Volume 12 Issue 5, May 2015

Strong associations exist between sleep disordered breathing (SDB) and both atrial fibrillation (AF) and heart failure (HF). Burgeoning epidemics of obesity, SDB, AF, and HF make these conditions priorities for health-care policymakers. Two observational studies now suggest outcome benefits from screening and treating for SDB in AF and HF.

The precise physiological mechanisms linking cigarette smoking with increased coronary risk remain largely speculative. Similarly, the reason why smoking cessation is effective at ameliorating this risk is also unclear. The subclinical study by Nakanishi and colleagues has challenged the orthodoxy that plaque formation is the necessary ingredient underpinning these associations.

Cardiovascular disease and cognitive decline share similar pathogenetic processes such as atherosclerosis and ischaemia. Evidence from multidisciplinary studies has shown that vascular risk factors present during young adulthood and mid-life can be risk factors for the development of cognitive decline and dementia in later life. In this Review, Qiu and Fratiglioni discuss the literature examining the association of cardiovascular burden with cognitive decline and dementia over the life-course.

Cardiac sarcoidosis is a life-threatening condition characterized by the formation of granulomas in the heart, and can lead to heart failure, heart block, or rhythm disturbance. The diagnosis of cardiac sarcoidosis is complicated, as patients often remain asymptomatic, despite cardiac imaging results suggestive of heart disease. In this Review, Hamzeh et al. discuss the current screening and management protocols used to identify and treat patients with cardiac sarcoidosis.

Prehypertension affects 25–50% of adults worldwide and is associated with incident hypertension and cardiovascular disease. In this Review, Egan and Stevens-Fabry provide guidance to health-care professionals by summarizing the available data on the prevalence of prehypertension, the related risk of cardiovascular morbidity and mortality, and the effect of lifestyle and medical interventions on reducing incident disease.

Risk-assessment models are important for the identification of individuals at high risk of developing cardiovascular diseases. Although several well-known models for risk assessment have been published in Europe and the USA, very few studies have discussed the development of risk-assessment models from a global perspective. In this Review, Zhao and colleagues discuss differences in risk-assessment recommendations from developed compared with developing countries, and consider their effects on clinical practice.

Randomized clinical trials are the gold-standard clinical trial design, because they can control for confounding factors. However, they also limited by large financial costs and rigid selection criteria. A possible solution to these limitations is the registry-based randomized clinical trial (RRCT). In this Perspectives article, James et al. discuss the features of RRCTs, and how this trial design can be used to conduct studies efficiently and cost-effectively.