Volume 14 Issue 2, February 2017

In the PRECISION trial involving patients with arthritis, moderate doses of a selective cyclooxygenase 2 inhibitor were not associated with increased cardiovascular events compared with submaximal doses of nonselective NSAIDs. The balance between pain relief and cardiovascular risk with NSAIDs should be further investigated in patients with chronic inflammatory rheumatic diseases.

In 2016, advances in atherosclerosis research were focused on the discovery and validation of new targets with genetic and mechanistic links to atherothrombotic heart disease. Novel targets include proteins involved in glycoprotein recognition and clearance, regulators of triglyceride-rich particle metabolism, inflammatory pathways that impair efferocytosis, and the gut microbiome.

Much of the progress in cardiovascular genetics in 2016 has been driven by next-generation sequencing studies, and the clinical utility of knowing an individual's genotype for predicting their risk of cardiovascular disease is gaining credibility, both for monogenic and polygenic disorders. Additionally, phenotype data are increasingly abundant, although databases linking genotype with clinically relevant phenotypes require optimization.

Clinical cardiac electrophysiology has evolved rapidly over the past 2 decades. Although the fast pace of technical and therapeutic advances has occasionally outpaced evidence supporting widespread effectiveness, the highlights of electrophysiology research in 2016 illustrate the emergence of robust evidence for implementation of several important therapies.

The leading studies in 2016 on acute coronary syndromes focused on strategies of acute coronary management, from the influence of revascularization timing on outcomes, to selection of second-generation antiplatelet therapy and the utility of monitoring platelet function in patients at high risk of coronary artery disease.

Microorganisms that populate the human body have been shown to be involved in metabolic and cardiovascular disorders, but the precise mechanisms are not completely understood. In this Review, Lindskog Jonsson and Bäckhed describe the different pathways by which the gut microbiota might affect the development of atherosclerosis.

The association between exercise and increased risk of atrial fibrillation among athletes is well established. In this Review, Guasch and Mont discuss the evidence supporting the existence of exercise-induced arrhythmias and describe the special considerations for management of these patients.

Genetic cardiomyopathies are complex diseases with heterogeneous clinical presentations and phenotypes, and mild pathology can overlap with physiological variation, particularly in athletes. In this Review, three of the most common and controversial areas are discussed, including left ventricular hypertrophy; left ventricular dilatation, noncompaction, and fibrosis; and arrhythmias originating from the right ventricle.

Women with atrial fibrillation (AF) generally experience worse symptoms, poorer quality of life, and have higher risk of stroke and death than men with AF. In this Review, Ko et al. summarize the evidence on sex-specific differences in the utilization and outcomes of treatments for AF, including rate-control and rhythm-control strategies, and stroke-prevention therapy.