Reviews & Analysis

The cardiac lymphatic system has a physiological role in the maintenance of cardiac health, and its structure and function are altered in cardiovascular diseases such as atherosclerosis and myocardial infarction. Cardiac lymphatics might be a therapeutic target to reduce myocardial oedema and chronic inflammation.

Cardiovascular disease and cancer share several risk factors. Patients with heart failure have a higher rate of cancer than healthy control populations. Meijers and colleagues have taken this association a step further to present new evidence suggesting that, beyond simply sharing root causes, heart failure might actually cause cancer.

This Review summarizes the current knowledge on the biology and regional variability of the adipose tissue, highlighting the molecular mechanisms controlling the crosstalk between the adipose tissue and the cardiovascular system. Current state-of-the-art techniques in adipose tissue imaging for cardiovascular risk stratification and the potential of the adipose tissue as a target for the treatment of cardiovascular disease are also described.

In this Review, de la Pompa and colleagues describe the role of the Notch pathway during the differentiation and patterning of cardiac tissues and in valve and ventricular chamber development, discussing the crosstalk with other signalling pathways, how defective Notch signalling is linked to congenital heart diseases, and the relevance of the Notch pathway in heart regeneration and repair.

The incidence of atrial fibrillation (AF) and the risk of cognitive impairment both increase with age, and the two pathologies share important risk factors. In this Review, Madhavan and colleagues explore the association and mechanisms of cognitive decline and AF, and discuss potential therapies to prevent cognitive impairment in these patients.

In this Review, Meilhac and Buckingham discuss the origin of cardiac cell populations, their lineage relationships and the genes that regulate their behaviour and differentiation. Characterizing the progenitor cells that form the heart and the gene regulatory networks controlling their deployment is of major importance for understanding the origin of congenital heart malformations and for developing cardiac regeneration therapies.

Patients with diabetes mellitus have a prothrombotic status that increases the risk of cardiovascular events and worsens prognosis after these events. In this Consensus Statement, the Working Group on Thrombosis of the Italian Society of Cardiology proposes antithrombotic strategies for patients with diabetes in various cardiovascular settings.

A wealth of data that culminated in a large clinical trial established that IL-1β blockade has beneficial effects in atherosclerotic cardiovascular disease. A new study in gene-targeted mice challenges this view by showing atheroprotective effects of IL-1β.

Over the past 20 years, new insights into cardiovascular immunopathology have shifted the therapeutic focus from lipids to inflammation. In this Review, Duivenvoorden and colleagues discuss recent discoveries in the immunopathology of atherosclerosis, advances in bioengineering techniques, and how these advances have guided the development of innovative nanoimmunotherapeutic strategies to modulate immune responses in cardiovascular disease.

Research on cardiac repair and regeneration is shifting from a stem cell focus towards the dynamic interplay of stromal and immune cells of the cardiac interstitium. This Review provides new insights into the immunoregulatory functions of cardiac interstitial cells and their complex network of interactions, highlighting the therapeutic potential for cardiac disease.

Mitochondrial dysfunction has a major role in the pathogenesis of multiple cardiovascular disorders. In this Review, Galluzzi and colleagues discuss the therapeutic potential of mitochondria-targeting agents in the treatment of cardiovascular disease, examine the obstacles that have limited their development thus far, and identify strategies for the development of these promising therapeutic tools.

The benefits of regular exercise extend beyond its effect on cardiovascular disease (CVD) risk factors. In this Review, the authors outline the non-traditional mechanisms underlying the benefits of exercise in CVD and highlight the importance of a holistic view of exercise in cardiovascular health.

This Review summarizes the current understanding on the roles of the Hippo–YAP pathway in cardiac development, growth, homeostasis, disease, and regeneration, with a particular focus on the roles of the Hippo–YAP pathway in endogenous cardiac muscle renewal, including the pivotal role of this pathway in regulating cardiomyocyte proliferation, differentiation, stress response, and mechanical signalling.

Inflammageing is a chronic, pro-inflammatory state that develops with age and is a risk factor for cardiovascular disease, comorbidities, frailty, and death. In this Review, Ferrucci and Fabbri discuss whether therapies to modulate inflammageing can reduce the age-related decline in health.

Various intrinsic and extrinsic factors influence the balance between cellular renewal and senescence in the ageing heart. In this Review, Gude and colleagues discuss these factors, including environment, lifestyle, genetics and epigenetics, inflammation, and oxidative stress, and how they might be therapeutically targeted.

Alterations in mitochondrial function, which are amplified by defective mitochondrial quality control (MQC) mechanisms, are major contributing factors to cardiac senescence. In this Review, the authors discuss the mechanisms linking defective MQC to organelle dysfunction in the context of cardiac ageing and consider how these pathways might be targeted for the prevention and treatment of age-related heart dysfunction.

The KardiaBand, which records a rhythm strip from an AppleWatch, was paired with an app for automated detection of atrial fibrillation. A new study by Bumgarner and colleagues is one of the first studies to examine the feasibility of using a smartwatch to discriminate between sinus rhythm and atrial fibrillation.

In this Review, a panel of leading experts in antithrombotic pharmacotherapy discuss the principles guiding the role of acetylsalicylic acid (aspirin)-free strategies in the prevention and management of cardiovascular disease, along with their implications for clinical trial design and development.

Familial hypercholesterolaemia (FH) is the most commonly encountered genetic condition that predisposes to premature cardiovascular disease. In this Review, Berberich and Hegele revisit the genetic complexity of FH and discuss our revised understanding of the mechanisms of FH and the implications for screening, diagnosis, and patient management.

The epicardium is a multipotent cardiac progenitor tissue that serves as a crucial signalling centre for heart development and repair. This Review describes recent advances in our understanding of the biology of the epicardium and discusses the potential to harness the properties of the epicardium to develop therapeutic strategies for heart repair and regeneration.