Volume 12 Issue 8, August 2015

Dual antiplatelet therapy is the cornerstone of treatment after drug-eluting stent implantation. Although treatment for 12 months is the standard of care in many parts of the world, the optimal duration of treatment is still being determined. Meta-analysis data now suggest that shorter or longer durations might yield preferred outcomes in different patient subgroups.

Uncertainty surrounds the benefit of preventive pharmacological therapies in reducing aortic disease in patients with Marfan syndrome. The Marfan Sartan trial now suggests that losartan is not beneficial in reducing the rate of aortic dilatation—the precursor of dissections and premature death in Marfan syndrome.

The Wells rule is the most widely used pretest clinical probability score for patients with suspected deep-vein thrombosis. However, the rule was developed and validated in the outpatient setting, and its accuracy in hospitalized patients has not been investigated previously. A new study indicates that this rule should not be used in the inpatient setting.

Percutaneous device-based intervention has received increasing attention over the past 10 years. Carotid baroreflex activation therapy holds promise as a device-based intervention to supplement, but not replace, drug therapy for patients with drug-resistant hypertension. In this Review, Victor provides an overview of the current body of evidence for the utility of this intervention in patients with drug-resistant hypertension, and discusses the promise and possible pitfalls of this technology, highlighting potential solutions.

Venous thromboembolism, including deep-vein thrombosis and pulmonary embolism, is a common, often-recurring condition that is occurring with increasing frequency, despite the availability of prophylactic treatments. The epidemiology of VTE involves interactions between predispositions to thrombosis and a range of risk factors, including hospitalization, cancer, and pregnancy.

Drug response and the development of adverse effects can vary between individuals. The use of pharmacogenomics should aid in the delivery of the right drug to the right patient, but clinical implementation of pharmacogenetic principles has been difficult, owing to a lack of randomized clinical trials that demonstrate benefit of this approach. This article reviews the use of pharmacogenetic markers in randomized clinical trials, highlighting studies related to cardiovascular disease.

Cardiomyocyte function is regulated by epigenetic modifications (to cytosine residues on DNA, and post-translational acetylation or methylation of histones), as well as by noncoding RNAs (such as microRNAs and long noncoding RNAs). In this Review, Greco and Condorelli describe the complex roles of these two layers of gene-expression regulation in the pathogenesis of cardiac hypertrophy and failure.