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A new report has demonstrated the combined use of optical coherence tomography and molecular imaging within human coronary arteries. This combination provides a unique opportunity to look at plaque from a view not previously possible, opening the field for greater understanding of plaque biology in research and clinical practice.
Diabetes mellitus and hypertension are closely related, and guidelines have recommended aggressive treatment of hypertension in patients with diabetes. However, no single clinical trial is conclusive. An extensive review of the use of blood-pressure-lowering drugs in patients with diabetes supports treating blood pressure >140/90 mmHg, whereas reducing blood pressure in people with normal or high–normal blood pressure might have untoward effects.
A loss-of-function mutation in the gene encoding scavenger receptor class B member 1 (SRB1) has been identified. This mutation increases the risk of coronary heart disease (CHD) despite being associated with increased concentration of HDL cholesterol. Upregulation of SRB1 expression might be a novel therapeutic approach for reducing CHD risk.
Although patients with chronic kidney disease (CKD) are at high risk of developing cardiovascular disease, therapies proven to protect both the cardiovascular and renal systems are used only at low doses or not at all. Ruiz-Hurtado et al. describe available and emerging treatments that can provide adequate cardiorenal protection without adverse effects in patients with CKD.
Transcatheter aortic valve implantation (TAVI) is increasingly being used in patients with intermediate-risk and lower-risk profiles, but little is known about the durability of TAVI devices beyond 5 years. In this Review, Arsalan and Walther summarize the existing data on TAVI durability, highlight differences between surgical and transcatheter treatment of aortic stenosis that might influence durability, and discuss clinical solutions for failed prostheses.
Differences between women and men with atrial fibrillation have received far less attention in recent years than sex-specific differences in coronary heart disease and stroke. In this Review, Ko et al. discuss sex-specific differences in the incidence, prevalence, risk factors, and pathophysiology of atrial fibrillation, and the clinical presentation and prognosis of patients with this prevalent arrhythmia.
The current definition of pulmonary hypertension (PH) is based on resting mean pulmonary arterial pressure (mPAP) ≥25 mmHg; however, analysis of long-term follow-up data now reveals increased mortality even with mPAP ≥19 mmHg. Do we need to modify the definition of PH, and what are the implications for clinical practice?
Human induced pluripotent stem cells (hiPSCs) can be differentiated into many cardiovascular cell types, including cardiomyocytes and endothelial cells. hiPSC-derived cardiovascular cells can recapitulate patient-specific and disease-specific phenotypes. In this Review, Chen et al. discuss how hiPSCs can be used as a platform for cardiovascular drug development and disease modelling, and can facilitate individualized therapy in the era of precision medicine.
Big data analytics have tremendous potential to improve cardiovascular quality of care and patient outcomes. In this Review, Rumsfeld and colleagues provide an overview of the data sources and methods that comprise big data analytics, describe the potential applications of these analyses in cardiovascular care and research, and delineate the principal challenges to implementing big data applications in cardiovascular practice.
