Health sciences articles within Nature Reviews Cardiology

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  • News & Views |

    CABG surgery has been considered the optimal revascularization strategy for patients with diabetes mellitus who have left main and/or multivessel coronary artery disease. The results of a new analysis of data from the SYNTAX trial challenge this conventional wisdom and highlight additional coronary revascularization options to physicians and patients.

    • G. Robert Myers
    •  & William S. Weintraub

  • News & Views |

    The diagnosis of diabetes mellitus in clinical practice has been mainly based on the measurement of glucose levels in blood. Growing evidence, including results from a new large-scale population study, however, strongly suggests that the assessment of glycated hemoglobin levels has advantages over measurement of glucose levels in predicting the risk of developing diabetes or cardiovascular disease.

    • Nicholas J. Wareham
    •  & Roman Pfister

  • News & Views |

    Whether thiazolidinediones should be used to treat patients with type 2 diabetes mellitus is controversial, as studies on the cardiovascular effects of these drugs have produced conflicting results. A trial in which rosiglitazone and glipizide were compared supports earlier findings that rosiglitazone does not have an adverse effect on the progression of coronary atherosclerosis.

    • Michael E. Farkouh
    •  & Valentin Fuster

  • News & Views |

    The relationship between patent foramen ovale and migraine is a hotly debated issue. Conflicting data on the association or independence of these conditions have been reported by various study groups around the world. Now, a large-scale case–control study has shown no association between the two entities; however, there were a number of methodological flaws in this study and we are unlikely to see the end of the controversy in the near future.

    • Gianluca Rigatelli

  • News & Views |

    The impact of overlap of drug-eluting stents on clinical and angiographic outcomes is controversial. Individuals with long coronary lesions requiring implantation of multiple stents are an important patient subgroup for whom careful evaluation and decision-making with optimal stent deployment is needed to ensure the best possible short-term and long-term results.

    • Antonio Colombo
    •  & Rasha Al-Lamee

  • Review Article |

    Antithrombotic therapy with ADP-receptor antagonists or anticoagulant agents improves outcomes in patients with acute coronary syndromes and/or undergoing percutaneous coronary intervention. However, the current standard-of-care ADP-receptor antagonist for dual antiplatelet therapy, clopidogrel, and the currently available oral anticoagulants, the coumarins, have several limitations. In this Review, the authors discuss the pharmacology and clinical potential of new antithrombotic drugs, with an emphasis on data from phase III clinical trials.

    • Jeremy S. Paikin
    • , John W. Eikelboom
    •  & Jack Hirsh

  • Review Article |

    The Fontan palliation was introduced in 1968 for congenital heart defects with a single dominant ventricle. Although considerable technical improvements have meant that this procedure can be applied to a wide range of patients, the Fontan circulation has intrinsic limitations. Professors de Leval and Deanfield consider the past four decades of Fontan palliation and describe how developments have moved practice closer to the 'perfect' Fontan. Future challenges and possible solutions are also discussed.

    • Marc R. de Leval
    •  & John E. Deanfield

  • Review Article |

    Although effective therapies for hypertension exist, the prevalence of elevated blood pressure and resistant hypertension is increasing and novel treatment strategies are needed. In this Review, Drs. Paulis and Unger discuss new targets for antihypertensive therapy, many of which, including renalase and the (pro)renin receptor, are based on modulation of the renin–angiotensin–aldosterone system. Invasive strategies, such as renal denervation, are also explored.

    • Ludovit Paulis
    •  & Thomas Unger

  • Review Article |

    The duration and frequency of episodes of atrial fibrillation (AF) and the longitudinal history of this arrhythmia can vary markedly across patients. The currently accepted scheme for AF classification is based on temporal rhythm-based patterns. In this Review, the authors discuss the advantages and limitations of this categorization, highlighting gaps in knowledge that are opportunities to re-examine the current scheme and may lead to future improvements in AF classification.

    • Steven A. Lubitz
    • , Emelia J. Benjamin
    •  & Patrick T. Ellinor

  • News & Views |

    Combination therapy is used to lower blood pressure in the majority of patients with hypertension, yet there has been little evidence as to which classes of antihypertensive agents are most effective. The publication of findings from the ACCOMPLISH trial provides an opportunity to explore the merits of various combination therapies, with a focus on renal risk reduction.

    • William B. White

  • News & Views |

    Carotid endarterectomy (CEA) is considered the gold standard for treatment of stenosis, but carotid artery stenting (CAS) is a less invasive procedure that offers a promising alternative. Short-term data from ICASS suggest that CEA is superior to CAS; however, features of the study design may have affected the results, and long-term data are needed before conclusions can be made.

    • Sandra Narayanan
    •  & Seemant Chaturvedi

  • News & Views |

    The ankle–brachial index (ABI) can be used to assess the risk of cardiovascular events. The AAA trial aimed to determine whether low-dose aspirin was of net benefit among apparently healthy people with an ABI ≤0.95. The largely negative findings of this study raise important mechanistic and practical questions.

    • Carlo Patrono
    •  & Colin Baigent

  • 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

  • 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 |

    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

  • 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

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