Health care articles within Nature Reviews Cardiology

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  • Review Article |

    This Review highlights the often-overlooked role that nonadherence has in apparent 'resistance' to antiplatelet therapy. Emerging evidence indicates that the prevalence and clinical impact of nonadherence to therapy overshadow that of true biochemical nonresponsiveness in the chronic phases of antiplatelet treatment. Potential reasons for this nonadherence, which should be considered when trying to overcome apparent 'resistance' to this therapy, are discussed.

    • Kumaran Kolandaivelu
    •  & Deepak L. Bhatt

  • Opinion |

    Obesity is a major health challenge that is associated with chronic disease. The authors of this Perspectives article put forward a model that places sedentary behavior and calorie overload upstream of numerous disease processes. The authors highlight the importance of physical activity and cardiorespiratory fitness, which are possibly stronger predictors of risk than traditional factors, such as obesity.

    • Olivier L. Charansonney
    •  & Jean-Pierre Després

  • Review Article |

    Diagnosis of hereditary transthyretin-related amyloidosis (ATTR) is challenging owing to its extremely heterogeneous phenotype. The existence of predominantly cardiac presentations should prompt cardiologists to consider ATTR in patients with otherwise unexplained left ventricular wall thickening. Orthotopic liver transplantation (or combined heart–liver transplantation) can potentially provide surgical 'gene therapy' in patients with ATTR, provided that diagnosis is timely.

    • Claudio Rapezzi
    • , Candida Cristina Quarta
    •  & Angelo Branzi

  • Review Article |

    To date, treatment strategies for heart failure have focused on the symptomatic stage of disease, often after irreversible remodeling and functional impairment have occurred. Early identification of cardiac dysfunction would allow implementation of early intervention strategies to delay the progression or to prevent the onset of heart failure altogether. This Review highlights the utility of a staged approach for patients with predisposing risk factors, which uses serological biomarkers followed by noninvasive imaging techniques.

    • Geoffrey de Couto
    • , Maral Ouzounian
    •  & Peter P. Liu

  • Review Article |

    Echocardiography is commonly used to assess hypertrophic myopathies. The authors of this Review outline imaging modalities that are more sensitive than standard echocardiography, which can be used to determine characteristic changes in regional deformation at an earlier stage, and provide more information about the underlying processes associated with different hypertrophic myopathies.

    • Maja Cikes
    • , George R. Sutherland
    •  & Bart H. Bijnens

  • Review Article |

    Current strategies for prevention of cardiovascular disease (CVD) are focused on identifying individuals at high risk by recognizing and managing established cardiovascular risk factors. Early detection of subclinical atherosclerosis is a promising opportunity for CVD prevention. In this article, the authors review the role of noninvasive imaging techniques in understanding the mechanisms of atherosclerosis and in identifying early stages of disease, and highlight their potential impact on CVD prevention.

    • Valentin Fuster
    • , Fátima Lois
    •  & Manuel Franco

  • Opinion |

    The current guidelines for prevention of cardiovascular disease are based on estimates of long-term risk. Smeeth and Hingorani recommend awareness of the importance of fluctuations of risk over short periods of time and suggest a new paradigm for management of cardiovascular disease that is based on targeting therapy to short periods of enhanced risk.

    • Liam Smeeth
    •  & Aroon D. Hingorani

  • Review Article |

    In this Review, Drs Kullo and Cooper discuss the role of genomics and proteomics in cardiovascular risk assessment, using the specific example of atherosclerosis. The availability of good markers for risk stratification might enable the health-care system to become more proactive, moving the focus away from treatment of end-stage coronary heart disease and towards early detection of disease risk and prevention of adverse outcomes.

    • Iftikhar J. Kullo
    •  & Leslie T. Cooper

  • News & Views |

    The safest and most effective treatment for symptomatic vertebral artery stenosis has not yet been proven. Here, we discuss the merits and pitfalls of endovascular treatment for this under-recognized disease entity.

    • Mandy J. Binning
    •  & L. Nelson Hopkins

  • News & Views |

    The development of left ventricular assist devices could be considered an 'imaginative leap'. In the current phase of critical evaluation of these devices, a study of patients who received first-generation left ventricular assist devices has indicated that they might affect late post-transplant survival. The validity and significance of these findings need to be examined further.

    • Magdi H. Yacoub

  • Review Article |

    Detection of fetal conduction system abnormalities relies upon magnetocardiographic or electrocardiographic recording techniques. Appropriate fetal treatment requires awareness of arrhythmia characteristics, mechanisms, and their potential associations. This Review discusses current and future diagnostic techniques and pharmacologic treatments for fetal arrhythmia.

    • Janette F. Strasburger
    •  & Ronald T. Wakai

  • Review Article |

    Atrial fibrillation (AF) is the most common cardiac arrhythmia. Early management of this disorder using imaging, antiarrhythmia drugs and catheter ablation is necessary to prevent the progression of AF. In this Review, the authors discuss the current status of important facets of the early management of AF and emphasize the need for a greater understanding of the underlying etiology, which will lead to novel treatment approaches and amelioration of AF.

    • Ashok J. Shah
    • , Xingpeng Liu
    •  & Michel Haïssaguerre

  • Review Article |

    Sudden cardiac death (SCD) is a serious health concern worldwide. Despite the need for risk factors that can identify high-risk individuals, there are few available owing to the complex and often asymptomatic nature of SCD. In this Review, Sumeet Chugh outlines novel risk markers and predictors of SCD that will allow more effective prevention, and suggests a framework for studies in the future for the discovery and validation of these risk markers.

