Featured
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Review Article |
Environmental factors in cardiovascular disease
Exposure to air pollution and to metals in the environment contributes to the development and severity of cardiovascular disease. Cosselman et al. review the pathophysiological processes associated with long-term and short-term exposure to these pollutants, at levels above and below current regulatory standards, and discuss the need for further reductions in levels of environmental pollutants.
- Kristen E. Cosselman
- , Ana Navas-Acien
- & Joel D. Kaufman
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Research Highlight |
Guidelines with high statin eligibility target risk and are cost-effective
- Robert Phillips
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Review Article |
Cardiovascular risks and benefits of moderate and heavy alcohol consumption
Although the harmful cardiovascular effects of alcoholism are well-known, the potentially beneficial effects of low-to-moderate alcohol intake are still debated. In this Review, Fernández-Solà considers the evidence for and against the cardioprotective properties of alcohol, and makes the case for the overall health benefits of reductions in alcohol consumption.
- Joaquim Fernández-Solà
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Review Article |
Cardiotoxicity of anticancer treatments
Patients with cancer often experience concomitant cardiovascular disease that results from the malignant process itself, or from anticancer treatment. Treatment-induced cardiotoxicity can be either transient or irreversible, and is associated with arrhythmia, ischaemia, and myocardial infarction. The authors discuss the mechanisms by which anticancer treatments damage the heart, and suggest potential strategies on how to protect patients with cancer from anticancer therapy-induced cardiotoxicity.
- Michael S. Ewer
- & Steven M. Ewer
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News & Views |
Smoking and CAD—what's plaque got to do with it?
The precise physiological mechanisms linking cigarette smoking with increased coronary risk remain largely speculative. Similarly, the reason why smoking cessation is effective at ameliorating this risk is also unclear. The subclinical study by Nakanishi and colleagues has challenged the orthodoxy that plaque formation is the necessary ingredient underpinning these associations.
- Rachel Huxley
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Review Article |
The mobile revolution—using smartphone apps to prevent cardiovascular disease
In an increasingly digital world, widespread access to smartphones and mobile technology might be harnessed to improve cardiovascular disease prevention, management, and rehabilitation. In this Review, Neubeck et al. discuss the burgeoning market of health-related mobile apps, and question whether they are evidence-based and beneficial to individuals with cardiovascular disease, and what design features might encourage behavioural change.
- Lis Neubeck
- , Nicole Lowres
- & Julie Redfern
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Opinion |
Ethics of preparticipation cardiovascular screening for athletes
Preparicipation screening for cardiovascular disease in young competitive athletes is a controversial topic. Moreover, young people not engaged in competitive sports can harbour the same conditions that cause sudden death in athletes. In this Perspectives article, Maron et al. question whether arbitrarily excluding individuals from potentially life-saving clinical screening because they do not engage in competitive sports programmes is ethical.
- Barry J. Maron
- , Richard A. Friedman
- & Arthur Caplan
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Review Article |
Prehypertension—prevalence, health risks, and management strategies
Prehypertension affects 25–50% of adults worldwide and is associated with incident hypertension and cardiovascular disease. In this Review, Egan and Stevens-Fabry provide guidance to health-care professionals by summarizing the available data on the prevalence of prehypertension, the related risk of cardiovascular morbidity and mortality, and the effect of lifestyle and medical interventions on reducing incident disease.
- Brent M. Egan
- & Sean Stevens-Fabry
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Review Article |
A major role for cardiovascular burden in age-related cognitive decline
Cardiovascular disease and cognitive decline share similar pathogenetic processes such as atherosclerosis and ischaemia. Evidence from multidisciplinary studies has shown that vascular risk factors present during young adulthood and mid-life can be risk factors for the development of cognitive decline and dementia in later life. In this Review, Qiu and Fratiglioni discuss the literature examining the association of cardiovascular burden with cognitive decline and dementia over the life-course.
- Chengxuan Qiu
- & Laura Fratiglioni
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Research Highlight |
Reducing factor XI with antisense oligonucleotides superior to endoxaparin for postoperative venous thromboembolism
- João H. Duarte
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Year in Review |
Advances in the prevention of cardiovascular disease
Prevention of cardiovascular diseases (CVDs), particularly atherosclerosis, remains a priority on the global health agenda. A healthy lifestyle at both individual and population levels, combined with pharmacological treatment of CVD risk factors, is recommended. In this Year in Review article, we discuss the major advances in CVD prevention in 2014.
- Nizal Sarrafzadegan
- & Carolyn Gotay
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Research Highlight |
No benefit of antiplatelet pretreatment in patients with NSTE-ACS
- Gregory B. Lim
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Review Article |
Novel antiplatelet agents in acute coronary syndrome
Dual antiplatelet therapy (DAPT) with aspirin and the P2Y purinoceptor 12 (P2Y12)-receptor inhibitor clopidogrel has been considered the gold standard of care in patients with acute coronary syndrome (ACS). The FDA approval of the novel P2Y12-receptor antagonists prasugrel and ticagrelor, which are faster-acting and more potent than clopidogrel, in the past 5 years have improved clinical outcomes in patients with ACS. Even with these newer compounds, many patients continue to experience adverse ischaemic events. This Review will provide an overview of the antiplatelet agents currently used to treat patients with ACS. Furthermore, emerging antiplatelet therapies, including intravenous P2Y12antagonists, oral PAR-1 antagonists and thromboxane-receptor inhibitors will be discussed.
