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  • Dietary supplementation with NAD+ precursors or ketone esters has been shown to improve mitochondrial function in preclinical models of heart failure with either reduced or preserved ejection fraction. Both supplementation approaches hold promise but are in the early stages of development as clinical therapies for heart failure.

    • Kevin D. O’Brien
    • Rong Tian
    Comment
  • Atherosclerosis causes myocardial infarction, ischaemic cardiomyopathy, many ischaemic strokes and jeopardized limbs. Despite enormous progress, atherosclerosis has become the major cause of death worldwide. This Comment intertwines clinical and basic advances in atherosclerosis to illustrate their interdependence, which provides a template for a way forwards to conquer the scourge of atherosclerotic cardiovascular disease.

    • Peter Libby
    Comment
  • Genomic data are increasingly being integrated into health care. We propose an outline for structured training in cardiovascular genomics, recognizing the growing need for a cardiovascular genomics subspecialty and cardiovascular subspecialists who incorporate genomics advances to optimize the management of heritable cardiovascular diseases.

    • Maya S. Safarova
    • Michael J. Ackerman
    • Iftikhar J. Kullo
    Comment
  • The homogeneity of cardiovascular clinical trial populations limits the generalizability of results and compounds health inequities faced by women, older adults and people of colour. This Comment highlights the importance of diversity in clinical trial populations and describes multifaceted interventions that might help to close the diversity gap in trial enrolment.

    • Erin D. Michos
    • Harriette G. C. Van Spall
    Comment
  • Burnout is prevalent in medicine and has been further amplified by the COVID-19 pandemic. Strategies must be developed to reduce burnout by addressing a culture of wellness, efficiency of practice, and resiliency. The entire health-care community has a role in addressing burnout and promoting well-being.

    • Laxmi S. Mehta
    • Daniel J. Murphy Jr
    Comment
  • The COVID-19 pandemic has accelerated the adoption and acceptance of remote monitoring and other digital approaches to cardiovascular disease management across the world. We argue that considerable additional effort is required to ensure appropriate multi-stakeholder involvement in the development, evaluation and best use of an ever-increasing number of digital technologies.

    • Martin R. Cowie
    • Carolyn S. P. Lam
    Comment
  • Improper management of carotid artery disease for stroke prevention is prevalent. Accumulating misconceptions (‘furphies’) drive the overuse of carotid artery procedures and the inappropriate use of medicines. Recognition of these furphies is essential to improve disease management and optimize patient outcomes.

    • Anne L. Abbott
    Comment
  • Uncertainties remain about the diagnostic and therapeutic strategy to prevent left ventricular thrombus formation after myocardial infarction. In particular, the roles of predisposing factors and prophylactic anticoagulation have not been sufficiently considered. We propose an ‘uncertainties flowchart’ with the aim of stimulating research on the topic.

    • Luca A. F. Di Odoardo
    • Giulio G. Stefanini
    • Marco Vicenzi
    Comment
  • Growing evidence indicates that sexual and gender minority populations might be at greater risk of cardiovascular disease than the general population. Additional population and clinical health research is needed to inform the development of tailored, evidence-based interventions to promote the cardiovascular health of sexual and gender minority populations.

    • Billy A. Caceres
    • Carl G. Streed Jr
    Comment
  • There is still no consensus on the anatomical combinations that make up the so-called hypoplastic left heart syndrome. We argue that an intact ventricular septum should now be part of the definition. Addition of this feature is necessary if accurate predictions are to be made about the morphogenesis of the condition.

    • Robert H. Anderson
    • Diane E. Spicer
    • Adrian Crucean
    Comment
  • Extreme heat events are now more frequent in many parts of the world as a result of climate change. The combined effects of heat, air pollution, individual age, and socioeconomic and health status are responsible for avoidable acute events of cardiovascular disease and need to be considered in order to prevent and treat cardiovascular diseases effectively.

    • Annette Peters
    • Alexandra Schneider
    Comment
  • In this Comment, Nikki Gillum Posnack discusses how the increasing use of plastics in everyday life has potentially harmful effects on cardiovascular health.

    • Nikki Gillum Posnack
    Comment
  • The disparities amplified by the COVID-19 pandemic present disturbing evidence that we are far from cardiovascular health-care equity. Individuals, leaders and institutions must prioritize research, policies and structures to advance diversity, equity, inclusion and belonging — Diversity 4.0, a justice imperative, essential to advancing workforce excellence and cardiovascular health.

    • Renate B. Schnabel
    • Emelia J. Benjamin
    Comment
  • The COVID-19 pandemic has provided the vital stepping stones to improve how clinical trials are conducted. We provide an overview of the major changes to the clinical trial process instigated by the pandemic and suggest ways to make these changes sustainable.

    • Prakriti Gaba
    • Deepak L. Bhatt
    Comment
  • Social determinants of health in the African diaspora drive the lack of disease testing, increased prevalence of comorbid disease and reduced access to drugs, resulting in disproportionately higher COVID-19-related mortality among Black individuals than the rest of the population. We urge decisive attention to and action against ethnicity-based inequities that undermine cardiovascular health.

    • Peter Chin-Hong
    • Kevin M. Alexander
    • Michelle A. Albert
    Comment
  • Yoga has been associated with improvements in numerous cardiovascular risk factors and has the potential to address the unmet needs of current cardiovascular prevention strategies. Large and well-designed clinical trials are needed to assess the benefits of yoga across the spectrum of cardiovascular diseases and to provide the evidence required for its widespread implementation.

    • Dorairaj Prabhakaran
    • Ambalam M. Chandrasekaran
    Comment
  • The notion that atherosclerosis can be prevented or mitigated by vaccination is now moving towards clinical trials. This strategy is based on the existence of autoimmunity to LDL, the cholesterol-carrying particles that accumulate in arteries. In this Comment, we discuss the underlying concepts, research basis and challenges for the development of a vaccine against atherosclerosis.

    • Göran K. Hansson
    • Jan Nilsson
    Comment
  • Cybersecurity vulnerabilities of cardiac implantable electronic devices have been an area of increasing concern in the past 4 years. Physicians should be informed of these issues as they evolve so they can counsel their patients with the most accurate and up-to-date information.

    • Bryce Alexander
    • Adrian Baranchuk
    Comment
  • The available literature suggests that electronic cigarettes (e-cigarettes), although not without risk, might decrease cardiovascular risk in chronic smokers of tobacco cigarettes who switch to e-cigarettes. However, to safeguard our youth, e-cigarettes must be required to meet product standards, all flavourings must be banned and laws regulating e-cigarette sales must be strictly enforced.

    • Holly R. Middlekauff
    Comment