves skeletal and cardiac muscle function and reduces cardiac arrhythmogenic vulnerability in a pig model of DMD and an in vitro model of human DMD.

    • Irene Fernández-Ruiz

  • Research Highlight |

    New analyses of the PARAGON-HF and PARADIGM-HF trials indicate that sacubitril–valsartan treatment might be beneficial in patients with heart failure with mildly reduced left ventricular ejection fraction and that the benefit might be greater in women than in men.

    • Irene Fernández-Ruiz

  • News & Views |

    Preclinical data and small clinical trials suggest that remote ischaemic conditioning (RIC) therapy protects patients with acute myocardial infarction undergoing percutaneous coronary intervention. In the CONDI-2/ERIC-PPCI trial, RIC proved to be safe but did not have any short-term benefits in reducing cardiac-related death and hospitalization for heart failure.

    • Martin Cour
    •  & Sandrine Lecour

  • Viewpoint |

    November 2019 marks 15 years since the launch of Nature Reviews Cardiology. To celebrate, we invited six of our Advisory Board members to discuss some of the highlights of cardiovascular research in the past 15 years and to make some projections about scientific research in the next 15 years.

    • Jonathan M. Kalman
    • , Sergio Lavandero
    •  & Dong Zhao

  • Comment |

    Scientific research drives discoveries and innovations that improve the prevention and management of cardiovascular disease. Cardiovascular research in China is thriving, as evidenced by the increasing number of publications and funding support for projects. However, data collection and the quality of publications require much improvement to propel the research field forward.

    • Jing Liu
    •  & Changsheng Ma

  • Research Highlight |

    Both systolic and diastolic hypertension independently contribute to the risk of adverse cardiovascular events, even though systolic hypertension has a greater effect on cardiovascular outcomes, and this relationship is not altered by the threshold used for the definition of hypertension.

    • Irene Fernández-Ruiz

  • Perspective |

    The Framingham Heart Study (FHS) has been collecting epidemiological data on cardiovascular risk factors and disease for >70 years. In this Timeline Perspectives article, the authors summarize the major achievements of the FHS, highlight some of the seminal publications and discuss how epidemiological research has changed and continues to evolve.

    • Charlotte Andersson
    • , Andrew D. Johnson
    •  & Ramachandran S. Vasan

  • Review Article |

    Various models of cardiac arrhythmia have been developed in several different animal species to study the mechanisms of disease. In this Review, Clauss and colleagues summarize the advantages and disadvantages of the models and species used in arrhythmia research and provide guidance to investigators planning experiments in this field.

    • Sebastian Clauss
    • , Christina Bleyer
    •  & Stefan Kääb

  • Review Article |

    In this Review, a panel of leading experts in antithrombotic pharmacotherapy discuss the principles guiding the role of acetylsalicylic acid (aspirin)-free strategies in the prevention and management of cardiovascular disease, along with their implications for clinical trial design and development.

    • Davide Capodanno
    • , Roxana Mehran
    •  & Dominick J. Angiolillo

  • News & Views |

    The immaturity of stem cell-derived cardiomyocytes has impeded their use for in vitro disease modelling, cardiotoxicity assays, and cell-replacement therapy. Ronaldson-Bouchard and colleagues report unparalleled in vitro maturation of stem cell-derived cardiomyocytes. This advance promises to unlock the translational potential of these cells.

    • Donghui Zhang
    •  & William T. Pu

  • Review Article |

    The conflicting results of cell therapy clinical trials for heart regeneration have led to some confusion over the efficacy of this approach. This Review summarizes the main outcomes of these studies and gives perspectives for future cell-based regenerative trials largely based on the primary therapeutic target: regeneration of lost myocardium by exogenous cells or promotion of intrinsic repair though paracrine signalling.

    • Philippe Menasché

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