News & Comment

The use of intravenous levothyroxine does not increase the likelihood of hearts being transplanted from haemodynamically unstable, brain-dead potential donors, suggesting that current practice recommendations should be revised.

The risk of stroke in patients with atrial high-rate episodes (AHREs) depends on age, comorbidities and AHRE burden. Two randomized clinical trials on the use of oral anticoagulant therapy for stroke prevention in older patients with short and rare AHREs have reported conflicting findings on the efficacy of oral anticoagulation in this patient population, although both trials report a significantly increased risk of major bleeding with oral anticoagulation.

Representation of Black patients in cardiovascular clinical trials remains dismally low, reflective of systemic and structural barriers, which can lead to missed opportunities to meet community-identified needs, understand responses to medical therapies and improve cardiovascular care. Innovative, multilevel strategies focused on Black communities are warranted to increase enrolment of this population into clinical research.

Mosaic loss of chromosome Y (mLOY) refers to the condition in male individuals in which a detectable fraction of cells lose the Y chromosome. Prevalent in haematopoietic cells, this common somatic mutation is associated with decreased longevity and an increased risk of age-related diseases, including cardiovascular disease. Haematopoietic mLOY provides further insight into the sex-specific disparities that exist in disease susceptibility.

Gene therapy involving adenine base editing can correct a pathogenic variant in the Scn5a gene and alleviate arrhythmia phenotypes in a mouse model of long QT syndrome type 3.

Racial and ethnic disparities in cardiovascular health in the USA result in a persistent mortality gap between white and Black individuals, increase health-care costs and compromise an egalitarian society. Solutions to racial inequities require risk factor control and the implementation of evidence-based medicine and anti-racism policies. Overcoming these disparities is not only a practical necessity, but also a moral imperative.

Aster proteins are involved in the non-vesicular transport of cholesterol derived from dietary lipids in the small intestine from the plasma membrane to the endoplasmic reticulum in enterocytes.

In the ORBITA-2 trial, percutaneous coronary intervention was associated with a lower angina symptom score compared with a placebo procedure in patients with stable angina who were receiving minimal or no antianginal medication.

In patients with severe calcified aortic valve stenosis, treatment with transthoracically delivered non-invasive ultrasound is safe and improves valve function.

A liberal strategy of blood transfusion might improve outcomes in patients with acute myocardial infarction and anaemia, according to results from the MINT trial.

Treatment with the glucagon-like peptide 1 receptor agonist semaglutide, administered subcutaneously at a dose of 2.4 mg once per week, reduces the risk of major cardiovascular events by 20% compared with placebo in patients who are overweight or obese and with pre-existing cardiovascular disease but without diabetes mellitus, according to findings from the SELECT trial.

In women with elevated levels of blood pressure during pregnancy, the use of a physician-guided remote telemonitoring programme during the postpartum period improves BP control, according to findings from the POP-HT trial.

Data from the ARIES-HM3 trial show that excluding aspirin from the antithrombotic regimen in patients with advanced heart failure and a left ventricular assist device reduces the number of bleeding events and does not increase the risk of thromboembolism.

Activation of a specific set of vagal sensory neurons connecting the ventricular wall of the heart to the area postrema in the brainstem causes mice to faint. This finding defines a cardiac reflex that recapitulates characteristics of human syncope.

Two new studies using cryo-electron microscopy describe the structure and conformation of myosin in the cardiac thick filaments and how it interacts with other thick-filament proteins, such as titin and cardiac myosin-binding protein C, in mammalian hearts.

An approach that increases the expression of the chemokine receptor CXCR4 in vascular cells by targeting a microRNA-based repressive pathway attenuates atherosclerosis in mice and promotes atheroprotective functions in human and mouse vascular cells in vitro.

Treatment with the small interfering RNA patisiran preserves functional capacity and improves health status and quality of life in patients with transthyretin cardiac amyloidosis, according to data from the 12-month double-blind period of the ongoing APOLLO-B trial.

In the LIFE-BTK trial, treatment with an everolimus-eluting resorbable scaffold was superior to angioplasty in improving clinical outcomes in patients with chronic limb-threatening ischaemia due to infrapopliteal artery disease.

Transcatheter aortic valve implantation (TAVI) has become an important treatment option for aortic stenosis, even among younger patients, with similar rates of efficacy as compared with surgical valve replacement. However, complications including device failure persist; these can be addressed by surgical explantation and repeat TAVI. Ongoing research emphasizes the long-term potential of TAVI as an alternative to surgical intervention for aortic stenosis.

For patients with heart failure and reduced left ventricular ejection fraction, intravenous iron is likely to deliver clinical and prognostic benefits for those with anaemia and transferrin saturation <20%, especially if serum ferritin exceeds 100 μg/l. A serum ferritin of <100 μg/l does not appear to be useful as a marker of iron deficiency.