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Atrial fibrillation (AF) is increasingly being treated using percutaneous or surgical procedures. During 2012, various key studies improved our understanding of which forms of AF respond best to catheter ablation, how to optimize the ablation procedure and postprocedural care, and which patients should receive medical therapy.
New findings published in 2012 have challenged common beliefs about stable coronary artery disease. Studies have shown that β-blockers and n-3-polyunsaturated fatty acids have no impact on prognosis, that percutaneous coronary intervention is not always the best option, and that women do not have worse cardiovascular outcomes than men.
In the 2012 ESC guidelines for the management of heart failure, various gaps in the clinical evidence base were identified. Four studies published in 2012 go some way to resolving this data deficit, and treatment recommendations can now be updated accordingly.
In 2012, results from three studies in interventional cardiology have enhanced our knowledge on the best practices to improve clinical outcomes. These trials were focused on treatment safety as well as efficacy. The optimal therapeutic strategy for patients undergoing percutaneous coronary intervention continues to evolve.
Studies published in 2012 in the field of HDL research have provided further evidence suggesting that a low HDL-cholesterol level, in the absence of related lipid or nonlipid risk factors, is not associated with increased risk of coronary heart disease.
Gliptins are a novel class of oral antihyperglycaemic agent that inhibit dipeptidyl peptidase 4. Professor Scheen describes the pleiotropic beneficial effects of these drugs, beyond basic glycaemic control in patients with type 2 diabetes mellitus, to emerging data and ongoing trials on cardiovascular protection in patients with ischaemic heart disease or congestive heart failure.
Patients hospitalized for heart failure (HF) have a high risk of postdischarge rehospitalization or mortality. Phase III trials of HF drugs have failed to show safety or efficacy, despite encouraging results from phase II studies. Muthiah Vaduganathan and colleagues overview five drug development programs for HF and discuss the importance of choosing the 'right' drug, target population, and clinical end points to optimize trial design.
Medical devices are often life-saving therapies in patients with advanced heart failure whose condition worsens despite optimal medical therapy. Drs Abraham and Smith expertly review the development of cardiac resynchronization therapy and left ventricular assist devices, describe the current challenges associated with these treatment strategies, and speculate on future advances in this fast-moving field.
Current algorithms for cardiovascular-risk prediction focus on identifying individuals who are at high short-term risk of experiencing a cardiovascular event. Drs Karmali and Lloyd-Jones advocate that lifetime-risk estimation should be used as an adjunct to 10 year risk prediction, to motivate individuals who have a low short-term, but substantial lifetime, risk (such as many women and young men) to adopt healthy, preventive behaviour.
