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Current medical therapies for chronic stable angina pectoris do not always render patients free of symptoms and may not be well tolerated. Xanthine oxidase inhibition with drugs such as allopurinol might be a promising new approach to treat these patients.
Hypertrophic cardiomyopathy is the most common genetic heart disease and is associated with sudden cardiac death and development of heart failure. Risk stratification currently relies only on clinical risk factors, which have low positive predictive value. Myocardial fibrosis, assessed by contrast-enhanced cardiovascular magnetic resonance imaging, may improve risk stratification.
Anxiety has been shown to have prognostic importance in the development of coronary heart disease in initially healthy adults. This finding highlights the need of future research that includes representative samples of women and minorities, and uses precise assessment tools and careful ascertainment of clinical end points.
The hope that a simple, affordable, and safe homocysteine-lowering intervention with folic acid and vitamin B12 would improve outcomes for patients with established cardiovascular or renal disease has been crushed by the null results from large B-vitamin treatment trials completed to date.
Patients with diabetes mellitus and hypertension are at high cardiovascular risk and treatment guidelines recommend aggressive blood pressure (BP) control. However, a reanalysis of data from the previously published INVEST trial indicates that achieving systolic BPs <130 mmHg in patients with diabetes and coronary artery disease increases mortality, although this finding might reflect the speculative conclusions produced by post-hoc analyses.
In the second part of their Review on pulmonary embolism (PE), van Es and colleagues discuss risk stratification of patients with this condition, the short-term and long-term treatment options, and introduce some of the novel therapeutic agents under investigation for PE.
Cardiac magnetic resonance imaging (CMR) is an established diagnostic tool that provides accurate information on the myocardium. The authors of this Review suggest how CMR can be used in the acute setting to manage treatment and improve prognosis in patients with acute coronary syndromes. Current and emerging CMR techniques are discussed, as well as challenges facing CMR applications in clinical practice.
Animal models have generated much evidence to implicate the activation of Rho family proteins in the pathogenesis of hypertension. Pharmacological and genetic studies have indicated that Rho-protein signaling pathways also have a role in the generation of high blood pressure in humans. In this article, Drs. Loirand and Pacaud discuss our current knowledge of Rho-protein signaling in hypertension.
Pulmonary hypertension is frequently associated with left-sided heart disease. Patients with this condition have a poor outcome, and few therapeutic strategies are available. In this Review, Drs. Guazzi and Arena describe the consequences and clinical features of this form of pulmonary hypertension, from reversible injury to permanent remodeling. Current and emerging therapeutic approaches are also examined.
