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Prevention of stroke in patients with atrial fibrillation (AF) requires oral anticoagulation therapy. We discuss the clinical utility of the GRASP-AF tool to identify patients with AF who are suitable for oral anticoagulation on the basis of their stroke risk profile, and propose assessment using the CHA2DS2–VASc score.
The diagnosis of obstructive coronary artery disease (CAD) can be challenging and relies on noninvasive imaging methods and coronary angiography. Advances in genetic technologies have enabled large-scale gene-expression studies. A gene-expression score has been shown to predict the presence of obstructive CAD.
No therapy has been proven to reduce morbidity and mortality in patients with heart failure and preserved ejection fraction (HFpEF). Owing to the deleterious cardiovascular effects of aldosterone, mineralocorticoid antagonists hold promise to treat this disorder. The Aldo-DHF trial provides valuable insights into the effects of these agents in HFpEF.
Trials in patients with dyslipidaemia or cardiovascular disease have shown no beneficial effects on 'hard' clinical end points, and increased rates of adverse effects, when niacin is added to statin therapy. These findings lead us to question whether niacin has a role in modern lipid-lowering strategies.
New-generation drug-eluting stents (DES) utilize various drugs, polymers, and scaffold technologies, which have improved the safety of these stents in comparison with first-generation DES. Clinicians now have a variety of stents to choose from, and the choice can be tailored to the individual patient. Garg and colleagues present the concepts and rationale behind these new stent designs, and introduce some of the clinical data that support their use. In this Review, they aim to provide an update for general and interventional cardiologists who treat patients undergoing percutaneous coronary intervention.
Cardiorenal comorbidity results from both the concordance of shared risk factors, and the systemic inflammation and vascular calcification that occur in patients with cardiac and renal disease. Kahn and colleagues review the epidemiology, pathophysiology, diagnosis, and pharmacological and interventional treatment of cardiovascular conditions in patients with chronic kidney disease or end-stage renal disease.
Telomere shortening, along with various other endogenous and environmental factors, can drive cells into senescence, which is involved in the complex process of biological ageing. In this Review, Fyhrquist and colleagues discuss the associations between cardiovascular risk factors and telomere shortening, and whether cellular senescence has a causal role in conditions such as atherosclerosis, heart failure, and hypertension.
Rheumatic fever (RF) and rheumatic heart disease (RHD) are neglected diseases, although RHD remains the most common cardiovascular disease among the young people. This position statement is a declaration of the World Heart Federation Working Group on RF and RHD strategic goal to reduce by 25% the number of premature deaths from RF and RHD among individuals aged <25 years by the year 2025. The Working Group affirms key strategic targets, reviews barriers to RF and RHD control, and identify the actions required to change the trajectory of control for these diseases.
Resistant hypertension is difficult to treat. In a Perspectives, Solini and Ruilope argue that many patients with resistant hypertension actually have mismanaged primary hypertension. They discuss how to identify misclassified patients and how to correctly manage hypertension.
