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Care pathways for ST-segment elevation myocardial infarction (STEMI) were interrupted during the coronavirus disease 2019 (COVID-19) pandemic. A new cardiac MRI study has revealed that increased total ischaemic time for patients with STEMI during major public health restrictions was associated with increased infarct size and other markers of myocardial damage.
The field of cardiac cell therapy is under siege. Legacies of excessive hype, scientific misconduct and dead ends have fuelled the prevailing scepticism. However, promising clinical data, along with more trenchant mechanistic understanding, together provide glimmers of hope for the future of cell therapy for the heart.
Nanotherapies are emerging rapidly as options to treat cardiovascular disease. However, insufficient and heterogeneous delivery remain critical issues. Novel strategies to boost targeted delivery of systemically administered nanoparticles by optimizing the particle physical properties or using immune cells as carriers promise to increase nanotherapeutic effectiveness in cardiovascular and other inflammatory diseases.
Mounting evidence from the SPRINT trial and the Blood Pressure Lowering Treatment Trialists points towards the use of absolute cardiovascular risk assessment to guide blood-pressure management. But who will fall between the cracks? We need to be pragmatic in keeping blood-pressure targets, if only to serve the >1 billion people at risk of cardiovascular disease living in low-resource settings.
Surgical mitral valve repair produces exceptional long-term survival, durable relief from mitral regurgitation, and physiological valve performance. Percutaneous mitral valve repair might prohibit subsequent surgical reconstruction. This finding has important implications, including for patient consent and clinical trial design. The objectives of mitral valve intervention must focus on life expectancy and long-term valve function.
Sequencing studies demonstrate a strong clinical association between clonal haematopoiesis driven by acquired mutations and atherosclerotic disease. Previous research supports the idea that this association reflects a direct contribution of some clonal haematopoiesis-related mutations to atherosclerosis. Now, mathematical modelling suggests that atherosclerosis could instead accelerate clonal haematopoiesis.
Although an unplanned, interim analysis from an ongoing randomized trial in Sweden has suggested no significant difference in mortality between patients with peripheral artery disease receiving paclitaxel-coated devices and those receiving uncoated devices for lower-extremity revascularization, the analysis did not resolve the question of whether paclitaxel-coated devices are safe for these patients.
Valve replacement is currently the only treatment for calcific aortic valve disease. Studies of an uncommon, genetic form of aortic valve disease have yielded in vitro and mouse models of the disease and a transcriptomic disease signature. Machine learning-driven screens for compounds that normalize this signature promise to enable medical management of aortic valve disease.
Mouse embryonic organoids that model cardiac development ex vivo could be used as a high-throughput, experimentally tractable system to evaluate crucial cell populations and environmental factors that contribute to normal and abnormal cardiogenesis.
Statin nocebo effects have been demonstrated in numerous randomized, double-blind, placebo-controlled and active-controlled trials. Emerging evidence suggests that brain pathways might mediate statin nocebo hyperalgesia. Evidence-based pain-management approaches can be used to manage nocebo symptoms that occur during statin therapy.
