Reviews & Analysis

Recent intensification of the controversy surrounding drug-eluting stents (DESs) has polarized opinion on how best to manage patients referred for percutaneous coronary intervention. In this Viewpoint, Farkouhet al.advocate a strategy of profiling patients to determine their suitability for DES implantation, based on their individual risk of developing late-stent thrombosis or bleeding associated with prolonged antiplatelet therapy.

'End-stage' hypertrophic cardiomyopathy (HCM) is one of the most serious manifestations of HCM, yet its etiology remains poorly understood. Here, Yacoub et al. discuss recent advances in our knowledge of end-stage HCM, explore avenues for future research, and propose that elucidating this 'mysterious' condition might provide a model for other myocardial diseases.

Despite the growing prevalence and high morbidity and mortality associated with calcific aortic stenosis, until recently little was known about the cellular mechanism of this condition. Recent studies have demonstrated that the pathophysiology of aortic valve disease and vascular atherosclerosis is similar. Here, Nalini Rajamannan, Robert Bonow and Shahbudin Rahimtoola discuss the etiology and mechanisms of calcific aortic stenosis, its diagnosis and future medical therapies in the context of recent developments.

L-Arginine, the substrate for nitric oxide synthase, is the precursor for nitric oxide synthesis in the vascular endothelium. Experimental and preliminary clinical studies have indicated that intra-arterial or intravenous infusion ofL-arginine could improve nitric oxide bioavailability in the coronary arteries. Here, Tousoulis et al. examine the literature on the role of L-arginine in the prevention of atherosclerosis from a clinical perspective.

Vasculogenic erectile dysfunction has assumed center stage as a powerful risk-marker for cardiovascular disease. A readily treatable disorder, erectile dysfunction could potentially independently predict cardiovascular risk. Here, Watts et al. review the linked pathogenesis of endothelial and erectile dysfunction, and the relationship between and the clinical management of erectile dysfunction and cardiovascular disease.

In recent years, virtual reality simulation has become recommended for training in complex endovascular procedures. Here, Christopher Cates discusses the benefits of this emerging paradigm in medical education, highlighting the applications of the state-of-the-art Vascular Interventional System Trainer (VIST^®) for carotid artery stenting.

Endovascular stent-graft repair of abdominal aortic aneurysms is a less-invasive alternative to open repair. Since the first description of the technique in 1990, the technology used has developed rapidly. In this Surgery Insight, Donald Baril, Tikva Jacobs and Michael Marin summarize the history of endovascular stent-graft development and discuss recent data on patients treated with this technique, and outline some new advances in stent-graft repairs.

The beneficial effects of statins in the treatment and prevention of ischemic coronary artery disease are well-established; their value in the treatment of heart failure is, however, still being investigated. Here, Lipinskiet al. discuss how the pleiotropic effects of statins could improve survival in the setting of ischemic and nonischemic heart failure.

Familial hypercholesterolemia (FH) is an inherited disorder characterized by raised serum LDL cholesterol, which leads to accelerated atherosclerosis and a steep rise in the risk of premature coronary heart disease. Here, Anne Soutar and Rossi Naoumova examine the genetic mechanisms behind FH and discuss what effect new discoveries will have on the clinical management of FH.

Cardiologists have been hesitant to prescribe extended-release dipyridamole and aspirin for stroke prevention in patients with cardiovascular disease because of concerns that this combination might increase the risk of cardiac events. Here, Gregory Albers reviews new ESPRIT data, which demonstrate that the combination is more effective than aspirin alone for the prevention of stroke in patients with a recent cerebrovascular event, and does not increase cardiac risk. Cardiologists should now be reassured that dipyridamole and aspirin is appropriate for patients with recent stroke and cardiovascular disease.

Individuals with diabetes mellitus have worse outcomes, and particularly a higher rate of restenosis, following revascularization than those without diabetes. The advent of drug-eluting stents has, however, reignited enthusiasm for percutaneous coronary intervention in individuals with diabetes. In this Review, Victor Legrand evaluates drug-eluting stents as an alternative revascularization strategy to surgery in diabetic patients.

In this instructive Review, Skelding et al. explain how the recently published Haplotype Genetic Map (HapMap) has the potential to revolutionize our genetic discoveries. By cataloguing common haplotypes in the human genome, the HapMap will help elucidate the multiple genetic variants underlying common complex processes, such as in-stent restenosis. Jargon-free and informative, this Review provides insight into the relevance of HapMap to cardiovascular practice.

Approximately one-third of patients with diabetes have peripheral arterial disease (PAD) and concomitant diabetes amplifies the already high risk of atherothrombotic events present in those with PAD. Here, Emile R Mohler III discusses atherothrombosis and PAD in patients with diabetes in the context of the 2006 American College of Cardiology/American Heart Association guidelines for PAD management.

Collaboration between clinicians and basic scientists is vital for effective bench-to-bedside research translations, but the interdependent nature of the two professions is currently underemphasized. Cardiovascular developmental biology in particular has important implications for our understanding of adult disease processes. Here Roger Markwald and Jonathan Butcher discuss key discoveries in developmental biology that have the potential to impact the diagnosis and treatment of adult cardiac disease, and appeal to clinicians and basic scientists alike to improve dialogue and learn from each other.

Despite aggressive lipid-lowering therapy, coronary heart disease event rates remain unacceptably high, indicating the need for additional therapeutic approaches. Notably, low HDL-cholesterol levels remain an independent risk factor for adverse coronary events even in patients with naturally low or therapeutically lowered LDL-cholesterol levels. Here, Daniel Rader examines the current status of the development of novel therapies aimed at raising HDL-cholesterol levels or improving the function of HDL.