Year in Review

The VITAL trial showed that neither vitamin D nor fish oil supplementation significantly reduced the incidence of cardiovascular disease (CVD). Conversely, current evidence supports the benefits of multiple dietary patterns, especially the Mediterranean diet, in primary prevention of CVD. Health effects of low-carbohydrate diets depend on the food sources of macronutrients.

More than 150 years after acetylsalicylic acid was synthesized by French chemist Charles Frédéric Gerhardt, aspirin is still one of the most prescribed medications worldwide. In 2018, several trials have suggested that the role of aspirin in the contemporary era might be less pre-eminent than in previous decades.

The main advances in interventional cardiology in 2018 include the new European guidelines on revascularization, new developments in the treatment of cardiogenic shock, novel stent technology from Asia and clinical trial data showing no benefit of dropping aspirin after stenting.

A number of papers published in 2018 have provided important information expected to influence clinical practice, particularly for the management of functional mitral regurgitation in patients with heart failure caused by ischaemic or non-ischaemic cardiomyopathy and for the treatment of severe aortic stenosis in patients at low surgical risk.

Precision cardiology is a vision of a health-care approach that identifies the optimal course of care for each patient. Although precision cardiology is still in its nascent stage, new approaches and methodologies are being developed to achieve this goal and to overcome technical and implementation barriers. In 2018, several high-impact studies made progress in this direction.

Considerable evidence supports a role for low-grade chronic inflammation in the atherothrombotic process, from plaque initiation to acute plaque rupture preceding myocardial infarction. Publications in 2018 revealed both the promise and challenges of targeting inflammation to treat atherosclerotic cardiovascular disease and highlighted the importance of understanding the mechanistic diversity of inflammatory pathways contributing to atherosclerosis.

Important milestones in cardiac regenerative medicine that will define future research were reached in 2017: demonstration of adult cardiomyocyte renewal capacity, recognition of the importance of the extracellular matrix and the higher regenerative efficacy of repetitive dose protocols, and the publication of human data supporting paracrine effects of stem cell therapies and guidelines from TACTICS, the first international alliance on cardiac regenerative medicine.

Research on dyslipidaemias in 2017 reaffirmed the central role of reducing the levels of atherogenic apolipoprotein B-containing lipoproteins, predominantly LDL, in preventing ischaemic cardiovascular events. However, whether increasing HDL-cholesterol levels in isolation can reduce cardiovascular risk remains to be determined.

In 2017, several high-impact studies in thrombosis were published. Refinements were made in the optimal therapy for patients with stable atherosclerosis or with atrial fibrillation undergoing percutaneous coronary intervention. Risk scores to determine duration of antiplatelet therapy were developed. The potential risk of subclinical valve leaflet thrombosis was identified.

In 2017, genetic research on cardiovascular disease (CVD) produced seemingly paradoxical findings. Thanks to the continuous upscaling of genotyping and sequencing data, researchers have discovered that whereas numerous genetic variants among the general population can increase CVD risk, an individual can tolerate most severe genetic alterations.

In 2017, a cluster of papers have provided strong evidence in favour of the inflammation hypothesis in cardiovascular disease. From fundamental observations on clonal haematopoiesis to clinical evidence indicating that blocking an inflammatory cytokine mitigates heart disease, 2017 has been a watershed year.

The past year provided strong evidence on the use of the instantaneous wave-free ratio to determine the severity of coronary artery disease, the improving outcomes of contemporary percutaneous coronary intervention, the increased risk of thrombosis with bioresorbable vascular scaffolds, and the benefits of a simple revascularization strategy in cardiogenic shock.

In 2016, advances in atherosclerosis research were focused on the discovery and validation of new targets with genetic and mechanistic links to atherothrombotic heart disease. Novel targets include proteins involved in glycoprotein recognition and clearance, regulators of triglyceride-rich particle metabolism, inflammatory pathways that impair efferocytosis, and the gut microbiome.

Clinical cardiac electrophysiology has evolved rapidly over the past 2 decades. Although the fast pace of technical and therapeutic advances has occasionally outpaced evidence supporting widespread effectiveness, the highlights of electrophysiology research in 2016 illustrate the emergence of robust evidence for implementation of several important therapies.

Much of the progress in cardiovascular genetics in 2016 has been driven by next-generation sequencing studies, and the clinical utility of knowing an individual's genotype for predicting their risk of cardiovascular disease is gaining credibility, both for monogenic and polygenic disorders. Additionally, phenotype data are increasingly abundant, although databases linking genotype with clinically relevant phenotypes require optimization.

The leading studies in 2016 on acute coronary syndromes focused on strategies of acute coronary management, from the influence of revascularization timing on outcomes, to selection of second-generation antiplatelet therapy and the utility of monitoring platelet function in patients at high risk of coronary artery disease.

Statins remain the first-line therapy for dyslipidaemia. In 2015, however, effectiveness in reducing serum cholesterol levels and decreasing rates of cardiovascular disease in combination with statins has been demonstrated for two new classes of drugs: cholesterol-absorption inhibitors and PCSK9 inhibitors. The latter rival statins in their capacity to lower cholesterol levels.

The proportion of the lay population that is trained in cardiopulmonary resuscitation is closely linked to the probability of an individual surviving cardiac arrest. New mobile-assisted technologies might increase the benefit of population-based training. Furthermore, admission of patients to specialized hospitals can increase the likelihood of survival.

Cardiovascular genomics has evolved substantially in the past 2 decades. Numerous papers published in 2015 demonstrate that new genomic approaches, often used synergistically, can yield noteworthy findings. A range of laboratory, analytical, and bioinformatic techniques to uncover genetic contributors to coronary artery disease, myocardial infarction, and dilated cardiomyopathy are described.

Third-generation drug-eluting stents (DES) have emerged as first-line devices for percutaneous coronary intervention, even in patients with high bleeding risk. Studies published in 2015 report that bioabsorbable vascular scaffolds are equally effective and safe as DES in low-risk populations and, with the addition of extended dual antiplatelet therapy, might improve long-term outcomes.