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This Review highlights the often-overlooked role that nonadherence has in apparent 'resistance' to antiplatelet therapy. Emerging evidence indicates that the prevalence and clinical impact of nonadherence to therapy overshadow that of true biochemical nonresponsiveness in the chronic phases of antiplatelet treatment. Potential reasons for this nonadherence, which should be considered when trying to overcome apparent 'resistance' to this therapy, are discussed.
Obesity is a major health challenge that is associated with chronic disease. The authors of this Perspectives article put forward a model that places sedentary behavior and calorie overload upstream of numerous disease processes. The authors highlight the importance of physical activity and cardiorespiratory fitness, which are possibly stronger predictors of risk than traditional factors, such as obesity.
Diagnosis of hereditary transthyretin-related amyloidosis (ATTR) is challenging owing to its extremely heterogeneous phenotype. The existence of predominantly cardiac presentations should prompt cardiologists to consider ATTR in patients with otherwise unexplained left ventricular wall thickening. Orthotopic liver transplantation (or combined heart–liver transplantation) can potentially provide surgical 'gene therapy' in patients with ATTR, provided that diagnosis is timely.
To date, treatment strategies for heart failure have focused on the symptomatic stage of disease, often after irreversible remodeling and functional impairment have occurred. Early identification of cardiac dysfunction would allow implementation of early intervention strategies to delay the progression or to prevent the onset of heart failure altogether. This Review highlights the utility of a staged approach for patients with predisposing risk factors, which uses serological biomarkers followed by noninvasive imaging techniques.
Echocardiography is commonly used to assess hypertrophic myopathies. The authors of this Review outline imaging modalities that are more sensitive than standard echocardiography, which can be used to determine characteristic changes in regional deformation at an earlier stage, and provide more information about the underlying processes associated with different hypertrophic myopathies.
Current strategies for prevention of cardiovascular disease (CVD) are focused on identifying individuals at high risk by recognizing and managing established cardiovascular risk factors. Early detection of subclinical atherosclerosis is a promising opportunity for CVD prevention. In this article, the authors review the role of noninvasive imaging techniques in understanding the mechanisms of atherosclerosis and in identifying early stages of disease, and highlight their potential impact on CVD prevention.
The current guidelines for prevention of cardiovascular disease are based on estimates of long-term risk. Smeeth and Hingorani recommend awareness of the importance of fluctuations of risk over short periods of time and suggest a new paradigm for management of cardiovascular disease that is based on targeting therapy to short periods of enhanced risk.
In this Review, Drs Kullo and Cooper discuss the role of genomics and proteomics in cardiovascular risk assessment, using the specific example of atherosclerosis. The availability of good markers for risk stratification might enable the health-care system to become more proactive, moving the focus away from treatment of end-stage coronary heart disease and towards early detection of disease risk and prevention of adverse outcomes.