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Representation of Black patients in cardiovascular clinical trials remains dismally low, reflective of systemic and structural barriers, which can lead to missed opportunities to meet community-identified needs, understand responses to medical therapies and improve cardiovascular care. Innovative, multilevel strategies focused on Black communities are warranted to increase enrolment of this population into clinical research.
Mosaic loss of chromosome Y (mLOY) refers to the condition in male individuals in which a detectable fraction of cells lose the Y chromosome. Prevalent in haematopoietic cells, this common somatic mutation is associated with decreased longevity and an increased risk of age-related diseases, including cardiovascular disease. Haematopoietic mLOY provides further insight into the sex-specific disparities that exist in disease susceptibility.
Racial and ethnic disparities in cardiovascular health in the USA result in a persistent mortality gap between white and Black individuals, increase health-care costs and compromise an egalitarian society. Solutions to racial inequities require risk factor control and the implementation of evidence-based medicine and anti-racism policies. Overcoming these disparities is not only a practical necessity, but also a moral imperative.
For patients with heart failure and reduced left ventricular ejection fraction, intravenous iron is likely to deliver clinical and prognostic benefits for those with anaemia and transferrin saturation <20%, especially if serum ferritin exceeds 100 μg/l. A serum ferritin of <100 μg/l does not appear to be useful as a marker of iron deficiency.
Despite the high consumption of fermented foods and beverages worldwide, their role in a healthy diet is still up for debate. Some fermented beverages have been demonstrated to protect against cardiovascular disease, but many aspects of the effects of fermented foods on cardiovascular health are uncertain. Better-designed studies are warranted.
Cardiovascular health is essential to achieving the United Nations Sustainable Development Goals (SDGs), particularly SDG3.4. Barriers include inequalities and a lack of political will and prioritization. A comprehensive approach is needed to reduce the global burden of cardiovascular disease and to achieve SDG3.4. The World Heart Federation addresses the determinants of cardiovascular disease and mobilizes the global community through roadmaps, roundtables and advocacy.
Clonal haematopoiesis of indeterminate potential (CHIP) is defined as an expansion of mutant blood stem cells in individuals without haematological malignancies. CHIP is linked to an increased risk of non-cancerous disorders such as atherosclerotic cardiovascular disease, possibly because mutant innate immune cells have pro-inflammatory phenotypes. Prospective studies are needed to determine whether individuals with CHIP might benefit from anti-inflammatory therapies.
IgM antibodies have gained much attention as risk markers of atherosclerotic cardiovascular disease, but the exact antigenic determinants and the full spectrum of functions remain to be defined. A better understanding of the potentially diverse nature of the antigens that they recognize will help to dissect the function of IgM in atherosclerosis.
Lipophagy is a type of selective autophagy that targets lipid droplets for degradation. Since the discovery of lipophagy in 2009, research has uncovered a central role for this process in cellular lipid metabolism, including in atherogenic foam cells. Therefore, increasing lipophagy might be a therapeutic target to reverse lipid build-up in atherosclerosis.
Excessive salt intake is a known risk factor for cardiovascular disease commonly associated with hypertension. However, we propose that a high-salt diet can promote cardiovascular and other diseases independently of high blood pressure through inflammatory pathways that increase the production of myeloid cells.
Establishing and enforcing LGBTQ-inclusive policies at the national, state and institutional level are essential for advancing health equity and ensuring the highest quality cardiology workforce.
Low plasma levels of HDL cholesterol are a risk factor for infection and hospitalization for infectious disease. Recent work suggests that inadequate levels of HDL particles of specific sizes — small and medium — account for this risk. In this Comment, we discuss the mechanistic implications of these observations and the methodologies used to quantify HDL size.
