Viewpoint in 2006

Diagnosis of dyslipidemia currently relies on calculating LDL cholesterol concentration, a strategy with limitations that can lead to underestimation of the patient's lipid levels and, consequently, their cardiovascular risk. In this Viewpoint, James Stein and Patrick McBride discuss how alternative options for characterizing dyslipidemia, such as measurement of apoplipoprotein B-100 and non-HDL cholesterol, and determining LDL particle size by nuclear magnetic resonance spectroscopy, could have clinical application.

The early promise of drug-eluting stents (DESs) led to their rapid assimilation into routine clinical practice, but enthusiasm for this relatively novel technology could be tempered by emerging safety concerns. In this Viewpoint, David Kandzari examines incidence and predictors of stent thrombosis in DESs versus bare-metal stents and contributes to the debate on whether the effi cacy of DESs outweighs the dangers associated with this therapy.

There are few available data on the incidence and risk factors of thromboembolism in heart failure, and the decision to recommend anticoagulant therapy for these patients is complex. In this Viewpoint, Drs Freudenberger and Halperin discuss the limited existing data on prophylactic approaches to this problem and appeal to physicians to support well-designed, randomized clinical trials of antithrombotic therapy in patients with heart failure.

Cardiovascular disease kills more women each year than any other condition, yet women's cardiovascular risks continue to be underestimated. Women tend to be diagnosed later in the course of their disease and receive less-intense therapy than men. In this Viewpoint, Sharonne Hayes discusses the causes of disparities in prevention, diagnosis, treatment and outcome between men and women with cardiovascular disease and emphasizes that educating the medical community, and women themselves, is crucial to reducing the sex bias and optimizing care.

Although genetic testing for hypertrophic cardiomyopathy and long QT syndrome is now clinically available, are we ready to reap the practical benefits of these molecular discoveries? How can genetic testing for heritable cardiovascular disorders improve the care of our patients now and in the future? As Allison Cirino and Carolyn Ho outline in this month's Viewpoint, the best is yet to come for genetic testing in cardiac disease.

Major bleeding is the most common noncardiac complication after percutaneous coronary intervention for coronary artery disease. The reduction of vascular access site complications in PCI procedures is, therefore, a critical challenge. In this month's Viewpoint, Martial Hamon discusses why an alternative access site is needed and compares the benefits of the transradial approach with those of the femoral approach.

Major advances have been seen both in the development and design of left ventricular assist devices. As a result, the indications for use have increased substantially. In this month's Viewpoint, Jonathan Chen, Yoshifumi Naka and Eric Rose explore the clinical promise and the current technical barriers of widespread application of left ventricular assist devices as destination therapy.

A huge body of evidence now supports aggressive LDL cholesterol lowering to reduce cardiovascular risk, but what LDL cholesterol target level should be recommended? Here, Philip Barter and Kerry-Anne Rye examine the safety issues associated with achieving very low levels of LDL cholesterol and whether it is feasible to achieve very low levels in all high-risk people.

Why is aspirin so popular in the management of cardiovascular disease? Few therapies in cardiovascular medicine have been studied so intently and adopted so widely as aspirin. In this Viewpoint, John Cleland discusses why he believes that the use of aspirin should be reviewed and withdrawn in many patients in whom it fails to show long-term benefit.

Could the presence of a patent foramen ovale be associated with the occurrence of migraine headaches? In this the first of two Viewpoints on patent foramen ovales, Jeremy Orr and Jonathan Tobis discuss the possibility that the majority of migraine headache could be treated by closing this patent foramen ovale passageway though the heart.

Here, Hans-Christoph Diener and Christian Weimar argue that patent foramen ovale closure should not be used for the prophylaxis of migraine until further evidence is obtained from properly conducted, prospective studies.

Studies have found that one of the most widely used illicit drugs, marijuana, could hold great therapeutic promise for the treatment of obesity, dyslipidemia, insulin resistance and atherosclerosis. Paul Szmitko and Subodh Verma discuss how modulation of the endocannabinoid system might form the basis of new therapeutic strategies for these pathophysiologically linked conditions.

Cardiac transplantation research has focused on predicting risk and determining pathogenic pathways, and hence finding targets for intervention. As the Human Genome Project is now ready to provide the information required for personalized treatment, this Viewpoint discusses genetic association studies and their potential application at different stages before and after cardiac transplantation.

The complexity of the anatomy and physiology with which patients with congenital heart disease present in adulthood often exceed the expertise of physicians not trained specifically in congenital heart disease. In this viewpoint, Michael A Gatzoulis argues that education is the key to improving care of the growing population of adults with congenital heart disease.

The Women's Health Study seemed to contradict evidence from randomized trials of aspirin by identifying a sex-related difference in response to aspirin in cardiovascular disease. In this Viewpoint Hennekens et al. discuss the findings and argue that concluding that there are sex-related differences in response to aspirin could be premature.