Viewpoint

The early promise of drug-eluting stents (DESs) led to their rapid assimilation into routine clinical practice, but enthusiasm for this relatively novel technology could be tempered by emerging safety concerns. In this Viewpoint, David Kandzari examines incidence and predictors of stent thrombosis in DESs versus bare-metal stents and contributes to the debate on whether the effi cacy of DESs outweighs the dangers associated with this therapy.

There are few available data on the incidence and risk factors of thromboembolism in heart failure, and the decision to recommend anticoagulant therapy for these patients is complex. In this Viewpoint, Drs Freudenberger and Halperin discuss the limited existing data on prophylactic approaches to this problem and appeal to physicians to support well-designed, randomized clinical trials of antithrombotic therapy in patients with heart failure.

Cardiovascular disease kills more women each year than any other condition, yet women's cardiovascular risks continue to be underestimated. Women tend to be diagnosed later in the course of their disease and receive less-intense therapy than men. In this Viewpoint, Sharonne Hayes discusses the causes of disparities in prevention, diagnosis, treatment and outcome between men and women with cardiovascular disease and emphasizes that educating the medical community, and women themselves, is crucial to reducing the sex bias and optimizing care.

Although genetic testing for hypertrophic cardiomyopathy and long QT syndrome is now clinically available, are we ready to reap the practical benefits of these molecular discoveries? How can genetic testing for heritable cardiovascular disorders improve the care of our patients now and in the future? As Allison Cirino and Carolyn Ho outline in this month's Viewpoint, the best is yet to come for genetic testing in cardiac disease.

Major bleeding is the most common noncardiac complication after percutaneous coronary intervention for coronary artery disease. The reduction of vascular access site complications in PCI procedures is, therefore, a critical challenge. In this month's Viewpoint, Martial Hamon discusses why an alternative access site is needed and compares the benefits of the transradial approach with those of the femoral approach.

Major advances have been seen both in the development and design of left ventricular assist devices. As a result, the indications for use have increased substantially. In this month's Viewpoint, Jonathan Chen, Yoshifumi Naka and Eric Rose explore the clinical promise and the current technical barriers of widespread application of left ventricular assist devices as destination therapy.

A huge body of evidence now supports aggressive LDL cholesterol lowering to reduce cardiovascular risk, but what LDL cholesterol target level should be recommended? Here, Philip Barter and Kerry-Anne Rye examine the safety issues associated with achieving very low levels of LDL cholesterol and whether it is feasible to achieve very low levels in all high-risk people.

Why is aspirin so popular in the management of cardiovascular disease? Few therapies in cardiovascular medicine have been studied so intently and adopted so widely as aspirin. In this Viewpoint, John Cleland discusses why he believes that the use of aspirin should be reviewed and withdrawn in many patients in whom it fails to show long-term benefit.

Could the presence of a patent foramen ovale be associated with the occurrence of migraine headaches? In this the first of two Viewpoints on patent foramen ovales, Jeremy Orr and Jonathan Tobis discuss the possibility that the majority of migraine headache could be treated by closing this patent foramen ovale passageway though the heart.

Here, Hans-Christoph Diener and Christian Weimar argue that patent foramen ovale closure should not be used for the prophylaxis of migraine until further evidence is obtained from properly conducted, prospective studies.

Studies have found that one of the most widely used illicit drugs, marijuana, could hold great therapeutic promise for the treatment of obesity, dyslipidemia, insulin resistance and atherosclerosis. Paul Szmitko and Subodh Verma discuss how modulation of the endocannabinoid system might form the basis of new therapeutic strategies for these pathophysiologically linked conditions.

Cardiac transplantation research has focused on predicting risk and determining pathogenic pathways, and hence finding targets for intervention. As the Human Genome Project is now ready to provide the information required for personalized treatment, this Viewpoint discusses genetic association studies and their potential application at different stages before and after cardiac transplantation.

The complexity of the anatomy and physiology with which patients with congenital heart disease present in adulthood often exceed the expertise of physicians not trained specifically in congenital heart disease. In this viewpoint, Michael A Gatzoulis argues that education is the key to improving care of the growing population of adults with congenital heart disease.

The Women's Health Study seemed to contradict evidence from randomized trials of aspirin by identifying a sex-related difference in response to aspirin in cardiovascular disease. In this Viewpoint Hennekens et al. discuss the findings and argue that concluding that there are sex-related differences in response to aspirin could be premature.

There has been a rapid increase in the number of catheter ablation procedures for atrial fibrillation. Importantly, several new catheter-based strategies have shown atrial fibrillation to be a treatable condition. In this Viewpoint, Carlo Pappone and Vincenzo Santinelli discuss the best techniques for atrial fibrillation ablation.

The use of organs donated after death is associated with much controversy and currently the supply of organs does not meet the demand, underlining the need for alternative organ sources. In this Viewpoint, Jean-Paul Soulillou examines the possibility of xenotransplantation with the tools and techniques currently available.

The rising incidence of impaired glucose tolerance and diabetes has resulted in a worldwide health-care crisis. Despite lifestyle changes and pharmacotherapy, over 25% of patients with diabetes have severe myocardial ischemia, myocardial infarction or both but without chest pain. Robert O’Rourke examines whether all patients with type 2 diabetes should be investigated for coronary artery disease, and possible treatment options.

There has been an alarming increase in the occurrence of childhood obesity, the long-term consequences of which are at least partly those of adult obesity. The direct consequences of childhood obesity on long-term cardiovascular risk, however, are less certain. Here, Peter H Whincup and John E Deanfield discuss the substantial challenges childhood obesity presents to clinicians.

Electronic pacemakers are lifesaving devices but require regular maintenance and do not readily respond to the demands of exercise and emotion. This viewpoint focuses on the rapidly evolving field of biological pacemakers, addresses the issues that need to be confronted before clinical use and discusses how far we are from a clinical reality.

Hypertrophic cardiomyopathy is a widespread condition that is often neglected and undiagnosed. Although there are still large gaps in our knowledge of the basic disease mechanisms, population studies have shown us that patients can have normal life expectancy but often develop disease-related complications. In this Viewpoint, Franco Cecchi, Magdi Yacoub and Iacopo Olivotto highlight the disease's screening and treatment, and some of the exciting new knowledge in the field.