- Francesco Franchi
- & Dominick J. Angiolillo
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Opinion |
Top 10 cardiovascular therapies and interventions for the next decade
The global epidemic of cardiovascular disease is being fuelled by the spread of a Western lifestyle characterized by a high prevalence of cardiovascular risk factors. In this Perspectives article, Valentin Fuster highlights 10 therapies and interventions that, in his opinion, will be most useful in combating cardiovascular disease and promoting cardiovascular health over the next decade.
- Valentin Fuster
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Research Highlight |
Colchicine therapy prevents postpericardiotomy syndrome but not postoperative atrial fibrillation
- João H. Duarte
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Review Article |
Global availability of cardiac rehabilitation
Cardiac rehabilitation participation reduces mortality and rehospitalization of patients with cardiovascular disease, but this cost-effective treatment programme is still underused worldwide. In this Review, Turk-Adawi and colleagues describe the global availability of cardiac rehabilitation and highlight strategies that might increase its use, particularly in low and middle-income countries.
- Karam Turk-Adawi
- , Nizal Sarrafzadegan
- & Sherry L. Grace
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Opinion |
Does cardiovascular protection translate into renal protection?
Cardiovascular and renal disease often have similar origins and shared risk factors. With the progression of chronic kidney disease, additional risk factors develop, contributing to the evolution of both diseases. In this Perspectives article, Ruiz-Hurtado and Ruilope postulate that that simultaneous protection for both cardiovascular and renal disease can be achieved with the same therapy. They review the evidence from clinical trials supporting this theory, and discuss strategies to prevent both cardiovascular and chronic kidney disease.
- Gema Ruiz-Hurtado
- & Luis M. Ruilope
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Research Highlight |
Mechanistic insights into the cardiovascular benefits of a Mediterranean diet
- Gregory B. Lim
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News & Views |
Aspirin in primary prevention needs individual judgements
In May 2014, the FDA astutely stated that any decision to use aspirin should be an individual clinical judgement by health-care providers. Almost simultaneously, the MESA investigators formulated, but did not test, a hypothesis that coronary artery calcification scoring might aid health-care providers in making this judgement.
- Charles H. Hennekens
- & David L. DeMets
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Review Article |
Lipid lowering with PCSK9 inhibitors
Statins and other drugs are widely used to lower the LDL-cholesterol level, which has been shown to prevent cardiovascular events. In this Review, Dadu and Ballantyne review the latest evidence on a novel class of LDL-lowering agents: proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors. In particular, monoclonal antibodies against PCSK9 have proven efficacious and safe in phase I–III clinical trials.
- Razvan T. Dadu
- & Christie M. Ballantyne
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Research Highlight |
Childhood exposure to parental smoking confers lifelong increase in cardiovascular risk
- Gregory B. Lim
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Correspondence |
Optimizing treatment benefit: individualized therapy or the polypill?
- Jasper J. Brugts
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Review Article |
Oral anticoagulants for Asian patients with atrial fibrillation
Asian individuals have a higher risk of stroke associated with atrial fibrillation (AF) than white patients. The use of the vitamin K antagonist warfarin is low in Asian countries, owing to the challenge of controlling anticoagulation and the high-risk of haemorrhage with warfarin in Asians. The non-vitamin K antagonist, oral anticoagulant drugs offer a solution to these challenges. In this article, Sabir et al. discuss the use of these agents in the management of AF in Asian populations.
- Ian Sabir
- , Kaivan Khavandi
- & A. John Camm
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Review Article |
Cardiac sympathetic denervation to prevent life-threatening arrhythmias
Left cardiac sympathetic denervation (LCSD) has antiarrhythmic and antifibrillatory effects that are beneficial for patients with channelopathies, such as long QT syndrome or catecholaminergic polymorphic ventricular tachycardia. In this Review, Peter Schwartz expertly summarizes the development and current indications for LCSD, including emerging evidence for a potential beneficial effect in patients with ischaemic cardiomyopathy or heart failure.
- Peter J. Schwartz
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Research Highlight |
Increased risk of cardiovascular death in adults who eat high levels of added sugar
- Bryony M. Mearns
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News & Views |
New risk-assessment guidelines—more or less personalized?
The new ACC/AHA cardiovascular-risk guidelines feature updated equations for women, distinct equations for African–American individuals, and include stroke prediction. However, the equations rely on the same traditional risk factors as previous versions, are driven predominantly by age, and curtail the intermediate-risk group, in which personalized risk assessment is recommended.
- Michael J. Blaha
- & Roger S. Blumenthal
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Year in Review |
New statin guidelines and promising novel therapeutics
The new ACC/AHA guidelines on treatment of blood cholesterol focus on intensity of statin therapy rather than target levels of lipids. Early studies show substantial reductions in LDL-cholesterol level with antibodies against PCSK9. MicroRNA silencing and gene-repair techniques to treat dyslipidaemia are promising strategies under development.
- Dimitri P. Mikhailidis
- & Vasilios G. Athyros
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In Brief |
A little education goes a long way
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Research Highlight |
Genotype-guided anticoagulation therapy—the jury is still out
- Alexandra Roberts
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News & Views |
Coronary artery calcium and polypill therapy
Controversy surrounds the use of polypills in the primary prevention of cardiovascular disease, particularly in relation to which individuals should be targeted for treatment. Coronary artery calcium imaging has been presented as being of potential benefit in excluding those who are least likely to benefit from such treatment.
- Ruth Webster
- & Anthony Rodgers