Volume 13 Issue 6, June 2016

Results from the HOPE-3 randomized trial reinforce and expand the evidence base supporting current clinical practice guidelines that recommend initiation of statin therapy in individuals at intermediate risk of atherosclerotic events. Furthermore, the results support the initiation of antihypertensive medication for patients with blood pressure above threshold values.

Clinical trials are designed to test efficacy and safety of interventions in populations with carefully defined medical illnesses. Clinical practice is aimed at caring for individuals who might have similar characteristics. Clinical trial guidelines can obscure benefits of interventions in individuals, which might account for the failure to demonstrate benefit of a renin inhibitor in heart failure.

Sex has an important role in the diagnosis of coronary artery disease (CAD). Results from the PROMISE trial highlight the influence of sex on presentation characteristics, diagnostic testing, and subsequent cardiac events among patients with suspected CAD. Differences in plaque characteristics among patients with stable CAD have also been suggested.

Differences between women and men with atrial fibrillation have received far less attention in recent years than sex-specific differences in coronary heart disease and stroke. In this Review, Ko et al. discuss sex-specific differences in the incidence, prevalence, risk factors, and pathophysiology of atrial fibrillation, and the clinical presentation and prognosis of patients with this prevalent arrhythmia.

Human induced pluripotent stem cells (hiPSCs) can be differentiated into many cardiovascular cell types, including cardiomyocytes and endothelial cells. hiPSC-derived cardiovascular cells can recapitulate patient-specific and disease-specific phenotypes. In this Review, Chen et al. discuss how hiPSCs can be used as a platform for cardiovascular drug development and disease modelling, and can facilitate individualized therapy in the era of precision medicine.

Big data analytics have tremendous potential to improve cardiovascular quality of care and patient outcomes. In this Review, Rumsfeld and colleagues provide an overview of the data sources and methods that comprise big data analytics, describe the potential applications of these analyses in cardiovascular care and research, and delineate the principal challenges to implementing big data applications in cardiovascular practice.

Transcatheter aortic valve implantation (TAVI) is increasingly being used in patients with intermediate-risk and lower-risk profiles, but little is known about the durability of TAVI devices beyond 5 years. In this Review, Arsalan and Walther summarize the existing data on TAVI durability, highlight differences between surgical and transcatheter treatment of aortic stenosis that might influence durability, and discuss clinical solutions for failed prostheses.

Heart failure (HF) is a global epidemic affecting >37.7 million individuals globally. HF is associated with increased morbidity and mortality, and confers a substantial burden on the health-care system. In this Review, Ziaeian and Fonarow summarize the latest epidemiological data on HF in both developed and developing countries, and provide an overview of associated risk factors and aetiologies contributing to the disease burden.