Review Articles in 2010

The prevalence of coronary artery disease, and its manifestation as acute coronary syndromes (ACS), has reached a pandemic level as a consequence of modernization of the developing world. Drs. Ruff and Braunwald discuss the evolving demographics of ACS, including the impact of the introduction of troponin testing and the change in the definition of myocardial infarction. They also highlight the importance of modifiable risk factors and adherence to guideline-recommended therapy.

Thoracic aortic dissection (TAD) is the progressive separation of the layers of the thoracic aortic wall; this condition is strongly related to excessive dilatation of the aorta and is associated with very high mortality. The authors of this article present an in-depth review of the incidence, demographic distribution, and factors associated with TAD and related thoracic aortic syndromes, as well as a discussion of the challenges involved in assessing the epidemiology of these conditions.

The population of aged patients treated with percutaneous coronary intervention (PCI) is growing in contemporary practice. The elderly might derive greater benefits from PCI than younger patients, but also have specific age-related characteristics that can increase interventional risks. The authors of this Review discuss the benefits and challenges of PCI in the elderly and make recommendations to optimize patient care.

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.

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.

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.

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.

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.

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.

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.

Induced pluripotent stem (iPS) cells are somatic cells that have been reprogrammed to an embryonic stem-cell-like state. This technology enables us to study the molecular mechanisms of development and disease processes, and provides a strategy for individualized diagnostics and therapy. In this Review, Timothy Nelson and colleagues describe the steps involved in bioengineering somatic cells to achieve pluripotency, allowing their differentiation into cardiomyocytes or any other cell type. Clinical applications of iPS cells, including treatment of cardiovascular conditions, are also discussed.

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.

Obstructive sleep apnea syndrome is known to cause hypertension and might also be an independent risk factor for stroke and myocardial ischemia. In this Review, Dr. Malcolm Kohler and Professor John Stradling discuss the biological mechanisms thought to underpin the association of obstructive sleep apnea with endothelial dysfunction and arterial disease.

Cardiac magnetic resonance imaging (CMR) is an established diagnostic tool that provides accurate information on the myocardium. The authors of this Review suggest how CMR can be used in the acute setting to manage treatment and improve prognosis in patients with acute coronary syndromes. Current and emerging CMR techniques are discussed, as well as challenges facing CMR applications in clinical practice.

In the second part of their Review on pulmonary embolism (PE), van Es and colleagues discuss risk stratification of patients with this condition, the short-term and long-term treatment options, and introduce some of the novel therapeutic agents under investigation for PE.

Percutaneous coronary intervention can be performed successfully in most lesions; however, some specific types of lesion continue to present unique technical challenges. In this Review, stenting of bifurcations, fibrocalcific and undilatable lesions, chronic total occlusions, unprotected left main coronary artery stenoses, thrombotic lesions, and saphenous vein grafts are discussed in detail.

Animal models have generated much evidence to implicate the activation of Rho family proteins in the pathogenesis of hypertension. Pharmacological and genetic studies have indicated that Rho-protein signaling pathways also have a role in the generation of high blood pressure in humans. In this article, Drs. Loirand and Pacaud discuss our current knowledge of Rho-protein signaling in hypertension.

Cancer therapies can have a profound, and often permanent, effect on the cardiovascular system. Patients at high risk of cardiotoxicity should be identified before treatment, closely monitored, and given cardioprotective agents to reduce adverse events. The authors of this Review discuss the complications that can occur as a result of cancer therapy, and emphasize the importance of assessing both the cardiotoxicity and benefits of cancer treatment.

Excess dietary salt is associated with insulin resistance and hypertension, and may lead to type 2 diabetes, cardiovascular disease and chronic kidney disease. The mechanisms underlying the pathogenic effects of salt on the cardiovascular system include impaired glucose homeostasis and activation of the sympathetic nervous system and renin–angiotensin–aldosterone system. Mineralocorticoid receptor blockers are promising therapies to counteract the adverse metabolic and cardiovascular effects of salt.

The morphology, structure and position of the right ventricle differ substantially from those of the left ventricle and have posed difficulties in the assessment of right ventricular function. Imaging techniques, notably echocardiography and MRI, have enabled a better understanding of right ventricular performance. Mertens and Friedberg discuss the advantages and disadvantages of established and new methods of right ventricular imaging and their potential in the clinical setting.