    • Sumeet S. Chugh

  • Review Article |

    The number of patients undergoing implantation of a cardioverter-defibrillator (ICD) is increasing, as the indications for device therapy have broadened. Despite the mortality benefits associated with ICDs, they can also cause substantial complications. Drs. Wazni and Wilkoff explore the issues involved in managing patients with an ICD and discuss approaches for reducing these adverse effects, from prevention of infection, and the choice of lead and implantation technique, to strategies for programming and monitoring the device.

    • Oussama Wazni
    •  & Bruce L. Wilkoff

  • Review Article |

    This Review discusses the effects of intensive glycemic control on cardiovascular disease in patients with diabetes, and examines key factors in recent intervention trials that might have contributed to their disparate findings. The authors suggest that care of these patients should focus on achieving current treatment goals, rather than on changes to glycemic targets.

    • Aparna Brown
    • , L. Raymond Reynolds
    •  & Dennis Bruemmer

  • News & Views |

    A continuous-flow left ventricular assist device (LVAD) improved survival free from disabling stroke compared with a pulsatile LVAD, when used as destination therapy over a 2-year period in patients with advanced heart failure. Both devices improved patient quality of life. Continuous-flow devices are smaller, lighter, and more simple than pulsatile LVADs and have the potential to fulfill all the requirements of a permanently implanted blood pump.

    • Yukihiko Nosé

  • News & Views |

    Klersy et al. have performed a meta-analysis of remote monitoring of patients with heart failure. Programs using structured telephone support (telephone-monitoring approach) were combined with those using transmission of physiological data (technology-assisted approach) in combination with telephone communication. Results from this study may inform policy makers regarding a potential solution to reducing hospital readmissions.

    • Mary Ann McLaughlin

  • News & Views |

    Patients with structural heart disease are at risk for life-threatening ventricular tachycardias (VTs). Implantable cardioverter-defibrillators (ICDs) can terminate VT, but often at the cost of traumatic shocks, syncope, or even exacerbation of underlying heart disease. Catheter ablation for VT can reduce the need for ICD therapies and is an increasingly important adjunct to the treatment of these patients.

    • Usha B. Tedrow
    •  & William G. Stevenson

  • Review Article |

    Over the past 30 years, we have witnessed a steady improvement in life expectancy of patients with Marfan syndrome, owing to advances in various treatments. In Part 2 of a 2-part Review on Marfan syndrome, Dr. Cañadas and colleagues discuss the present the state of the art in the management of patients with this disease.

    • Victoria Cañadas
    • , Isidre Vilacosta
    •  & Valentin Fuster

  • Review Article |

    The cardiovascular manifestations of Marfan syndrome are the main cause of morbidity and mortality in patients with this disease. In Part 1 of a 2-part Review on Marfan syndrome, Dr Cañadas and colleagues discuss the pathogenesis of Marfan syndrome, our idea of which has dramatically changed in the past decade, as well as the current strategy for diagnosis.

    • Victoria Cañadas
    • , Isidre Vilacosta
    •  & Valentin Fuster

  • Opinion |

    Controversy exists as to whether the detection of myocardial edema, to quantify myocardial damage and assess myocardial salvage, is ready for clinical use or is still only practical as a research tool. In this Perspectives article, Matthias Friedrich explains his point of view on this issue—that myocardial edema imaging using magnetic resonance technology should be seen as the essential diagnostic modality of choice for patients with suspected myocardial injury by virtue of its safety, versatility, and cost-efficiency.

    • Matthias G. Friedrich

  • Review Article |

    Statin therapy has been associated with improved outcomes in patients with heart failure. However, two large prospective, controlled trials showed neutral effects with rosuvastatin. The authors of this Review highlight data from observational studies that have showed positive outcomes, and discuss how the design of the two large trials may have contributed to the neutral effects of statin therapy on the survival of patients with heart failure.

    • W. H. Wilson Tang
    •  & Gary S. Francis

  • Review Article |

    Imaging techniques that assess myocardial perfusion and coronary anatomy obtain complementary information. Simultaneous dual-modality or sequential multimodal imaging techniques facilitate integration of this information, and thus have the potential to improve diagnostic and prognostic evaluations, as well as care of patients. This Review discusses the clinical utility and future directions of hybrid imaging.

    • Ron Blankstein
    •  & Marcelo F. Di Carli

  • Review Article |

    The introduction of drug-eluting stents (DES) has greatly reduced in-stent restenosis. Improvements to this technology are required, however, as safety and efficacy are still a problem. This Review describes current DES and the methods that are being used to optimize the performance of these stents. The author also suggests the direction of DES in the future, including tailored therapy to improve patient outcomes.

    • Rainer Wessely

  • News & Views |

    Inflammation might be involved in the pathophysiology of atrial fibrillation. Glucocorticoid use can attenuate inflammation and might be an effective therapy for atrial fibrillation. However, some population-based studies have reported an increased risk of atrial fibrillation associated with glucocorticoid use. Whether this link results from a direct effect of glucocorticoids or from the underlying inflammatory disease remains to be elucidated.

    • Michiel Rienstra
    •  & Isabelle C. Van Gelder

  • News & Views |

    Aldosterone antagonists decrease the mortality of patients with heart failure, but an observational study by Albert and colleagues has found that a surprisingly low number of patients receive aldosterone antagonists before discharge from hospital. This article highlights potential reasons for why there is such an underuse of efficient drugs in heart failure.

    • Jane-Lise Samuel
    •  & Claude Delcayre

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