Volume 13 Issue 3, March 2016

A new meta-analysis by Ettehad and colleagues, which included >613,000 patients with hypertension from randomized, controlled trials, clearly demonstrates that antihypertensive medication reduces cardiovascular events and death in all patients, including those with systolic blood pressure <130 mmHg and regardless of concomitant diseases. The risks of stroke and heart failure were particularly reduced.

Successful application of spinal cord stimulation (SCS) is dependent on the location of bioelectric stimuli, the stimulation protocol employed, and the substrate being targeted (neural and cardiac). Safety concerns for bioelectrical treatment of heart failure with reduced ejection fraction have been addressed, but optimization of SCS delivery remains a concern.

Glutathione is considered the major natural antioxidant, protecting cells from oxidative stress. Patel and colleagues used plasma levels of the aminothiols cystine and glutathione to quantify oxidative stress in patients with coronary artery disease, and show that the cystine/glutathione ratio is associated with increased mortality. Is this a new approach for clinical risk stratification?

Atrial fibrillation (AF) and heart failure (HF) are evolving epidemics with increasing global prevalence. HF is known to promote AF, but how AF exacerbates or even causes HF is uncertain. In this Review, Ling and colleagues present the current understanding of the epidemiology and pathophysiology of AF–HF, and the roles of pharmacological and interventional therapies in the management of patients with this comorbidity.

Systems of care have been established to optimize treatment of ST-segment elevation myocardial infarction (STEMI) occurring out of hospital, but not for patients in hospital. Unfavourable clinical characteristics of patients, combined with suboptimal strategies for diagnosis and treatment, mean that inpatient STEMI is associated with high mortality. Eliminating system delays and increasing use of reperfusion therapy could improve outcomes for inpatient STEMI.

The Purkinje system can be a source of arrhythmias and has been shown to trigger ventricular fibrillation. The complexity of the molecular mechanisms of ventricular fibrillation, and the incomplete understanding of Purkinje arrhythmogenicity, make the identification of vulnerable individuals challenging. In this Review, Haissaguerre and colleagues discuss the current knowledge of the pathophysiological mechanisms underlying Purkinje-related arrhythmias, and highlight the current therapeutic options.

Regulatory T (T_REG) cells are important for the induction and maintenance of immune homeostasis and tolerance. Numerous experimental and clinical studies have suggested a role for T_REG cells in protection against cardiovascular diseases, particularly atherosclerosis and abdominal aortic aneurysms. In this Review, Meng and colleagues summarize the available evidence on the role of T_REGcells in several cardiovascular disorders, such as atherosclerosis, hypertension, Kawasaki disease, and myocardial infarction.