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The early promise of drug-eluting stents (DESs) led to their rapid assimilation into routine clinical practice, but enthusiasm for this relatively novel technology could be tempered by emerging safety concerns. In this Viewpoint, David Kandzari examines incidence and predictors of stent thrombosis in DESs versus bare-metal stents and contributes to the debate on whether the effi cacy of DESs outweighs the dangers associated with this therapy.
Diagnosis of dyslipidemia currently relies on calculating LDL cholesterol concentration, a strategy with limitations that can lead to underestimation of the patient's lipid levels and, consequently, their cardiovascular risk. In this Viewpoint, James Stein and Patrick McBride discuss how alternative options for characterizing dyslipidemia, such as measurement of apoplipoprotein B-100 and non-HDL cholesterol, and determining LDL particle size by nuclear magnetic resonance spectroscopy, could have clinical application.
Currently, the only proven treatment to re-establish cerebral blood flow in acute ischemic stroke is intravenous tissue plasminogen activator within 3 h of symptom onset. Few patients, however, qualify for this therapy. Here, Juttler et al. provide an integrated view of the current state of reperfusion therapy in acute stroke patients and discuss future treatment options to extend the therapeutic window for intervention.
The cardiovascular benefits of statin therapy are well documented; however, no trial has identified a target level for LDL cholesterol below which no further benefit of treatment is seen. With the introduction of more-aggressive optional LDL-cholesterol targets in US guidelines, Antonio Gotto and John Farmer consider the rationale for combination therapy of statins with the cholesterol absorption inhibitor ezetimibe.
The current treatment for patients receiving coronary stents is dual antiplatelet therapy. Approximately 5% of these patients, however, require long-term anticoagulation because of an underlying chronic medical therapy and, theoretically, should receive triple therapy, which increases bleeding risk. Here, Helft et al. critically appraise the available literature concerning antithrombotic therapy and make recommendations for antiplatelet therapy following revascularization in the small subset of patients already receiving anticoagulation.
The loss of cardiomyocytes in failing or cardiomyopathic hearts is gradual and not accompanied by inflammation or major histomorphologic deformity. Apoptosis, therefore, seems to be the most logical mechanism of cell death. In this Review, Narula et al. discuss the role of apoptosis in systolic dysfunction and heart failure, and in the development of novel strategies for the management of heart failure.
