Reviews & Analysis

In this timely Review, Drs Rocha and Libby discuss the commonalities in the pathophysiology of atherosclerosis and obesity, with a particular focus on inflammation—an important aspect of both diseases. The authors also examine the clinical implications of the mechanistic links between the two conditions.

In the second part of their Review on resistance to antiplatelet medication, the authors discuss the various laboratory tests of platelet function and highlight the limitations of these methods for determining the true thrombotic status of the patient.

An effective risk score for patients undergoing coronary angioplasty is yet to be established. In this article we discuss the merits of using the EuroSCORE risk model for assessing these patients, and propose a potential modification to the system.

Two or more drugs are needed to control blood pressure in the majority of patients with hypertension. The most commonly used combinations include a diuretic; however, results of two large, controlled trials show that better cardiovascular protection is provided by a combination of a renin-angiotensin inhibitor and a long-acting calcium-channel blocker than combinations that include a diuretic.

Poor responders to clopidogrel have low levels of circulating active metabolite. However, in vitro experiments have shown that blood platelets from poor responders are fully inhibited by the active metabolite of this prodrug. Impaired platelet inhibition reflects inadequate plasma levels of active metabolites, and not differences in platelet P2Y₁₂ receptor function.

Magnetic Resonance Spectroscopy is a novel research tool used to noninvasively quantify myocardial triglyceride content. This method provides the opportunity to study myocardial steatosis in patients with diabetes.

Dr Pasquale and colleagues demonstrate that dynamic left ventricular outflow tract obstruction was the cause of exertional chest pain and dyspnea in a patient with no evidence of hypertrophic cardiomyopathy or ischemic heart disease.

In this fascinating Perspective article, the authors propose a novel hypothesis for the developmental origin of the variable phenotypes seen in hypertrophic cardiomyopathy (HCM). They suggest that cross-talk between healthy epicardium-derived cells and abnormally contracting cardiomyocytes could account for the extramyocardial manifestations of HCM, by a putative mechanism of mechanotransduction leading to abnormal gene expression and cell differentiation.

In the first section of this two-part Review, Dr Sweeny and colleagues explore the phenomenon of 'resistance' to antiplatelet drug therapy. They discuss the various factors influencing the patient's response to these drugs, and examine the link between laboratory-assessed nonresposiveness and clinical outcome.

Ventricular remodeling occurs over the weeks and months after myocardial infarction, and, therefore, provides a large temporal therapeutic window. In this Review, Dr Dorn examines recent developments in pharmacological treatment of ventricular remodeling in preclinical models of myocardial infarction.

Current treatment guidelines recommend exercise training in patients with heart failure classified as NYHA functional class II and III. This Review focuses on current knowledge of mechanisms by which progressive and moderate exercise training can have sustained beneficial effects on these patients.

Proteinuria often precedes any detectable decline in renal filtration function and is a strong and independent predictor of increased risk for all-cause and cardiovascular mortality. In this Review, Dr Agrawal and colleagues examine potential pathophysiologic mechanisms to explain simultaneous renal and cardiac disease, as well as therapeutic strategies for amelioration of proteinuria.

Understanding the mechanism by which hypertension induces vascular disease is important for the prevention of this adverse process. In this Review, Dr Rabkin examines the data on interleukin 18 involvement in the pathogenesis of hypertension-induced vascular disease.

Imaging of atheromatous plaques can provide important information about the natural history and progression of atherosclerotic disease and can help inform treatment decisions. Here, Umar Sadat and colleagues review various noninvasive imaging techniques for the clinical assessment of carotid plaques, including radionuclide imaging, CT, and MRI.

Renal artery stenosis (RAS) is common among patients with atherosclerosis. In this Review, Drs White and Olin outline the clinical problem of atherosclerotic RAS and its diagnosis, and critically assess treatment options and strategies to improve patient outcomes.

Valve-sparing aortic root replacement in patients with Marfan syndrome avoids the complications of a prosthetic heart valve, particularly life-long anticoagulation therapy. Despite proven durability and excellent event-free survival, the majority of cardiac surgeons have not adopted this approach. Here, Stephen Westaby suggests that the time is right for a change in the surgical guidelines and explains that an early, elective valve-sparing operation can transform the long-term prognosis of patients with Marfan syndrome.

In this month's Case Study, George and colleagues present a case of antiphospholipid syndrome. The IgG anti-β₂GPI antibodies isolated from this patient enhanced experimental atherosclerosis and attenuated plaque stability in apolipoprotein-E-knockout mice.

In this month's Case Study, Versaci and colleagues present a case of congenital coronary artery fistula originating from the left anterior coronary artery and draining into right ventricle, in conjunction with an aneurysm of the left anterior descending artery. The high risk of rupture lead the authors to close the fistula surgically using normothermic cardiopulmonary bypass.