Volume 10 Issue 11, November 2013

PCSK9 antibodies effectively lower the LDL-cholesterol level and, therefore, address an unmet clinical need in patients with either refractory hypercholesterolaemia, statin intolerance, or an elevated lipoprotein(a) level. On the basis of ongoing clinical outcome trials, these agents might reset the target LDL-cholesterol level to <50 mg/dl.

Remote ischaemic conditioning has been extensively studied, and encouraging proof-of-concept clinical trial data have emerged. A study newly published in The Lancet takes the field an important step forward, demonstrating for the first time that remote ischaemic conditioning before CABG surgery reduces all-cause mortality.

A case–control study of five classes of antihypertensive medication used among 2,851 women shows that taking calcium-channel blockers for ≥10 years is associated with increased risk of invasive ductal and lobular breast carcinoma. These results are intriguing, but warrant additional investigation given the study limitations and inconsistent findings in the literature.

Cardiac troponins (cTn) are the preferred biomarkers for the noninvasive detection of myocardial injury. However, cTn are not exclusively released as a result of ischaemic myocardial cell necrosis, but also with acute and chronic nonischaemic conditions. In this Review, Giannitsis and Katus describe the causes and the prognostic importance of the release of cTn not related to acute coronary syndromes, and recommend strategies to discriminate between ischaemic and nonischaemic cTn elevation.

Patients with coronary artery disease, who do not respond to optimal medical therapy, are candidates for revascularization. In this Review, Javaid Iqbal and colleagues discuss the evidence for CABG surgery versus percutaneous coronary intervention as the optimal revascularization method in patients with complex coronary artery disease. The choice of technique is dependent on the patient's overall medical state, and the authors highlight the most appropriate surgery in specific patient groups.

Hypertriglyceridaemia is heterogeneous in aetiology, involving interactions between genetic and nongenetic factors. Although the importance of elevated triglyceride concentrations in the primary and secondary prevention of cardiovascular disease is uncertain, hypertriglyceridaemia is known to be an indicator of other risk factors for cardiometabolic diseases and atherosclerosis. In this Review, Watts and colleagues present contemporary knowledge in the field of hypertriglyceridaemia, and provide practical guidance on managing this condition.

The techniques and indications for percutaneous intervention in adults with congenital heart disease can vary considerably from those of paediatric populations. Here, the most common percutaneous techniques applied in adults with structural congenital lesions are described. Singh et al. also discuss the additional requirements of specialized catheterization laboratories, the integration of imaging modalities, and the need for a collaborative multidisciplinary model for improved patient care.