Review Articles

Inflammatory processes have a crucial role in abdominal aortic aneurysm and aortic wall remodelling. This Review focuses on the involvement of monocytes and macrophages, summarizing current knowledge on their origin and the roles of distinct monocyte and macrophage subsets in AAA development and complications, and highlighting potential translational applications targeting monocytes and macrophages.

Troponin is a widely used biomarker in patients with cardiac disease. In this Review, Westermann et al. describe the development of high-sensitivity assays for troponin, and their practical use in clinical diagnosis of acute myocardial infarction. Elevated concentrations of troponin in myocardial injury and chronic cardiac disease are also discussed.

Spiral-wave generators, or 'rotors', have been identified by advanced mapping methods in experimental and clinical atrial fibrillation (AF). In this Review, Nattel and colleagues describe the concepts of phase mapping and spiral-wave rotors, and summarize the ways in which rotor sources might be involved in AF maintenance. They also consider the relevance of spiral-wave rotors to the management of patients with AF.

Autophagy is a ubiquitous cellular catabolic process responsive to energy stress. Activation of autophagy is cardioprotective in some settings (ischaemia and ischaemic preconditioning), but sustained autophagy has been linked with cardiopathology in other settings (prolonged pressure overload and heart failure). In this Review, induction of autophagy associated with cardiac benefit or detriment is considered, and prospects for pharmacological intervention are discussed.

The use of electronic cigarettes has increased dramatically in the past decade, but its effects on cardiovascular health are still unknown. In this Review, Benowitz and Fraiman discuss the constituents, exposure, and potential mechanisms of cardiovascular toxicity of electronic cigarettes compared with conventional tobacco cigarettes.

Accumulating evidence has challenged the dogma of monocytes as short-lived macrophage precursors. Monocyte populations are heterogeneous and have subset-specific functions. This Review provides an updated view of the role of monocytes in cardiovascular disease and their relationship with macrophages, highlighting current theories on monocyte ontogeny, and discussing the effects of dyslipidaemia on monocyte production, phenotype, and function.

The role of hypertriglyceridaemia as a risk factor for coronary artery disease (CAD) is debated. In this Review, Reiner summarizes the causes of hypertriglyceridaemia, and discusses whether elevated blood triglyceride levels are an important and independent risk factor for CAD. Finally, current and emerging management options for hypertriglyceridaemia are detailed.

Mitochondrial metabolism is essential for the dynamic regulation of cardiac and vascular tissues, and the relevance of basic mitochondrial biology in cardiovascular disease is being increasingly recognized. In this Review, the authors explore the physical interaction between mitochondria and sarco/endoplasmic reticulum, discussing how the communication between these two organelles is involved in cardiovascular pathologies.

From a global perspective, the large and diverse African population is disproportionately affected by cardiovascular disease. In their Review, Keates et al. provide a contemporary overview of the cardiovascular risk profile of the African population by summarizing the historical pattern of cardiovascular disease in Africa.

Antithrombotic therapy, including antiplatelet and anticoagulant agents, is the cornerstone of pharmacological treatment to optimize clinical outcomes in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). In this Review, Franchi et al. provide an overview of currently available antithrombotic therapies used in these patients, results from pivotal clinical trials and their implications for guidelines, as well as recommendations for clinical practice.

The optimal duration and type of antiplatelet therapy after implantation of a drug-eluting stent (DES) remains uncertain. In this Review, Miyazaki et al. summarize the evidence on the duration of dual antiplatelet therapy and the risk of bleeding and adverse cardiac events after DES implantation, and describe the pitfalls of trial interpretation. Ongoing trials to test single antiplatelet therapy after DES implantation are also discussed.

Extracellular vesicles regulate the transfer of biological information, acting locally and remotely. Interest in extracellular vesicles, in particular exosomes, in the cardiovascular field emerged a decade ago, opening new research and therapeutic avenues. This Review summarizes current knowledge on the role of extracellular vesicles in coronary artery disease, and their emerging potential as biomarkers and therapeutic agents.

Innovations in noninvasive imaging have provided new insights in the pathophysiology and quantification of valvular heart disease. In this Review, Bax and Delgado discuss the novel imaging modalities used to assess the pathophysiology, dysfunction, and prognosis of aortic stenosis, mitral regurgitation, and aortic regurgitation.

Natural killer T (NKT) cells can be activated by both endogenous and exogenous lipid antigens. In this Review, Getz and Reardon provide an overview of NKT cells in the immune system, and propose mechanisms by which NKT cells can promote atherosclerosis.

In this Review, the authors discuss the pathological mechanisms involved in thoracic aortic aneurysms (TAAs), including extracellular matrix homeostasis, transforming growth factor-β signalling, and vascular smooth muscle cell contractility. The understanding of TAA genetics might not only help to characterize the aetiology of more complex forms of this disease, but can also lead to the development of new therapeutic strategies and patient management.

Left ventricular hypertrabeculation or noncompaction is a myocardial abnormality frequently associated with monogenic disorders, particularly neuromuscular disorders, or with chromosomal defects. The pathogenesis of this cardiomyopathy remains unknown, and the diagnostic criteria, prognosis, and optimal treatment are under debate. In this Review, Finsterer et al. provide an update on the aetiology, pathophysiology, diagnosis, treatment, and prognosis of left ventricular hypertrabeculation.

The dual-acting angiotensin-receptor–neprilysin inhibitor (ARNI) LCZ696, approved for treatment of heart failure with reduced ejection fraction, is the first approval for chronic neprilysin inhibition. Neprilysin metabolizes many peptides, suggesting many potential consequences of chronic neprilysin inhibition, both beneficial and adverse. This Review summarizes current knowledge on neprilysin inhibitor therapy, and the possible consequences of chronic inhibition.

Microorganisms that populate the human body have been shown to be involved in metabolic and cardiovascular disorders, but the precise mechanisms are not completely understood. In this Review, Lindskog Jonsson and Bäckhed describe the different pathways by which the gut microbiota might affect the development of atherosclerosis.

Inflammatory processes are central to the development and complications of atherosclerosis and acute myocardial infarction. In this Review, Ruparelia et al. summarize the inflammatory pathways involved in these cardiovascular diseases, highlight contemporary techniques to characterize and quantify inflammation, and consider how they might be used to guide specific treatments.

Depression is a highly prevalent risk factor for incident coronary heart disease (CHD) and for cardiovascular morbidity and mortality in patients with established CHD. In this Review, Carney and Freedland consider the evidence for depression as a cardiac risk factor, and summarize the biological and behavioural mechanisms that might link depression to CHD. They also consider whether treatment of depression can prevent cardiac morbidity and mortality in patients with CHD.