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Adherence to medication is a prerequisite for treatment to be effective, but fewer than half of patients are adherent to long-term therapies for cardiovascular diseases, such as antihypertensive drugs and statins. In this Perspectives article, Tajouri and colleagues propose that multifaceted, individually tailored strategies that harness incentives schemes and modern technology are required to improve both adherence to medication and patient health.
Chelation therapy with ethylenediamine tetra acetic acid is increasingly being used in patients with cardiovascular disease, without definitive evidence for its efficacy. In this Perspectives article, Sidhu et al. discuss data from major studies of chelation therapy in this field, with particular emphasis on TACT. They opine that the findings from this trial are not robust and do not marshal evidence in support of the potential clinical use of chelation therapy for cardiovascular disease.
Opium is a widely abused substance throughout the Middle East and Asia. In this Perspectives article, Dr Masoudkabir and colleagues dispel the commonly held misconception in these regions that opium has beneficial effects on cardiovascular health, and summarize the available evidence showing that, conversely, opium use is a risk factor for cardiometabolic diseases.
Heart transplantation has become the treatment of choice for eligible patients with end-stage heart failure. In this Perspectives article, David Baran challenges the presupposed need for multidrug immunosuppression after transplantation, and draws on data and experience from the TICTAC randomized trial to explore the potential efficacy and benefits of monotherapy.
In this opinion article, the authors discuss multicentre clinical trials in Asia. Asians have been under-represented in many clinical trials; differences in cardiovascular disease risk and drug responses between Asians and white people underscore the importance of ethnicity-specific intervention testing. Challenges specific to Asia need to be addressed before Asia can rival Europe and the USA as a location-of-choice for clinical trials.
Resistant hypertension is difficult to treat. In a Perspectives, Solini and Ruilope argue that many patients with resistant hypertension actually have mismanaged primary hypertension. They discuss how to identify misclassified patients and how to correctly manage hypertension.
In many clinical trials, procedure-related myocardial infarctions are assigned a similar prognostic value to spontaneous myocardial infarctions. Robbert de Winter and colleagues argue that procedure-related myocardial infarctions do not necessarily have important prognostic implications, and that the recent definition of a procedure-related myocardial infarction, including a relevant biomarker increase and supporting evidence, needs to be closely followed.
In this opinion article, the authors suggest an alternative hypothesis for the pathogenesis of rheumatic heart disease. They believe that an interaction between streptococcal M protein and the infected individual's collagen results in the production of anticollagen autoantibodies. They also believe that molecular mimicry, which has previously been implicated in rheumatic heart disease, probably has no role in the pathogenesis of this condition.
Current algorithms for cardiovascular-risk prediction focus on identifying individuals who are at high short-term risk of experiencing a cardiovascular event. Drs Karmali and Lloyd-Jones advocate that lifetime-risk estimation should be used as an adjunct to 10 year risk prediction, to motivate individuals who have a low short-term, but substantial lifetime, risk (such as many women and young men) to adopt healthy, preventive behaviour.
