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Major advances in the diagnosis of acute coronary syndromes (ACS) have occurred in 2011, but physicians treating ACS still walk the tightrope between efficacy and bleeding. Key publications have shed light on this delicate balance and heralded a new era of novel oral anticoagulants for the treatment of ACS.
In 2011, key trials with oral factor Xa inhibitors in patients with atrial fibrillation highlighted promising data on these novel anticoagulants. Patients with ≥1 stroke risk factors can be considered for oral anticoagulation. These novel, fixed-dose drugs are given without monitoring, so clinicians must learn to balance stroke and bleeding risks.
The results of several hypertension studies published in 2011 have contributed to our knowledge on the risks of and treatment for this condition, including the effects of slow-wave sleep, nocturnal dosing of medication, variability in post-stroke blood-pressure reduction, and the impacts of a low-sodium diet.
During 2010, several landmark studies, including the PARTNER trial, have made huge advances in the field of transcatheter aortic valve implantation. Other studies have made major contributions to the therapeutic management of young adult patients with severe aortic valve disease and of patients with asymptomatic severe mitral regurgitation.
Clinical research into the management of atrial fibrillation—the most common serious arrhythmia—has mostly focused on arrhythmia prevention and the reduction of vascular events and death. In 2010, important advances have been made in stroke prevention with new anticoagulants and in atrial fibrillation rhythm management.
Controversies in the treatment of atherosclerosis include uncertainty about the benefits of fibric acid derivatives, whether inhibition of cholesterol ester transfer protein is helpful or harmful, and about the benefits of statins in patients with renal failure. Key studies in 2010 contributed to the resolution of these long-standing controversies.
Provocative new studies have shown that tight blood pressure (BP) control (goal systolic BP <120 mmHg) in high-risk patients with diabetes mellitus confers no significant cardiovascular benefit other than stroke reduction, and that BP variability is important for the diagnosis and management of hypertension. The impact of these findings on future hypertension guidelines remains to be assessed.
Patients with heart failure (HF) fall into two categories—those who are stable and ambulatory with a relatively low event rate, and patients requiring hospitalization who are characterized by high post-discharge mortality and rates of rehospitalization. HF trials in 2010 contributed to the advancement of outpatient management, whereas the development of novel therapies with a survival benefit remains an unmet need in acute HF syndromes.
Despite incremental progress in the treatment of acute coronary syndromes (ACS), major uncertainties remain about the translation of evidence from trials into improved clinical practice. Key publications in 2010 have addressed this issue and questioned whether specific ACS therapies should be targeted according to clinical and genetic characteristics.
