News & Views in 2016

Atherosclerosis is a disease of ageing, and the most common cause of death in the industrialized world. Cell senescence and the therapeutic removal of senescent cells using 'senolytics' are topical areas of science and translational medicine. A new study reports surprising findings on cell senescence and atherosclerosis with important therapeutic implications.

Ischaemic cardiomyopathy leads to destruction of cardiomyocytes beyond the regenerative potential of the adult human heart. The murine heart can regenerate in utero and shortly after birth, but oxidative stress eventually arrests cardiomyocyte division. Chronic hypoxia in mice has now been shown to induce the cell cycle in cardiomyocytes, resulting in cardiac regeneration.

When administered in the setting of an acute myocardial infarction, β-blockers decrease myocardial ischaemia, reduce the rates of reinfarction and serious ventricular tachyarrhythmias, and have substantial early benefits. However, the benefits of prolonged β-blockade after acute myocardial infarction are unproven and are discussed.

Blood-pressure lowering has undisputable benefits, but the optimal values to which blood pressure should be lowered are debated. Interpretation of recent trials is controversial, and post-hoc analyses to investigate the inflection point of the curve relating events to blood pressure are disputed. Meta-analyses of randomized trials and prospective, cohort studies might guide decision-making.

The ANTARCTIC trial does not provide sufficient evidence to refute the utility of platelet function monitoring in patients with high risk of coronary artery disease. Future trials on personalized antiplatelet therapy should try to address the limitations of previous studies.

The primary analysis of FIRE AND ICE demonstrated that cryoablation was noninferior to radiofrequency ablation for the primary efficacy end point of first documented clinical failure. Secondary analysis suggested that cryoablation had advantages over radiofrequency ablation in terms of rehospitalizations and repeat procedures; however, the validity of these results must be questioned.

In a new scientific statement, the AHA addresses the revolution brought by smartphones and social media to the field of emergency cardiology. New, attractive opportunities exist alongside new dangers. Information is currently delivered to the Internet without control. Trustworthy medical information is needed: it is time for scientific societies to take action.

Clinical guidelines advocate oral anticoagulation (OAC) for stroke prevention in patients with atrial fibrillation and ≥1 risk factors for stroke, but 40% of eligible patients receive aspirin, and those at greatest risk are least likely to be prescribed OAC. Why is there a discrepancy between guidelines and clinical practice?

The success of transcatheter aortic valve implantation (TAVI) is centred around the collaboration between cardiac surgeons and interventional cardiologists. A report from the German Quality Assurance Registry on TAVI now suggests that clinical outcomes in hospitals without cardiac surgery departments are similar to those in centres with onsite cardiac surgery support.

After some alarming results of intensified glucose control in patients with type 2 diabetes mellitus, and noninferiority (without superiority) of alogliptin, saxagliptin, sitagliptin, and lixisenatide treatment compared with placebo, the positive results in survival and cardiovascular and renal outcomes with empagliflozin and liraglutide have been acknowledged with enthusiasm by diabetologists and should deeply interest cardiologists.

Patients with acute coronary syndromes have an increased risk of stent thrombosis. A considerable proportion of these patients are also at increased risk of bleeding, representing a challenge to optimal selection of stent type and duration of dual antiplatelet therapy. Recent evidence supports polymer-free drug-eluting stents as a safe and effective option for this challenging subset of patients.

A recent pooled analysis of data from four studies found no increased risk of cardiovascular events and death with increased sodium intake in patients without hypertension. However, the study estimated sodium intake using only overnight urine collections rather than 24-h samples, and sodium excretion was not constantly monitored.

Mitochondria provide energy for specialized functions at the cellular and organ level. The remarkable symbiotic relationship between mitochondria and the cell touches on every aspect of cell biology. Recent studies in mitochondrial biology have uncovered ways in which mitochondria affect human disease and have identified new targets for clinical intervention.

Many patients who undergo doxorubicin chemotherapy develop cardiac complications later in life. Patient-derived cardiomyocytes can be used to predict individual susceptibility to drug-induced cardiotoxicity, as evidenced by enhanced doxorubicin responses in cardiomyocytes derived from induced pluripotent stem cells of patients who developed heart failure after chemotherapy.

Results from the HOPE-3 randomized trial reinforce and expand the evidence base supporting current clinical practice guidelines that recommend initiation of statin therapy in individuals at intermediate risk of atherosclerotic events. Furthermore, the results support the initiation of antihypertensive medication for patients with blood pressure above threshold values.

Sex has an important role in the diagnosis of coronary artery disease (CAD). Results from the PROMISE trial highlight the influence of sex on presentation characteristics, diagnostic testing, and subsequent cardiac events among patients with suspected CAD. Differences in plaque characteristics among patients with stable CAD have also been suggested.

Clinical trials are designed to test efficacy and safety of interventions in populations with carefully defined medical illnesses. Clinical practice is aimed at caring for individuals who might have similar characteristics. Clinical trial guidelines can obscure benefits of interventions in individuals, which might account for the failure to demonstrate benefit of a renin inhibitor in heart failure.

Newly published data recovered from a large, randomized, controlled trial conducted >4 decades ago show no difference in mortality between individuals with a diet rich in saturated fat and those with a diet rich in linoleic acid, despite the cholesterol-lowering effect of the latter. These findings challenge the widely accepted diet–heart hypothesis.

A new report has demonstrated the combined use of optical coherence tomography and molecular imaging within human coronary arteries. This combination provides a unique opportunity to look at plaque from a view not previously possible, opening the field for greater understanding of plaque biology in research and clinical practice.

Diabetes mellitus and hypertension are closely related, and guidelines have recommended aggressive treatment of hypertension in patients with diabetes. However, no single clinical trial is conclusive. An extensive review of the use of blood-pressure-lowering drugs in patients with diabetes supports treating blood pressure >140/90 mmHg, whereas reducing blood pressure in people with normal or high–normal blood pressure might have untoward effects.