Comment

Cardiovascular health is essential to achieving the United Nations Sustainable Development Goals (SDGs), particularly SDG3.4. Barriers include inequalities and a lack of political will and prioritization. A comprehensive approach is needed to reduce the global burden of cardiovascular disease and to achieve SDG3.4. The World Heart Federation addresses the determinants of cardiovascular disease and mobilizes the global community through roadmaps, roundtables and advocacy.

Clonal haematopoiesis of indeterminate potential (CHIP) is defined as an expansion of mutant blood stem cells in individuals without haematological malignancies. CHIP is linked to an increased risk of non-cancerous disorders such as atherosclerotic cardiovascular disease, possibly because mutant innate immune cells have pro-inflammatory phenotypes. Prospective studies are needed to determine whether individuals with CHIP might benefit from anti-inflammatory therapies.

IgM antibodies have gained much attention as risk markers of atherosclerotic cardiovascular disease, but the exact antigenic determinants and the full spectrum of functions remain to be defined. A better understanding of the potentially diverse nature of the antigens that they recognize will help to dissect the function of IgM in atherosclerosis.

Lipophagy is a type of selective autophagy that targets lipid droplets for degradation. Since the discovery of lipophagy in 2009, research has uncovered a central role for this process in cellular lipid metabolism, including in atherogenic foam cells. Therefore, increasing lipophagy might be a therapeutic target to reverse lipid build-up in atherosclerosis.

Excessive salt intake is a known risk factor for cardiovascular disease commonly associated with hypertension. However, we propose that a high-salt diet can promote cardiovascular and other diseases independently of high blood pressure through inflammatory pathways that increase the production of myeloid cells.

Establishing and enforcing LGBTQ-inclusive policies at the national, state and institutional level are essential for advancing health equity and ensuring the highest quality cardiology workforce.

Low plasma levels of HDL cholesterol are a risk factor for infection and hospitalization for infectious disease. Recent work suggests that inadequate levels of HDL particles of specific sizes — small and medium — account for this risk. In this Comment, we discuss the mechanistic implications of these observations and the methodologies used to quantify HDL size.

After 40 years of spectacular technological innovation, catheter ablation has become central to the treatment of cardiac arrhythmias, revolutionizing patient care but with no consideration for environmental sustainability. With climate change being the biggest threat to humanity, all stakeholders urgently need to promote more virtuous and circular practices in the catheterization laboratory.

While there is understandable excitement about the development of new cardiovascular drugs, an unmet and equally important need is to perform new clinical trials of old drugs, including to determine their longer-term effects and if and when they should be discontinued after years of use. New trials of old drugs can inform clinical practice and are much needed.

Globally, Black people have some of the highest rates of cardiovascular disease. Racial inequities in cardiovascular health must be tackled. Black In Cardio is a trainee-led initiative aimed at promoting Black people in the cardiovascular field and raising awareness about issues related to the cardiovascular health of Black communities.

Bullying is common in cardiology and can have substantial adverse effects. However, bullying can be addressed by substantive leadership, organizational and individual efforts to build an inclusive and respectful culture.

Childbearing cardiologists face a number of challenges before, during and after pregnancy, including radiation concerns, infertility, pregnancy-related complications, and inadequate parental leave and return-to-work structures. Institutions can promote an equitable work environment by creating policies to mitigate these challenges.

The AIM2 inflammasome is activated by host and pathogen DNA. Work from the past 5 years indicates that the AIM2 inflammasome has an important role in advanced atherosclerosis driven by clonal haematopoiesis and possibly in atherosclerosis accelerated by acute infection. Therefore, the AIM2 inflammasome might be an important target for precision medicine.

The lowering of dietary recommendations for the consumption of free or added sugar from 25% to 10% of daily calories has been criticized as being based on low-quality scientific evidence, ill-informed opinions and over-extrapolation of results from studies on sugar-sweetened beverages. This Comment rebuts these criticisms.

Important lessons about human susceptibility to coronary atherosclerosis can be learned from the relative resilience of chimpanzees to coronary artery disease (CAD), despite their higher baseline plasma levels of LDL cholesterol and lipoprotein(a) than in humans. Evolutionary pressure and hyper-reactive T cells might have a role in the unique susceptibility of humans to CAD.

Mentorship is a crucial element to success and satisfaction among medical professionals. For a successful relationship, both mentors and mentees must examine their roles and goals. In this Comment article, a mentor–mentee pair discuss the necessary attributes for a productive partnership.

Moderate coffee consumption (2–5 cups per day) has been consistently associated with a lower risk of cardiovascular disease in epidemiological studies. For most individuals, a caffeine intake of up to 400 mg per day is safe and moderate coffee consumption can be included as part of a healthy lifestyle.

Heart failure is a systemic disease in which neuroendocrine activation, inflammation and metabolic changes can impair cardiac function. In addition, variants in genes encoding sarcomeric proteins can predispose individuals to develop heart failure. The 2022 Gordon Research Conference on Cardiac Regulatory Mechanisms aims to identify novel treatment targets by applying high-resolution approaches to complex cardiac disorders.

The risk of acute myocarditis associated with COVID-19 mRNA vaccination has garnered intense (social) media attention. However, myocarditis after COVID-19 mRNA vaccination is rare and usually resolves within days or weeks. Moreover, the risks of hospitalization and death associated with COVID-19 are greater than the risk associated with COVID-19 vaccination. Therefore, COVID-19 vaccination should be recommended in adolescents and adults.

Large differences in cardiovascular disease (CVD) morbidity and mortality exist between migrant populations and host populations. Understanding the drivers behind these disparities may help to mitigate the unequal burden of CVD and identify new causal pathways that contribute to CVD risk in the population at large.