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The 'funny' current (If) has been the subject of 30 years of laboratory research and is an important therapeutic target in heart disease owing to its effects on heart rate. SHIFT, a trial in patients with all-cause heart failure, shows that If inhibition reduces combined mortality and rate of hospitalization and opens further avenues of research and therapeutic challenges.
In the past 3 years, several studies have reignited the controversy regarding the cardiovascular risk associated with the use of rosiglitazone. Until a prospective, well-controlled, randomized clinical trial is performed to adjudicate the issue definitively, physicians should be free to exercise clinical judgment, and weigh the comparative risks and benefits of agents such as rosiglitazone on a case-by-case basis.
Accurate early diagnosis of acute coronary syndrome (ACS) is a challenging clinical problem. Imaging myocardial fatty acid metabolism with β-methyl-p-[123I]-iodophenyl-pentadecanoic acid single-photon emission computed tomography was shown to improve the accuracy of ACS diagnosis in patients presenting with chest pain and might be a valuable technique in the emergency setting.
Vuurmans et al. have reported that, among 69,214 patients who underwent coronary angiography or percutaneous coronary intervention, transradial access was associated with a lower incidence of chronic kidney disease than the femoral approach. We discuss the importance of kidney injury following these procedures, and the potential protective mechanisms of transradial access.
Obstructive sleep apnea syndrome is known to cause hypertension and might also be an independent risk factor for stroke and myocardial ischemia. In this Review, Dr. Malcolm Kohler and Professor John Stradling discuss the biological mechanisms thought to underpin the association of obstructive sleep apnea with endothelial dysfunction and arterial disease.
Both hypertension and hypotension have been associated with late-life cognitive decline and dementia. Novak and Hajjar discuss evidence supporting the relationship between blood pressure and cognition and its underlying pathophysiological mechanisms. The role that antihypertensive therapy may have in the prevention of cognitive decline is also explored.
Induced pluripotent stem (iPS) cells are somatic cells that have been reprogrammed to an embryonic stem-cell-like state. This technology enables us to study the molecular mechanisms of development and disease processes, and provides a strategy for individualized diagnostics and therapy. In this Review, Timothy Nelson and colleagues describe the steps involved in bioengineering somatic cells to achieve pluripotency, allowing their differentiation into cardiomyocytes or any other cell type. Clinical applications of iPS cells, including treatment of cardiovascular conditions, are also discussed.
Prosthetic aortic valves are often required for patients with aortic stenosis. The optimal choice of valve in middle-aged patients is not clear and the available options all have drawbacks. Patient choice is the most important factor in deciding which valve to use, with biological valves increasingly favored over mechanical valves. The authors of this Review present the various prosthetic aortic valves currently in use and discuss the implications of prosthesis selection in this group of patients.
