Volume 5 Issue 7, July 2008

In this opinion piece, Dr Alejandro Lucia and colleagues assert that physically inactive modern lifestyles are incompatible with our genetic makeup, which is essentially unchanged from that of our Paleolithic ancestors. The authors highlight the importance of regular physical exercise in preventing the 'diseases of civilization' and to achieving cardiovascular health.

Considerable controversy continues to surround diastolic heart failure—is diastolic heart failure even a separate entity from systolic heart failure? In this Review, Maral Ouzounian, Douglas Lee and Peter Liu examine the evolving understanding of this important, albeit controversial, condition from molecular mechanisms to how the population is affected.

There is considerable semantic confusion when it comes to differentiating between the array of chemically and functionally distinct progestins used therapeutically. Hermsmeyer et al. consider the research reported to date, clearly distinguishing between the cardiovascular actions of estrogen, medroxyprogesterone acetate (a synthetic progestin) and progesterone (the naturally occurring progestin).

Noninvasivein vivoimaging to monitor the trafficking or homing of hematopoietic progenitor cells to vascular lesions is essential for both basic research and clinical practice. Here Qiu and Yang examine molecular MRI of stem-progenitor cells in atherosclerosis. They discuss advanced techniques for magnetic labeling of stem-progenitor cells, and how this modality could be used to monitor stem-progenitor cells migrating to injured arteries and vascular gene therapy mediated by stem-progenitor cells.

In this month's Case Study, Cha and colleagues present a 51-year-old male patient referred for consideration for heart transplantation because of recently diagnosed congestive heart failure refractory to medical therapy. He was diagnosed with cardiomyopathy resulting from pulmonary vein tachycardia, which was treated with catheter-based radiofrequency ablation of pulmonary vein tachycardia focus.

Rheumatic heart disease is an important problem in developing countries but many cases are detected only when the disease has progressed to cardiac failure. Screening can detect cases earlier, but there are no screening guidelines. In this paper the authors describe a novel screening protocol and report a high echocardiographically confirmed prevalence of rheumatic heart disease among Tongan schoolchildren.

Leptin may be a key regulator of C-reactive protein (CRP) levels, which in turn, is a marker of systemic inflammation. Both leptin and CRP are predictors of cardiovascular disease (CVD). High leptin levels are independently associated with CVD even after adjustment for CRP; elevated CRP levels are not associated with CVD after adjustment for leptin. However, subjects with increased leptin and CRP are at the highest risk for CVD.

Clinical Context commentary on Carapetis et al. This article sets out the clinical context of the research presented by Carapetis et al. in an accompanying article in this issue. No screening guidelines exist for early detection of rheumatic heart disease (RHD). The lack of agreed diagnostic criteria is one of the reasons why large proportions of cases in resource poor nations go untreated and are detected only when the disease has progressed to cardiac failure. Here, Poole-Wilson and Seth discuss the study carried out by Jonathan Carapetis and colleagues—a cross-sectional screening protocol in Tongan primary school children. The protocol designed by Carapetis et al. identified the highest echocardiographically confirmed prevalence of RHD reported to date. Poole-Wilson and Seth explore how modern technology, in the shape of portable echocardiography, can help to move the focus on rheumatic heart disease away from epidemiology and crude preventive programs, and towards screening programs that can effectively identify people who should receive treatment before cardiac failure occurs.

Clinical Context commentary on Romero-Corral et al.