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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.
