Reviews & Analysis

Understanding how adverse professional life experiences affect the mental well-being of cardiologists is important. An unmet and equally important need is to design and implement strategies to prevent emotional harassment and discrimination at health-care workplaces and to effectively support cardiologists who have been exposed to adverse professional life experiences. These strategies are especially needed for female, younger or divorced cardiologists.

Calcific aortic valve disease (CAVD) is a common disorder characterized by thickening, fibrosis and mineralization of the aortic valve leaflets. In this Review, Mathieu and colleagues summarize the risk factors, genetics and molecular mechanisms involved in CAVD and the implications for treatment of the condition.

Aldehyde dehydrogenase 2 (ALDH2), a key enzyme for the detoxification of alcohol-derived acetaldehyde, has been implicated in the pathogenesis of various types of cardiovascular disease. In this Review, Xu and colleagues present the latest evidence showing a link between the inactivating ALDH2 rs671 polymorphism and an increased or decreased risk of cardiovascular disease such as coronary artery disease.

The STRONG-HF and COACH trials have shown a reduction in morbidity and mortality in patients with acute decompensated heart failure, for whom therapeutical options are currently limited, using two different approaches that have in common the aim of more effective treatment optimization through a better transition phase from in-hospital to outpatient care.

Health-care delivery is evolving, with an increased availability of consumer and medical technology-enabled diagnostic devices powered by artificial intelligence. Physicians need to evolve by deprioritizing old skills in favour of new skills in statistics and medical decision-making psychology. Technology moves fast; physicians will need to pivot and adapt quickly.

Alternative splicing determines which exons are included in mature RNA and accounts for the majority of transcriptomic diversity. In this Review, Gotthardt and colleagues discuss how alternative splicing is regulated in the heart and how it differs in cardiac development, physiological adaptation and pathological remodelling. They also summarize technological advances in the field and potential applications of splicing data in cardiovascular medicine.

The prevalence of hypertension in China has risen steadily in the past two to three decades. In this Review, Wang and colleagues summarize the latest epidemiological data on hypertension in China, describe the risk factors for hypertension that are relevant to this population, and provide an overview of initiatives aimed at improving awareness, treatment and control of hypertension, especially in the low-resource rural setting.

Macrophages are one of the most active cell types during all stages after myocardial infarction. In this Review, Boisvert and co-workers describe the populations of cardiac macrophage involved in myocardial infarction, their cardioprotective functions and their interactions with other cardiac cell types. The authors also explore potential therapeutic approaches to target macrophage-mediated inflammation in myocardial infarction.

Calcific aortic valve disease and stenosis have a complex pathogenesis, and no therapies are available that can halt or slow their progression. In this Perspective, Narula and colleagues explore a possible relationship between amyloid deposition, calcification and the development of aortic valve stenosis.

In this Review, Ntusi and colleagues examine the mechanistic links between dysbiosis of the oral microbiome and the pathogenesis of cardiovascular diseases, and explore potential strategies for prevention and treatment.

Cardiopulmonary resuscitation (CPR) provided by a bystander has saved the lives of many patients with out-of-hospital cardiac arrest. Several factors have been hypothesized to contribute to the low rates of bystander CPR, including the race and/or ethnicity of the recipient and the location of the out-of-hospital cardiac arrest.

In this Review, Packer summarizes the latest advances in our understanding of the mechanisms that underlie the benefits of sodium–glucose cotransporter 2 (SGLT2) inhibitors in heart failure, identifies specific pathways that are likely to mediate a direct effect of SGLT2 inhibitors on cardiomyocytes and proposes a novel conceptual framework that explains the findings from experimental studies and clinical trials.

In this Review, the authors summarize the evidence for physiological and pathological cardiac hypertrophy regression from clinical and basic science studies, discussing therapies and mechanisms involved in regression of cardiac hypertrophy and highlighting knowledge gaps and questions for future investigation to design specific therapies to promote regression of pathological hypertrophy.

The global prevalence of atrial fibrillation (AF) is increasing, largely as a result of a rise in modifiable risk factors. In this Review, Sanders and colleagues summarize the epidemiology of AF and discuss lifestyle changes and risk factor interventions for the primary and secondary prevention of AF.

In this Review, Noseda and colleagues provide an overview of the technical challenges in the experimental design of single-cell and single-nucleus transcriptomics studies, and describe novel findings derived from transcriptomics studies for each major cardiac cell type in both health and disease, and from development to adulthood.

In this Review, Gatsiou and Stellos summarize the current knowledge on RNA modifications in cardiovascular health and disease, discussing their effect on cardiovascular biology and function, and the potential for development and application of epitranscriptome-based prognostic, diagnostic and therapeutic tools for cardiovascular disease.

A growing body of evidence suggests that the mechanical functions of cardiac fibroblasts are an active and necessary component of myocardial growth and homeostasis. In this Review, Van Linthout and colleagues describe cell mechanosensation as a regulator of cardiac maturation and disease, and summarize the evidence showing that remodelling of the cardiac extracellular matrix, as a result of disease, can induce changes in the mechanical properties of the myocardium.

Originally intended for life-saving salvage therapy, the use of temporary mechanical circulatory support (MCS) devices has become increasingly widespread. In this Review, Salter and colleagues discuss the functionality, indications, management and complications associated with temporary MCS in specific clinical scenarios.

In this Review, the authors summarize the evidence on the different effects of sex and gender on the pathogenesis, clinical manifestations and treatment responses of patients with ischaemic heart disease or heart failure. In addition, they highlight unexplored areas of sex-related and gender-related factors in cardiovascular disease such as in individuals with gender dysphoria.

In this Review, Lutsey and Zakai describe the epidemiology of venous thromboembolism, including incidence, risk factors and outcomes; summarize opportunities for primordial, primary and secondary prevention; and highlight the importance of reducing disparities in venous thromboembolism incidence and management, and opportunities to reduce them.