Health care articles within Nature Reviews Cardiology

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  • News & Views |

    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.

    • Giora Weisz
    •  & Martin B. Leon

  • News & Views |

    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.

    • Raphaël Duivenvoorden
    •  & Zahi A. Fayad

  • News & Views |

    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.

    • Sanjay Kaul
    •  & George A. Diamond

  • News & Views |

    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.

    • Cesare M. Terracciano
    •  & Magdi H. Yacoub

  • News & Views |

    Patient selection for implantation of a cardioverter-defibrillator for primary prevention of sudden cardiac death is especially difficult in inherited arrhythmia syndromes, owing to a lack of randomized outcome studies in this setting. Two registry studies and the first report of a long-term follow-up of defibrillators in primary prophylaxis have provided some information regarding patient selection, but have important limitations.

    • Arnold Pinter
    •  & Paul Dorian

  • Review Article |

    Abdominal aortic aneurysms (AAAs) are a localized dilatation of the aorta that represents a systemic disease process. Mortality associated with a ruptured AAA is high, but no tests to predict the risk of rupture currently exist. In this Review, Nordon and colleagues outline the pathophysiology and epidemiology of AAA and the risk factors for this condition. They also discuss factors that influence the outcome of patients with AAA after surgical management.

    • Ian M. Nordon
    • , Robert J. Hinchliffe
    •  & Matt M. Thompson

  • Review Article |

    Blood pressure (BP) targets in patients with hypertension and diabetes mellitus have generally been based on global guidelines. However, these targets are often aggressive, and do not consider the patient's individual risk. Some studies have indicated that intensive BP lowering might not always reduce the risk of cardiovascular events. The authors of this Review present the evidence both for and against intensive BP lowering therapy, and suggest a personalized approach to treatment in the future.

    • Rhonda M. Cooper-DeHoff
    • , Eric F. Egelund
    •  & Carl J. Pepine

  • Review Article |

    Heart failure (HF) is a clinical syndrome that carries substantial morbidity and mortality. The prevalence of HF is increasing and represents a large burden to the health-care system and society. The authors of this Review discuss the epidemiology of HF and the impact of HF on health services. The risk profile of HF is also examined, highlighting factors that contribute to HF and identifying those who are most at risk of developing this syndrome.

    • Anh L. Bui
    • , Tamara B. Horwich
    •  & Gregg C. Fonarow

  • Opinion |

    In this opinion article, Dr. Vedanthan and Dr. Fuster discuss the urgent need to integrate CVD-related human resource requirements into the global agenda for increasing human resources for health care. They suggest strategies and emphasize gaps in knowledge regarding human resources for global CVD-related care.

    • Rajesh Vedanthan
    •  & Valentin Fuster

  • Review Article |

    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.

    • Joanna Chikwe
    • , Farzan Filsoufi
    •  & Alain F. Carpentier

  • Review Article |

    Congenital heart disease is the most frequent of congenital disorders in newborns. Reliable epidemiological data for congenital heart disease, however, have been difficult to obtain owing to divergences in definitions, classifications, and methodologies of different studies. The authors of this Review discuss the latest changes in the epidemiology of congenital heart disease and its complications.

    • Teun van der Bom
    • , A. Carla Zomer
    •  & Barbara J. M. Mulder

  • Review Article |

    Increasing life expectancy in industrialized societies has resulted in a huge population of older adults with cardiovascular disease. Pharmacological treatment is the mainstay of therapy for these patients. In this extensive Review, Jerome Fleg and colleagues address the challenges associated with cardiovascular drug therapy in the elderly, as well as providing an in-depth discussion of specific disease states and drug types in this patient population.

    • Jerome L. Fleg
    • , Wilbert S. Aronow
    •  & William H. Frishman

  • Review Article |

    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.

    • Vera Novak
    •  & Ihab Hajjar

  • News & Views |

    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.

    • Nina Ajmone Marsan
    •  & Jeroen J. Bax

  • News & Views |

    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.

    • James A. Blumenthal
    •  & Patrick J. Smith

  • News & Views |

    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.

    • Ranil de Silva
    •  & Kim M. Fox

  • News & Views |

    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.

    • Michael A. Weber

  • News & Views |

    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.

    • Marta Ebbing
    •  & Per Magne Ueland

  • Review Article |

    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.

    • Marco Guazzi
    •  & Ross Arena

  • News & Views |

    Determining the appropriate dose of warfarin that should be used in each patient is challenging, and the rate of adverse events at the beginning of therapy remains high. Testing for genetic variability related to warfarin sensitivity at the start of treatment is a promising strategy to guide dosing in clinical practice.

    • Sarina A. van der Zee
    •  & Jonathan L. Halperin

  • News & Views |

    The best strategy for management of patients with non-ST-segment elevation acute coronary syndrome is still a matter of debate. A meta-analysis, in which results from three large-scale studies were pooled, shows that a routine invasive approach is associated with better 5-year outcomes than a selectively invasive approach.

    • Charles V. Pollack Jr
    •  & George W. Christy

  • News & Views |

    Transvenous leads are the most common source of complications associated with the use of implantable cardioverter-defibrillators (ICDs). A preliminary experience with an entirely subcutaneous ICD system, which avoids the need for transvenous leads, has been reported. We discuss these results and the importance of investigations in this new field.

    • Paolo Spirito
    •  & Giuseppe Boriani

  • News & Views |

    T2-weighted cardiovascular magnetic resonance imaging (T2W-CMR) has been championed as the best noninvasive method to determine the myocardial area at risk and to quantify myocardial salvage in patients with acute coronary syndromes. However, several unresolved issues warrant discussion and we urge caution when utilizing T2W-CMR for this purpose.

    • W. Benjamin Wince
    •  & Raymond J. Kim

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