News & Views

The Apple Heart Study demonstrates that the Apple Watch can detect atrial fibrillation inferred from the smartwatch heart-rate sensor with a high positive predictive value. However, we must now contend with many clinically relevant unknowns that were not addressed by the study, such as the ramifications of a false-positive result.

Findings from a large, international study comprising 4.9 million people with mild hypertension suggest that thiazide and thiazide-like diuretics might be more effective and safer than other first-line antihypertensive drugs. However, the study was not randomized, and the findings might be explained by a phenomenon known as ‘confounding by indication’.

Results from a prospective study by Santema and colleagues suggest that women with heart failure and reduced ejection fraction might need lower doses of standard heart failure drugs than men. However, this conclusion was formed on the basis of data from a small proportion of the population studied and might only be relevant to participants taking β-blockers.

The myocardial viability substudy from the STICH trial has reaffirmed the 10-year survival benefit of CABG surgery in patients with left ventricular dysfunction, but whether myocardial viability must be present for the long-term benefits of revascularization to be realized remains inconclusive.

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.

In a 15-year follow-up of the VADT study, no differences in major cardiovascular outcomes were found among individuals with type 2 diabetes mellitus who underwent either intensive or standard glucose control. These results indicate that intensification of glycaemic control might not be expected to mitigate the risk of cardiovascular events.

The global burden of cardiovascular disease morbidity and mortality demands increased awareness of effective prevention strategies by patients, communities and health-care providers. The new 2019 ACC/AHA guidelines provide evidence-based, preventive recommendations for patients without known cardiovascular disease, focusing on risk estimation, a healthy lifestyle and selective indications for pharmacotherapy.

Nonresolving inflammation underpins several prevalent diseases, including atherosclerosis and Alzheimer disease. The resolution of inflammation is an active process that tempers pro-inflammatory pathways and promotes tissue repair. Understanding the mechanisms that boost endogenous resolution is important for the design of new treatment strategies for nonresolving diseases.

High-sensitivity cardiac troponin (hs-cTn) assays facilitate the ruling-out of myocardial infarction (MI) but identify a high number of patients with elevated troponin levels but without MI. Consequently, the term myocardial injury was included in the latest universal definition of MI. In the High-STEACS trial, use of a hs-cTnI assay was safe but had no prognostic benefit.

Cardiovascular disease and cancer share several risk factors. Patients with heart failure have a higher rate of cancer than healthy control populations. Meijers and colleagues have taken this association a step further to present new evidence suggesting that, beyond simply sharing root causes, heart failure might actually cause cancer.

A wealth of data that culminated in a large clinical trial established that IL-1β blockade has beneficial effects in atherosclerotic cardiovascular disease. A new study in gene-targeted mice challenges this view by showing atheroprotective effects of IL-1β.

The KardiaBand, which records a rhythm strip from an AppleWatch, was paired with an app for automated detection of atrial fibrillation. A new study by Bumgarner and colleagues is one of the first studies to examine the feasibility of using a smartwatch to discriminate between sinus rhythm and atrial fibrillation.

Early studies showing that KIT⁺ cardiac progenitor cells (CPCs) could differentiate into cardiomyocytes generated excitement regarding their potential therapeutic application. Subsequent studies called their functional relevance into question, and while claims for a contribution of KIT⁺ CPCs to myocardial regeneration continue, two new studies confirm the doubts about their relevance to cardiomyogenesis and provide unexpected new insights.

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.

Hyperlipidaemia is an important risk factor for coronary artery disease. Chadwick and colleagues report significantly reduced blood lipid levels following CRISPR-based in vivo genome editing in mice to introduce loss-of-function mutations in Angptl3, encoding a lipoprotein lipase inhibitor. Treatment was effective in both wild-type and Ldlr^−/− mice and had a similar effect to that of Pcsk9-targeted genome editing, without causing off-target mutations.

Advances in breast cancer therapy mean that more women are surviving cancer but are at increased risk of cardiovascular disease (CVD). In a statement released by the AHA, Mehta and colleagues summarize the intersection between breast cancer and CVD, and highlight the importance of vigilance in preventive measures.

Catheter ablation for atrial fibrillation (AF) in patients with concomitant AF and heart failure (HF) is associated with significantly lower HF hospitalizations and all-cause mortality compared with medical therapy, according to the CASTLE-AF trial. This trial, along with previous trials such as AATAC, highlights the important role of AF ablation in the management of patients with HF and AF.

The radical new US hypertension guidelines, released 3 years after the previous scientific statement, have implications far beyond their intended recipients. They include a new definition for hypertension, lower treatment targets, and extended guidance on the implementation of multidisciplinary care, including self-monitoring of blood pressure. Some recommendations are likely to generate controversy.

Cardiovascular disease is the world's leading cause of death, with a disproportionate burden in low-income and middle-income countries. The Resolve initiative — eliminating artificial trans fats, reducing dietary sodium, and improving treatment of elevated blood pressure — is a substantial step in the right direction, but more combined efforts will be required.

The gut microbiota has been associated with many different disorders, including cardiovascular diseases. A new study by Jie and colleagues is the first large case–control study to examine directly the enrichment of certain communities of gut bacteria in patients with atherosclerotic cardiovascular disease compared with control individuals.