Review Articles

Despite major advances in immunosuppressive regimens, which have greatly improved heart-transplant outcomes, drugs are still being developed and tested. In this review, data for the various available drugs and combined regimens are discussed, as well as those for novel drugs, in terms of efficacy and safety and cardiac allograft vasculopathy.

Major sex-based differences for coronary heart disease remain inadequately appreciated by physicians. Nanette Wenger draws together information on some of the major issues that have arisen in 2 years since the coronary prevention guidelines for women were published and highlights that their application is likely to improve outcomes for women.

The main surveillance method for allograft rejection after heart transplantation is endomyocardial biopsy, but this method's invasive nature and poor uniformity of results pose problems. Noninvasive, reliable monitoring methods are, therefore, sought. In this review, protein-based and gene-based targets for the testing of allograft function to fulfill this role are discussed.

Although coronary angiography is an established technique in the assessment of atherosclerosis, it is limited by 2-dimensional imaging and poor differentiation between plaque types. Optical coherence tomography enables visualization of plaque architecture at the microscopic level, and in this review the possibilities of its use as an alternative modality are discussed.

Small, dense HDL possesses potent antioxidative activity but this is compromised under conditions of atherogenic dyslipidemia. The raising of HDL cholesterol levels might, however, improve functionality. In this review, Kontush and Chapman explore the mechanisms behind the antiatherogenic effects of small HDL, and the possible roles of these particles as therapeutic targets.

The implementation of guidelines into everyday practice does not always seem straightforward. In this primer article, Eagle and colleagues provide a summary of efforts to improve care for acute coronary syndromes in the Guidelines Applied in Practice program in Michigan, highlighting particularly methods that could be transferable to other cardiovascular subspecialties.

The integrity of the endothelium can be damaged in various ways, making the formation of atherosclerotic lesions possible. The source of cells involved in endothelial repair and smooth-muscle accumulation in lesions has been debated, but data suggest progenitor cells as a likely origin. Their role in the pathogenesis of atherosclerosis is discussed here.

The need for improved prevention of sudden cardiac death has led physicians to increase the use of implantable cardioverter-defibrillators. Despite data now being available from a variety of studies, how to identify patients who will benefit most from this invasive and expensive therapy is still unclear. Here, the impact of findings on clinical decision-making is explored.

Cardiovascular disease is a major concern in elderly adults, particularly in those with age-related reductions in renal function. Physicians are often cautious when prescribing therapy because of the perceived frailty of older patients and limited understanding of adverse effects. This review tackles the issue of prescribing considerations in elderly patients with concomitant renal and cardiovascular disease.

The role of the rennin–angiotensin system was previously thought to be restricted to the cardiovascular system, but important roles in other tissues are coming to light. This review concentrates on this system's effects on hematopoiesis and presents a discussion of the clinical relevance and possible therapeutic applications in this context.

The relationship between cardiovascular disease and the metabolic syndrome is now well known but is not yet fully elucidated. In this review, Yuji Matsuzawa discusses the role of intra-abdominal visceral fat accumulation and the release of bioactive substances termed adipocytokines in the development of disorders contributing to the metabolic syndrome.

Disease markers for cardiovascular disease have radically altered thinking about diagnosis and monitoring of disease course. Although a substantial amount of information seems available already, new data are emerging all the time. This review provides a snapshot of the current status of biomarkers in heart failure and acute coronary syndromes.

Several gene mutations in ryanodine receptors, affecting channel gating, have been associated with certain arrhythmias and cardiomyopathy. In this review, the authors highlight the role of the ryanodine receptor, a Ca2+-release channel, in the pathogenesis of fatal arrhythmia and heart failure. They discuss also the possibility of this receptor as a new therapeutic target.

Although vaccination has so far been used mainly for infectious disease, the varied roles of the immune system in atherosclerosis present the possibility of a vaccine being developed against this prevalent disease. Here, Shah and colleagues discuss some of the background and advances being made in this field.

Morbidity and mortality are high for chronic heart failure despite therapeutic advances, but the options are not exhausted. Ulf Landmesser and Helmut Drexler present an overview of heart failure therapy and summarize the major research being done to find new ways forward.

The introduction of drug-eluting stents has revolutionized interventional cardiology. The uptake of this technology has been rapid and widespread, but the long-term data are strikingly few. In this review, an overview is presented of the studies done so far and the emerging information on safety and efficacy. Future directions for this intervention are also discussed.

The relation between obesity and cardiovascular risk factors is well documented, and risks include hypertension, cardiac remodeling and lipid disturbances. The weight loss outcomes achieved with bariatric surgery can eliminate or ameliorate such cardiovascular effects. Blackburn and Mun present the evidence for cardiovascular benefits seen with this advancing therapy.

Various cardioprotective effects seen with ischemic preconditioning and postconditioning have been documented. The application of these methods in clinical practice is not, however, straightforward because of issues with timing and the need for further elucidation of mechanisms. This review discusses whether implementation in clinical practice is feasible.

This review presents an overview of MRI for assessment of the myocardium. This method is becoming popular for the study of morphology, function, perfusion and ischemia because data on various different biological parameters can be gathered from the same area within the same scanning session simply through changes to the software.

Despite ventricular septal defects being more common than atrial septal defects, fewer trials have been done of transcatheter closure. The available results do, however, suggest positive results with low complication rates. Douglas S Moodie provides in this review an overview of current applications of transcatheter closure for membranous, perimembranous and muscular ventricular septal defects.