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  • 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
  • Social determinants of health in the African diaspora drive the lack of disease testing, increased prevalence of comorbid disease and reduced access to drugs, resulting in disproportionately higher COVID-19-related mortality among Black individuals than the rest of the population. We urge decisive attention to and action against ethnicity-based inequities that undermine cardiovascular health.

    • Peter Chin-Hong
    • Kevin M. Alexander
    • Michelle A. Albert
  • Yoga has been associated with improvements in numerous cardiovascular risk factors and has the potential to address the unmet needs of current cardiovascular prevention strategies. Large and well-designed clinical trials are needed to assess the benefits of yoga across the spectrum of cardiovascular diseases and to provide the evidence required for its widespread implementation.

    • Dorairaj Prabhakaran
    • Ambalam M. Chandrasekaran
  • The notion that atherosclerosis can be prevented or mitigated by vaccination is now moving towards clinical trials. This strategy is based on the existence of autoimmunity to LDL, the cholesterol-carrying particles that accumulate in arteries. In this Comment, we discuss the underlying concepts, research basis and challenges for the development of a vaccine against atherosclerosis.

    • Göran K. Hansson
    • Jan Nilsson
  • Cybersecurity vulnerabilities of cardiac implantable electronic devices have been an area of increasing concern in the past 4 years. Physicians should be informed of these issues as they evolve so they can counsel their patients with the most accurate and up-to-date information.

    • Bryce Alexander
    • Adrian Baranchuk
  • The available literature suggests that electronic cigarettes (e-cigarettes), although not without risk, might decrease cardiovascular risk in chronic smokers of tobacco cigarettes who switch to e-cigarettes. However, to safeguard our youth, e-cigarettes must be required to meet product standards, all flavourings must be banned and laws regulating e-cigarette sales must be strictly enforced.

    • Holly R. Middlekauff
  • Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infects host cells through ACE2 receptors, leading to coronavirus disease (COVID-19)-related pneumonia, while also causing acute myocardial injury and chronic damage to the cardiovascular system. Therefore, particular attention should be given to cardiovascular protection during treatment for COVID-19.

    • Ying-Ying Zheng
    • Yi-Tong Ma
    • Xiang Xie
  • Awareness of the effect of the neighbourhood built environment on cardiovascular diseases is growing. In this Comment, we identify major conceptual, methodological and policy-relevant issues in research related to the built environment and describe potential future directions to improve the scientific rigour of research in this field.

    • Mohammad Javad Koohsari
    • Gavin R. McCormack
    • Koichiro Oka
  • Our understanding of the causes and consequences of pulmonary hypertension is limited. Consequently, its most distinctive forms with the worst prognosis have been the focus for diagnosis and treatment. We highlight the emerging challenge of reframing the prevalence and prognostic implications of pulmonary hypertension, focusing on the optimal therapeutic window to address the high mortality linked to this condition.

    • Simon Stewart
    • Geoffrey A. Strange
    • David Playford
  • Artificial intelligence (AI) holds promise for cardiovascular medicine but is limited by a lack of large, heterogeneous and granular data sets. Blockchain provides secure interoperability between siloed stakeholders and centralized data sources. We discuss integration of blockchain with AI for data-centric analysis and information flow, its current limitations and potential cardiovascular applications.

    • Chayakrit Krittanawong
    • Albert J. Rogers
    • Sanjiv M. Narayan
  • Africa is witnessing an epidemic of cardiovascular disease (CVD), with staggering morbidity and mortality. The spectrum of CVD includes hypertension, rheumatic heart disease, cardiomyopathy, atherosclerotic disease, congenital heart disease and tuberculous pericarditis. Opportunities exist to alter the trajectory of CVD epidemiology but require committed policy makers, functional health systems and an engaged citizenry.

    • Liesl Zühlke
    • Karen Sliwa
    • Ntobeko A. B. Ntusi
  • Africa faces many health challenges, many of which are unique to the continent. Although rarely considered an important contributor to premature death in high-income countries, cardiopulmonary disease (CPD) is, for a number of reasons, a common condition affecting Africans at a young age. In addition to recognizing CPD as an important condition, we outline a pragmatic screening protocol for identifying CPD in the African context.

    • Simon Stewart
    • Wael Al-Delaimy
    • Ana Mocumbi
  • 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
  • The advent of ‘big data’ and modern analytics mandates a change of scale in every aspect of the biomedical enterprise. These forces are realigning academic medicine and traditional industrial partners, and also creating the context for an emerging new ecosystem for discovery, translation, care and implementation that promises to transform and integrate all these areas of endeavour.

    • Calum A. MacRae
  • Retinal microvascular changes are strongly linked to prevalent and incident cardiovascular disease. These changes can now be mapped with unparalleled accuracy using retinal optical coherence tomography. Novel retinal imaging, combined with the power of deep learning, might soon equip clinicians with unique and precise risk-assessment tools that enable truly individualized patient management.

    • Tariq E. Farrah
    • David J. Webb
    • Neeraj Dhaun
  • LDL cholesterol is an important contributor to the risk of coronary heart disease, and its measurement is central to evaluating the effects of lipid-modifying therapies. Several ‘LDL-cholesterol’ assays exist but their methodologies differ, leading to between-assay heterogeneity in values of ‘LDL cholesterol’. We advocate the need for awareness of the potential implications.

    • Michael V. Holmes
    • Mika Ala-Korpela
  • Pacemaker therapy is inaccessible to most patients with bradycardia in Africa. Use of reconditioned pacemakers has been proposed as a safe, efficacious, and ethical means of delivering this therapy. A collaboration between PASCAR, Pace4Life, and Project My Heart Your Heart is working to address this deficit in health care in Africa.

    • Kevin Wunderly
    • Zaheer Yousef
    • Thomas C. Crawford
  • Despite substantial advances, bona fide regeneration of the damaged human heart is still an unmet ambition. By extracting our current knowledge from developmental biology, animal models of heart regeneration, and clinical observations, we propose five hallmarks of cardiac regeneration and suggest a holistic approach to reconstituting human heart function.

    • Alessandro Bertero
    • Charles E. Murry