News & Views in 2014

Biomarkers are needed to accurately represent or predict clinical outcomes for optimal management of patients with atrial fibrillation (AF) in clinical practice. Growth differentiation factor-15, a member of the transforming growth factor-β family, has an independent prognostic role for major bleeding and death in patients with AF receiving oral anticoagulation.

The results of the Q-SYMBIO trial showing a reduction in mortality in patients with heart failure treated with coenzyme Q₁₀ have substantial limitations. Nevertheless, they highlight the need to identify effective new therapies targeted at mitochondrial dysfunction and oxidative stress in heart failure.

In the EORP-AF Pilot registry on the prognosis and treatment of patients with atrial fibrillation (AF), 1-year mortality is high. Symptoms are still common in patients with AF, and hospital readmissions are mainly owing to AF and heart failure. Oral anticoagulation use has increased, but a rhythm-control strategy is uncommon.

A new meta-analysis challenges the notion that β-blockers improve survival in patients with heart failure (HF) and concomintant atrial fibrillation (AF). These results should be interpreted with caution. Although the mortality reduction conferred by β-blockers was likely overestimated in the past, benefits should be expected in a sizeable proportion of patients with HF and AF.

Clinical trials published during the past decade have had substantial effects on the treatment of peripheral vascular diseases. In this article, I discuss ten important trials that have influenced treatment for common vascular disorders, including peripheral artery disease, abdominal aortic aneurysm, renal artery disease, extracranial carotid artery disease, and venous thromboembolism.

Since Wallace Brigden first used the term 'cardiomyopathy' in 1952, this group of diseases has continued to attract the interest of clinicians, researchers, and importantly, patients. The past decade has seen a substantial accumulation of knowledge relating to various cardiomyopathies, which has partially lifted the mystery surrounding this topic.

Tremendous advances in the understanding and treatment of structural heart valve disease have been made in the past decade, including widespread utilization of minimally-invasive surgical procedures and the invention and evolution of numerous interventional techniques. These innovations will become the norm in therapy for valvular disease in the future.

Over the past decade, we have witnessed the unparalleled success of statins to treat dyslipidaemia. Target identification by Mendelian randomization, human monoclonal antibodies, gene therapy, RNA-based targets, and atherogenic lipoproteins other than LDL cholesterol have fuelled intense development efforts that might bear fruit in the very near future.

Cardiac rhythm disorders, or 'arrhythmias', are major sources of morbidity and mortality, and have been challenging to treat because classic pharmacological therapies are often ineffective and sometimes dangerous. In the past decade, groundbreaking developments have revolutionized the management of arrhythmias and prepared the groundwork for new advances in the future.

The Hispanic population will grow to represent nearly one-third of residents in the USA by mid-century. A new AHA Science Advisory paper provides an overview of current evidence on cardiovascular disease in this population, including prevailing risk factors and specific clinical approaches for treatment, and predicts what insights future research might reveal.

The association between HDL cholesterol and cardiovascular events, and the potential antiatherogenic effects of HDL particles, are altered in patients with established coronary heart disease. HDL particle composition has, therefore, gained attention after trials of therapies to increase HDL-cholesterol levels did not reduce the risk of an adverse cardiovascular event.

In this Decade in Review article, I highlight the top 10 advances in heart failure (HF) over the past decade, including new pharmacological therapies and expanded indications for devices in HF with reduced ejection fraction. The poor progress in acute HF and HF with preserved ejection fraction is emphasised. Biomarkers and devices that help prevent, detect, and guide treatment represent the future of HF management.

Hypertension research in the past decade has been a mixture of hope and hype. In the absence of new drug developments, clinical intervention procedures such as renal nerve ablation and baroreflex activation therapy have dominated the research, but the results have not yet fulfilled the great expectations.

The past decade has seen considerable advances in the treatment of acute coronary syndromes (ACS), particularly in the search for improved antithrombotic therapies. Despite these successes, however, renewed efforts are needed to improve long-term outcomes after ACS by reducing recurrent ischaemic events and lowering the risk of bleeding complications.

The 2014 revision of the 2005 AHA consensus statement on the evaluation of women with suspected ischaemic heart disease is a major update. The authors discuss the spectrum of ischaemic heart disease and review new data on the diagnostic and prognostic performance of the various diagnostic testing modalities now available.

Uncertainty surrounds the benefit of β-blocker treatment in various clinical settings. The researchers in a new retrospective analysis of preoperative β-blocker use in CABG surgery now add to the debate, and suggest that these drugs might not improve perioperative outcomes.

Cryptogenic stroke is an apology for ignorance about the cause of ischaemic stroke. Now, in two new studies involving long-term electrocardiogram monitoring, investigators from the EMBRACE and CRYSTAL-AF trials suggest that many instances of cryptogenic stroke might be caused by undetected atrial fibrillation.

In an analysis of electronic health records, 1.25 million patients aged ≥30 years without diagnosed cardiovascular disease experienced 83,098 cardiovascular events during follow-up (median 5.2 years). Associations between incident cardiovascular disease and blood pressure differed for systolic and diastolic blood pressures and between the 12 cardiovascular end points examined.

A meta-analysis by investigators from FDA of three major trials of cardiac resynchronization therapy (CRT) demonstrated that women have a reduced rate of heart failure (HF) and death with CRT at a shorter QRS duration than men. Recognizing these sex-specific differences is important to improve outcomes for women with HF.

In May 2014, the FDA astutely stated that any decision to use aspirin should be an individual clinical judgement by health-care providers. Almost simultaneously, the MESA investigators formulated, but did not test, a hypothesis that coronary artery calcification scoring might aid health-care providers in making this judgement.