Volume 10 Issue 3, March 2013

Adequate platelet inhibition early in the course of ST-segment elevation myocardial infarction treated by primary percutaneous coronary intervention is essential to reduce stent thrombosis and recurrent myocardial infarction. Pharmacodynamic data now suggest that additional platelet inhibition beyond that provided by either prasugrel or ticagrelor might be necessary.

Randomized trials of open versus endovascular repair (EVR) of abdominal aortic aneurysm have demonstrated the short-term superiority of EVR, but have raised questions about the long-term durability of this approach. The final report from the OVER trial now demonstrates that EVR is the treatment of choice for morphologically suitable aortic aneurysms.

The renin–angiotensin–aldosterone system (RAAS) is well established as a therapeutic target in patients with heart failure. Professors Lang and Struthers discuss new indications for existing drugs—angiotensin-converting-enzyme inhibitors, angiotensin II-receptor blockers, and mineralocorticoid-receptor antagonists—as well as novel ways of targeting the RAAS—direct inhibition of renin or dual blockade of the angiotensin II-receptor and neprilysin—in patients who have heart failure with or without reduced ejection fraction.

Incidence of sudden cardiac death is elevated in elderly individuals owing to increasing prevalence of coronary heart disease and congestive heart failure in this population. A substantial proportion of primary prevention implantable cardioverter-defibrillator (ICD) and cardiac resynchronization therapy (CRT) devices are being implanted in these patients; thus, additional outcomes data are needed. In this Review, Tung and Albert examine the causes of SCD in elderly individuals and discuss the existing evidence for effectiveness of ICD therapy and CRT in this growing population.

Blood pressure is characterized by short-term and long-term fluctuations, which are the result of complex interactions between environmental and behavioural factors, on the one side, and cardiovascular regulatory mechanisms on the other. Increased blood pressure variability (BPV) leads to cardiac, vascular, and renal damage and has been associated with an increased risk of cardiovascular morbidity and mortality. Parati et al. review the mechanisms, assessment and prognostic importance of BPV. They also address the question of whether BPV should be a target for antihypertensive treatment in the prevention of cardiovascular disease.

Pulmonary and peripheral oedema are fundamental features of heart failure; however, clinical data for optimal management of these conditions are lacking. In this Review, Clark and Cleland describe the pathophysiology of both types of cardiogenic oedema and discuss how knowledge of the pathophysiology can guide treatment.

In this opinion article, the authors suggest an alternative hypothesis for the pathogenesis of rheumatic heart disease. They believe that an interaction between streptococcal M protein and the infected individual's collagen results in the production of anticollagen autoantibodies. They also believe that molecular mimicry, which has previously been implicated in rheumatic heart disease, probably has no role in the pathogenesis of this condition.