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  • Cardiovascular disease is both a risk factor and potential outcome of the direct, indirect and long-term effects of COVID-19. A recent analysis in >150,000 survivors of COVID-19 demonstrates an increased 1-year risk of numerous cardiovascular diseases. Preventing and managing this new disease burden presents challenges to health systems and requires a learning health system approach.

    • Mohamed O. Mohamed
    • Amitava Banerjee
    News & Views
  • A new, very large genome-wide association study has uncovered many novel genetic factors associated with circulating lipid levels. The success of this study came partly from analysing many samples, but mostly from including individuals of non-European ancestry. So, why is studying genetic diversity important and how can it help to fight cardiovascular disease?

    • André G. Uitterlinden
    News & Views
  • In a pooled analysis of 144 high-quality randomized trials involving patients with coronary artery disease, application of the most stringent criteria for surrogacy demonstrated that a reduction in the rates of non-fatal myocardial infarction by any intervention did not necessarily predict a reduction in all-cause or cardiovascular mortality during follow-up.

    • Davide Capodanno
    • William Wijns
    News & Views
  • Care pathways for ST-segment elevation myocardial infarction (STEMI) were interrupted during the coronavirus disease 2019 (COVID-19) pandemic. A new cardiac MRI study has revealed that increased total ischaemic time for patients with STEMI during major public health restrictions was associated with increased infarct size and other markers of myocardial damage.

    • Ramesh Nadarajah
    • Chris P. Gale
    News & Views
  • The field of cardiac cell therapy is under siege. Legacies of excessive hype, scientific misconduct and dead ends have fuelled the prevailing scepticism. However, promising clinical data, along with more trenchant mechanistic understanding, together provide glimmers of hope for the future of cell therapy for the heart.

    • Eduardo Marbán
    News & Views
  • Nanotherapies are emerging rapidly as options to treat cardiovascular disease. However, insufficient and heterogeneous delivery remain critical issues. Novel strategies to boost targeted delivery of systemically administered nanoparticles by optimizing the particle physical properties or using immune cells as carriers promise to increase nanotherapeutic effectiveness in cardiovascular and other inflammatory diseases.

    • Bryan Ronain Smith
    News & Views
  • Mounting evidence from the SPRINT trial and the Blood Pressure Lowering Treatment Trialists points towards the use of absolute cardiovascular risk assessment to guide blood-pressure management. But who will fall between the cracks? We need to be pragmatic in keeping blood-pressure targets, if only to serve the >1 billion people at risk of cardiovascular disease living in low-resource settings.

    • Aletta E. Schutte
    News & Views
  • Surgical mitral valve repair produces exceptional long-term survival, durable relief from mitral regurgitation, and physiological valve performance. Percutaneous mitral valve repair might prohibit subsequent surgical reconstruction. This finding has important implications, including for patient consent and clinical trial design. The objectives of mitral valve intervention must focus on life expectancy and long-term valve function.

    • Michael Ibrahim
    • W. Clark Hargrove III
    News & Views
  • Sequencing studies demonstrate a strong clinical association between clonal haematopoiesis driven by acquired mutations and atherosclerotic disease. Previous research supports the idea that this association reflects a direct contribution of some clonal haematopoiesis-related mutations to atherosclerosis. Now, mathematical modelling suggests that atherosclerosis could instead accelerate clonal haematopoiesis.

    • Fátima Sánchez-Cabo
    • José J. Fuster
    News & Views
  • Although an unplanned, interim analysis from an ongoing randomized trial in Sweden has suggested no significant difference in mortality between patients with peripheral artery disease receiving paclitaxel-coated devices and those receiving uncoated devices for lower-extremity revascularization, the analysis did not resolve the question of whether paclitaxel-coated devices are safe for these patients.

    • Mary M. McDermott
    • Melina R. Kibbe
    News & Views
  • Valve replacement is currently the only treatment for calcific aortic valve disease. Studies of an uncommon, genetic form of aortic valve disease have yielded in vitro and mouse models of the disease and a transcriptomic disease signature. Machine learning-driven screens for compounds that normalize this signature promise to enable medical management of aortic valve disease.

    • Suya Wang
    • William T. Pu
    News & Views
  • Mouse embryonic organoids that model cardiac development ex vivo could be used as a high-throughput, experimentally tractable system to evaluate crucial cell populations and environmental factors that contribute to normal and abnormal cardiogenesis.

    • Deepak Srivastava
    • Todd C. McDevitt
    News & Views
  • Statin nocebo effects have been demonstrated in numerous randomized, double-blind, placebo-controlled and active-controlled trials. Emerging evidence suggests that brain pathways might mediate statin nocebo hyperalgesia. Evidence-based pain-management approaches can be used to manage nocebo symptoms that occur during statin therapy.

    • Jennifer G. Robinson
    News & Views
  • The overuse of opioids for acute pain management has led to an epidemic of persistent opioid use. A new study by Brown and colleagues evaluates opioids prescribed at discharge from hospital after coronary artery bypass graft surgery and heart valve procedures.

    • Elizabeth B. Habermann
    News & Views
  • Salt substitutes hold great potential for the control of blood pressure and prevention of chronic disease, but the evidence base remains inadequate. Data from a community-based trial in Peru add to this evidence base and support the conduct of large-scale trials to drive the global uptake of salt substitution.

    • Bruce Neal
    • Matti Marklund
    News & Views
  • In the decade after the introduction of Impella heart pumps, their use has rapidly increased. However, to date, clinical trial data have not conclusively supported their superiority over other contemporary support devices, and observational experiences have identified signals of increased harm with Impella. Large, adequately powered clinical trials of Impella are eagerly awaited.

    • Muthiah Vaduganathan
    • Mandeep R. Mehra
    News & Views
  • The Apple Heart Study demonstrates that the Apple Watch can detect atrial fibrillation inferred from the smartwatch heart-rate sensor with a high positive predictive value. However, we must now contend with many clinically relevant unknowns that were not addressed by the study, such as the ramifications of a false-positive result.

    • Gregory M. Marcus
    News & Views
  • Findings from a large, international study comprising 4.9 million people with mild hypertension suggest that thiazide and thiazide-like diuretics might be more effective and safer than other first-line antihypertensive drugs. However, the study was not randomized, and the findings might be explained by a phenomenon known as ‘confounding by indication’.

    • Sverre E. Kjeldsen
    • Ingrid Os
    News & Views
  • Results from a prospective study by Santema and colleagues suggest that women with heart failure and reduced ejection fraction might need lower doses of standard heart failure drugs than men. However, this conclusion was formed on the basis of data from a small proportion of the population studied and might only be relevant to participants taking β-blockers.

    • Andrew J. S. Coats
    News & Views
  • The myocardial viability substudy from the STICH trial has reaffirmed the 10-year survival benefit of CABG surgery in patients with left ventricular dysfunction, but whether myocardial viability must be present for the long-term benefits of revascularization to be realized remains inconclusive.

    • Björn Redfors
    • Gregg W. Stone
    News & Views