Comment in 2021

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.

Clinical practice guidelines provide evidence-informed recommendations to improve the delivery of high-quality health care. Despite their ubiquity, the translation of clinical guidelines into routine clinical practice remains suboptimal. We propose the use of implementation science methods in the development of clinical practice guidelines to improve uptake.

Precision medicine envisages a changed paradigm for health care through better understanding of individual disease susceptibility and prognosis, enabling more personalized treatment. Enabling technologies such as the health digital twin are rapidly evolving, presenting important challenges and opportunities to be tackled within local contexts.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.