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  • November 2019 marks 15 years since the launch of Nature Reviews Cardiology. To celebrate, we invited six of our Advisory Board members to discuss some of the highlights of cardiovascular research in the past 15 years and to make some projections about scientific research in the next 15 years.

    • Jonathan M. Kalman
    • Sergio Lavandero
    • Dong Zhao
    Viewpoint
  • The chairs of the ESC Task Force, the chairs of the ACC/AHA/HFSA Writing Committee, and an independent opinion leader in the field offer their expert insight into the new guidelines for the management of heart failure, highlighting what is new, what the main differences are between the two sets of guidelines, and what steps should be taken to improve the guidelines in future updates.

    • Mariell Jessup
    • Thomas H. Marwick
    • Clyde W. Yancy
    Viewpoint
  • To mark the 10th anniversary of Nature Reviews Cardiology, five of our Advisory Board members were invited to consider a topic within cardiology about which we know too little. The key opinion leaders from around the globe also suggest ways in which future research could be targeted to address the deficits in our understanding, with the aim of preventing cardiovascular disease, improving patient care, and reducing morbidity and mortality.

    • Ottavio Alfieri
    • Bongani M. Mayosi
    • Renu Virmani
    Viewpoint
  • Valve-sparing aortic root replacement in patients with Marfan syndrome avoids the complications of a prosthetic heart valve, particularly life-long anticoagulation therapy. Despite proven durability and excellent event-free survival, the majority of cardiac surgeons have not adopted this approach. Here, Stephen Westaby suggests that the time is right for a change in the surgical guidelines and explains that an early, elective valve-sparing operation can transform the long-term prognosis of patients with Marfan syndrome.

    • Stephen Westaby
    Viewpoint
  • The Polypill for prevention of cardiovascular disease was first proposed in 2003 and results of the first trials are eagerly anticipated. Regulatory agencies face the challenge of deciding which studies should be requested to meet reasonable demands regarding efficacy and safety of the Polypill in the intended (high-risk) target population. In this Viewpoint, Dr Forslund highlights the important issues that should be considered when generating these regulatory recommendations.

    • Lennart Forslund
    Viewpoint
  • In this thought-provoking Viewpoint and accompanying clinical vignettes, Sengupta and colleagues posit that clinicians should be aware of obstructive sleep apnea in patients with hypertrophic obstructive cardiomyopathy. They hypothesize that this sleep disorder could be the reason cardiomyopathy symptoms remain despite therapy and could also contribute to a raised gradient seen in some patients.

    • Partho P Sengupta
    • Dan Sorajja
    • A Jamil Tajik
    Viewpoint
  • Patient-prosthesis mismatch (PPM) is common after aortic valve replacement and has been shown to be associated with poor hemodynamic and symptomatic status, a high rate of cardiac events, and increased mortality. In this article, Philippe Pibarot and Jean G. Dumesnil highlight the importance of defining and recognizing PPM and its clinical impact. They also assert that, because PPM is a predictable and modifiable risk factor, it is vital to identify susceptible patients and to apply preventive strategies to avoid PPM or reduce its severity.

    • Philippe Pibarot
    • Jean G Dumesnil
    Viewpoint
  • In this opinion piece, Hideo Mitamura presents some of the new strategies that are increasing the use of automated external defibrillators (AEDs) by lay persons in Japan. Professor Mitamura hopes that, if other countries follow in adopting initiatives such as internet-based maps showing the location of public-access AEDs, the lives of many who suffer an out-of-hospital cardiac arrest will be saved.

    • Hideo Mitamura
    Viewpoint
  • Results of the STRADIVARIUS and ADAGIO-Lipids trials have fuelled debate about the use of the controversial CB1 receptor antagonist rimonabant. Here, Vincenzo Di Marzo discusses the key findings from these studies and their potential clinical sequelae, and identifies a subgroup of patients who might derive the most benefit from this drug.

    • Vincenzo Di Marzo
    Viewpoint
  • Patients with asymptomatic, severe aortic stenosis are at risk of cardiac death. In this Viewpoint, Pellikka and Sundt assert that aortic valve replacement should be considered in these patients, if surgery is likely to prolong life expectancy. Risk stratification of the asymptomatic aortic stenosis patient remains inadequate, however, and the decision to operate must be individualized, particularly in the elderly. The authors call for a randomized trial to help optimize the selection of patients for surgery.

    • Patricia A Pellikka
    • Thoralf M Sundt
    Viewpoint
  • Werner Mohl and coauthors present their Viewpoint examining pressure-controlled intermittent coronary sinus occlusion (PICSO). Here they postulate that PICSO should be introduced into the clinic as a valuable technique for activation of venous endothelium to initiate myocardial recovery and induce regeneration.

    • Werner Mohl
    • Stefan Mina
    • Gerald Maurer
    Viewpoint
  • Patients with dilated cardiomyopathy and functional mitral regurgitation (MR) have a very poor prognosis. Surgical correction of MR in this setting is controversial because survival benefit has not been proven; however, patients who have undergone mitral repair often show substantial symptomatic improvement and reverse left ventricular remodeling. Here, Michele De Bonis and Ottavio Alfieri argue that these 'end-stage' patients should not be denied surgery, and that mitral repair should be performed before irreversible deterioration occurs.

    • Michele De Bonis
    • Ottavio Alfieri
    Viewpoint
  • In this opinion piece, Dr Alejandro Lucia and colleagues assert that physically inactive modern lifestyles are incompatible with our genetic makeup, which is essentially unchanged from that of our Paleolithic ancestors. The authors highlight the importance of regular physical exercise in preventing the 'diseases of civilization' and to achieving cardiovascular health.

    • Alejandro Lucia
    • Carl Foster
    • Joaquín Arenas
    Viewpoint
  • There is much debate surrounding the etiology of cognitive decline following CABG surgery. In this Viewpoint, Neuropsychologist Ola Selnes postulates that this worrying complication is likely to be attributable to patient-related factors, such as the extent of pre-existing cerebrovascular disease, rather than to cardiopulmonary bypass.

    • Ola A Selnes
    Viewpoint
  • A substantial proportion of cardiovascular morbidity and mortality in developing countries is caused by cardiac complications of 'neglected diseases', such as Chagas disease, endomyocardial fibrosis, and rheumatic heart disease. Here, Yacoub et al. discuss management strategies for what they believe are potentially preventable diseases.

    • Sophie Yacoub
    • Susy Kotit
    • Magdi H Yacoub
    Viewpoint
  • Diuretics are used for symptomatic treatment of chronic heart failure; however, no randomized trials have yet assessed the long-term effects of these agents on morbidity and mortality. In this article, Vaz Pérez and colleagues question the assumption that long-term diuretic therapy is beneficial and opine that the currently available data do not support the routine use of diuretics as a cornerstone of long-term medical treatment for patients with chronic heart failure.

    • Amalia Vaz Pérez
    • Stefan D Anker
    • Mathias Rauchhaus
    Viewpoint