Review Articles in 2013

Dysfunctional blood vessel regulation is a key component in the pathophysiology of heart failure. Vascular endothelial growth factor (VEGF) has an essential role in the formation of new vessels. In this Review, Taimeh et al. outline the biological characterization of VEGF, and examine the evidence for its potential therapeutic application, including the novel concept of VEGF as adjuvant therapy to stem cell transplantation, in patients with heart failure.

Important differences exist between women and men in clinical presentation, recognition of symptoms, response to treatment, and outcomes in ischaemic heart disease (IHD). In this Review, Vaccarino et al. discuss the current evidence for sex-related differences in the manifestation of IHD, diagnostic strategy, and approaches to treatment, and identify gaps in the literature that need to be addressed in future research.

Exercise is associated with reduced long-term morbidity and mortality but, in some individuals, can transiently increase the risk of fatal or nonfatal cardiac events. In this Review, Dangardt and colleagues discuss the benefits and risks of physical activity and exercise in the general population and in patients with various forms of cardiovascular disease. Strategies to promote physical activity and improve public health are proposed.

Acute aortic syndrome refers to disruption of the medial layer of the aortic wall, and incorporates aortic dissection, intramural haematoma, and penetrating atherosclerotic ulcer. Evangelista and colleagues expertly review the various noninvasive imaging modalities available for the prompt and accurate diagnosis of these life-threatening conditions.

Increased sympathetic activity is associated with a number of diseases, including resistant hypertension. Renal denervation is becoming increasingly prevalent throughout Europe as a treatment for this condition. The pathophysiology of this technique, its use in treating hypertension, and its potential to treat other conditions are discussed in this Review.

Fractional flow reserve is routinely used to estimate the extent of myocardial ischaemia caused by the narrowing of a coronary artery. In this Review, the physiological basis of this measurement, its limitations, and its clinical use are discussed.

Lipid lowering with statins for the secondary prevention of cardiovascular disease (CVD) is well established, but the use of these drugs for primary prevention is controversial. Željko Reiner expertly reviews the evidence for the use of statins, and their potential adverse effects, in individuals without a history of CVD, and discusses selection according to age, sex, and level of cardiovascular risk.

The novel oral anticoagulants apixaban, dabigatran, edoxaban, and rivaroxaban have been examined for efficacy and safety in the prophylaxis and treatment of venous thromboembolism. In this Review, these clinical trials are summarized, and practical considerations in the use of these drugs are discussed.

Advanced vascular occlusion, a leading cause of death in Western countries, can be treated by CABG surgery. Autografts are the gold-standard treatment, but prosthetic grafts are under development as an alternative source of vessels. Vascular tissue engineering is a fast-moving area of research that promises soon to allow the synthesis of responsive, living conduits, with properties similar to those of native tissue.

Critical limb ischaemia (CLI) is the most-severe clinical manifestation of peripheral arterial disease (PAD), and is associated with a high risk of amputation and death. Therapeutic angiogenesis is an approach to stimulating blood vessel growth to improve tissue perfusion, and has the potential to benefit patients with CLI for whom revascularization is not an option. Here, Brian Annex reviews data from clinical trials of therapeutic angiogenesis in patients with PAD, and discusses how advances in systems biology, genetics, and gene therapy might be used in new approaches to this therapy.

Tirone David expertly reviews the surgical repair and replacement of the aortic valve. Patient selection for aortic valve-sparing operations, bioprosthetic or mechanical valve insertion, pulmonary autograft, aortic valve homograft, and aortic root replacement is discussed. Finally, the author assesses the long-term clinical outcomes of these procedures.

The development of new therapies for heart failure has led to substantial increases in the cost of care for these patients. Cost-effectiveness analyses can help quantify the relationship between clinical outcomes and the economic implications of available therapies. In this Review, Rohde and colleagues critically appraise cost-effectiveness studies on key areas of heart failure pharmacologically and nonpharmacological treatment options, including medical devices and heart transplant.

Atrial fibrillation is a very common sustained arrhythmia, but patients' response to medical and ablation therapy is highly variable. Drs Darbar and Roden expertly review the emerging data on the underlying genetic substrate of this condition, and discuss how understanding the pathological mechanisms might help to tailor antiarrhythmic therapies to individual patients and improve the response to treatment.

Therapeutic decision-making requires integration of complex information on patient-specific and therapy-specific factors. Physicians and prescribers face the daunting task of assessing the efficacy and safety of medications relative to each patient. In this Review, Drs Woosley and Romero discuss the challenges of safe medication prescribing to prevent drug-induced adverse events, and the efforts made to improve clinical decision support systems, using examples from several new evidence-based, online resources.

Rheumatic fever (RF) and rheumatic heart disease (RHD) are neglected diseases, although RHD remains the most common cardiovascular disease among the young people. This position statement is a declaration of the World Heart Federation Working Group on RF and RHD strategic goal to reduce by 25% the number of premature deaths from RF and RHD among individuals aged <25 years by the year 2025. The Working Group affirms key strategic targets, reviews barriers to RF and RHD control, and identify the actions required to change the trajectory of control for these diseases.

A key aim of personalized medicine is to optimize the prevention, diagnosis, and treatment of diseases by tailoring them to individual patient characteristics and genetics. In this Review, Henry Völzke and colleagues describe the methodological and statistical features of study design that will allow personalized medicine to be translated from a promising theoretical concept to a clinically beneficial, cost-effective reality in cardiovascular medicine.

Telomere shortening, along with various other endogenous and environmental factors, can drive cells into senescence, which is involved in the complex process of biological ageing. In this Review, Fyhrquist and colleagues discuss the associations between cardiovascular risk factors and telomere shortening, and whether cellular senescence has a causal role in conditions such as atherosclerosis, heart failure, and hypertension.

New-generation drug-eluting stents (DES) utilize various drugs, polymers, and scaffold technologies, which have improved the safety of these stents in comparison with first-generation DES. Clinicians now have a variety of stents to choose from, and the choice can be tailored to the individual patient. Garg and colleagues present the concepts and rationale behind these new stent designs, and introduce some of the clinical data that support their use. In this Review, they aim to provide an update for general and interventional cardiologists who treat patients undergoing percutaneous coronary intervention.

Cardiorenal comorbidity results from both the concordance of shared risk factors, and the systemic inflammation and vascular calcification that occur in patients with cardiac and renal disease. Kahn and colleagues review the epidemiology, pathophysiology, diagnosis, and pharmacological and interventional treatment of cardiovascular conditions in patients with chronic kidney disease or end-stage renal disease.

Right ventricular failure is a complex problem with several possible aetiologies—including pulmonary hypertension, cardiomyopathy, myocardial infarction, congenital or valvular heart disease, and sepsis—and commonly has a very poor prognosis. Many of the signs and symptoms of this condition are nonspecific and can be acute or chronic. In this Review, Dr Marc Simon describes the various pathophysiological causes of right ventricular failure, and discusses available diagnostic and management strategies, with a focus on patients who have underlying pulmonary hypertension.