Review Articles in 2021

Valvular heart disease (VHD) is a major contributor to loss of physical function, quality of life and longevity. In this Review, Prendergast and colleagues discuss the global burden of VHD, geographical variation in the presentation and clinical management, and temporal trends in disease burden.

Novel peroxisome proliferator-activated receptor (PPAR) agonists are providing new opportunities in the management of metabolic and cardiovascular diseases. In this Review, Staels and colleagues discuss the physiological regulation and actions of the PPAR family and their modulation of the atherogenic lipid profile, atherosclerosis and cardiac remodelling.

In this Review, Weldy and Ashley summarize the biology of heart failure (HF), the mechanisms of action of HF drugs, and both the Mendelian genetics of cardiomyopathies and the complex genetics of HF. Finally, they present a roadmap for the future of precision medicine in HF.

In this Review, Essien and colleagues discuss the contributions of social determinants, including race/ethnicity, financial resources, and rural or residential environment, to the evaluation, treatment and management of atrial fibrillation, identify gaps in the literature, and propose future directions to investigate and address social determinants of atrial fibrillation.

In this Review, Zhou and colleagues summarize the current data on the global epidemiology of blood pressure and hypertension and evaluate changes over time. They also present estimates of the mortality effects of elevated blood pressure and discuss interventions that can reduce the burden of high blood pressure.

Epidemiological studies indicate a genetic component to the risk of sudden cardiac death (SCD). In this Review, Behr and colleagues evaluate monogenic and polygenic contributions to the risk of SCD in the young and SCD associated with drug therapy and analyse the potential clinical role of genomic testing in the prevention of SCD in the general population.

In this Review, Dunstan and colleagues make a case for an approach to preventing and managing cardiovascular disease that involves sitting less and moving more, which will build on the well-established role of exercise in cardiovascular disease prevention and rehabilitation.

In this Review, Stark and Massberg discuss how the interplay between innate immunity, platelet activation and coagulation, known as immunothrombosis, functions as a host defence mechanism to limit pathogen spreading, yet its aberrant activation, termed thromboinflammation, results in thrombotic complications, highlighting the therapeutic potential of anti-inflammatory strategies in cardiovascular pathologies.

In this Review, Cavallari and colleagues examine the evidence supporting pharmacogenetic testing in cardiovascular medicine, describe guidelines for the use of cardiovascular pharmacogenetics and provide examples of the clinical implementation of genotype-guided therapies.

Atherosclerotic plaque erosion is becoming an increasingly common characteristic of culprit lesions in acute coronary syndromes. In this Review, Fahed and Jang discuss the patient phenotype and the molecular characteristics in plaque erosion and provide their vision for a potential major shift in the management of patients with plaque erosion.

In this Review, Gotto and colleagues summarize the evolution of our understanding of HDL structure and function, current models of atheroprotection by HDL involving reverse cholesterol transport, and their identification of a correlation between the bioavailability of free cholesterol contained in HDL and atherogenesis.

Dyslipidaemias, particularly hypercholesterolaemia, are major risk factors for cardiovascular disease. In this Review, Catapano and colleagues summarize the latest data on plasma lipid levels and associated deaths and trends in these parameters over the past four decades in different regions of the world.

In this Review, Münzel and colleagues summarize the epidemiological evidence on transportation noise pollution as a cardiovascular risk factor, discussing mechanistic insights for the adverse cardiovascular effects of noise pollution and highlighting new risk markers of noise-induced cardiovascular effects as well as promising noise-mitigation strategies.

The metabolism of lipids accumulated in blood vessel walls and the heart produces sphingolipids, such as ceramides, which are associated with the development of diabetes mellitus, atherosclerosis, hypertension and heart failure. In this Review, the authors discuss ceramides as drivers of cardiovascular disease and therapeutic strategies to lower plasma and cardiac levels of ceramides.

In this Review, Sermesant and colleagues discuss the applications of artificial intelligence (AI) in cardiovascular imaging and explain how pre-existing clinical knowledge can be included in AI methods to increase robustness. They also discuss the limitations of AI approaches in cardiovascular imaging and how they can be overcome.

In this Review, Holmes and colleagues compare and contrast the use of Mendelian randomization to evaluate potential drug targets versus quantitative traits and explain how genetic epidemiological studies can be used to assess the aetiological roles of biomarkers in disease and to prioritize drug targets, including designing their evaluation in clinical trials.

In this Review, Elshazly and colleagues summarize the basic engineering principles of common wearable sensors and discuss their broad applications in cardiovascular disease prevention, diagnosis and management.

In this Review, Nahrendorf and colleagues discuss the electrophysiological properties of leukocytes and how these cells relate to conduction in the heart, aiming to bridge the knowledge gap between electrophysiology and immunology and to explore the roles of leukocytes in cardiac conduction and arrhythmia.

In this Review, Simons and colleagues present the current knowledge of organ-specific signalling pathways involved in the maintenance of endothelial quiescence and the pathologies associated with their disruption. This knowledge will assist the development of innovative preventive strategies and identification of new therapeutic targets.

In this Review, Ren and colleagues summarize the latest advances in understanding the unfolded protein response and endoplasmic reticulum stress in the pathogenesis of cardiovascular disease and discuss potential therapeutic strategies aimed at restoring endoplasmic reticulum proteostasis in cardiovascular diseases.