Volume 11 Issue 7, July 2014

The SYMPLICITY HTN-3 trial demonstrated unexpectedly large and small blood pressure reductions in the control and renal denervation groups, respectively. Although this study was well designed, it had several weaknesses and the results are inconclusive, with the exception of the positive signal for renal denervation in non-African-American individuals.

In the CORP-2 trial, patients with multiple recurrences of idiopathic or autoimmune pericarditis were randomly assigned to receive colchicine or placebo, in addition to standard anti-inflammatory therapy. After 6 months, colchicine significantly reduced recurrent pericarditis rates. Are we moving closer to a reliable treatment for this common disease?

In this Review, Otsuka et al. describe how optical coherence tomography (OCT)—an intravascular imaging modality with high resolution—can be used to define various stages of plaque progression. The authors also highlight how OCT might be used in the identification of high-risk plaques vulnerable to rupture in patients with coronary disease, to enable pre-emptive interventional treatment, and how OCT might be used in the management of acute coronary syndromes.

Catastrophic acute coronary events are often the result of ruptured atherosclerotic plaques and subsequent luminal thrombosis. Preventing such an event seems to be the only effective strategy to reduce mortality and morbidity of coronary artery disease. This Review highlights how computed tomography angiography might be combined with fluid dynamic assessment to identify rupture-prone plaques in patients with coronary artery disease.

Dysregulation of the natriuretic peptide system has been associated with several life-style related metabolic and cardiovascular disorders, including obesity, type 2 diabetes mellitus, hypertension, atherosclerosis, thrombosis, and myocardial ischaemia, implying biological effects beyond pressure–volume homeostasis. In this Review, Zois et al. discuss the role of the various natriuretic peptides in the pathophysiology of these cardiometabolic conditions.

Angiotensin-converting enzyme 2, and its product angiotensin 1–7, are thought to have counteracting effects against the adverse actions of the better-known members of the renin–angiotensin system and might, therefore, be useful therapeutic targets in patients with cardiovascular disease. Professor Jiang and colleagues review the evidence for the potential roles of these proteins in various cardiovascular conditions, including hypertension, atherosclerosis, myocardial remodelling, heart failure, ischaemic stroke, and diabetes.

Coronary 'no-reflow' is a substantial clinical problem, even after successful percutaneous coronary intervention for myocardial infarction. In this Perspectives, article, O'Farrell and Attwell describe the similarities between this phenomenon and no-reflow in the brain after ischaemic stroke, and propose that pericytes contribute to the underlying pathophysiology in both situations. Cardiac pericytes might, therefore, be a novel therapeutic target for coronary no-reflow.