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Patients with known cardiovascular disease but no recent acute event are often referred to as having ‘stable’ coronary artery disease. In this Review, Fox and colleagues describe why this concept of stable disease is misleading and should instead be characterized as chronic disease with an increased risk of atherothrombotic events.
Lysine acetyltransferases (KATs) and lysine deacetylases (KDACs) are involved in the regulation of lysine acetylation, a conserved post-translational protein modification that is an important modulator of cardiac metabolism. Li and colleagues describe the complex roles of KATs and KDACs in both the normal and diseased heart and provide an overview of the evidence indicating a therapeutic role of KDAC inhibitors in cardiovascular disease.
This Review outlines the drawbacks and lessons learned from first-generation drug-eluting stents, and then discusses design features and preclinical, pathology and clinical data from newer-generation devices. The authors focus on how evolution in stent design has improved biomaterial–blood interactions and vascular healing.
In a 15-year follow-up of the VADT study, no differences in major cardiovascular outcomes were found among individuals with type 2 diabetes mellitus who underwent either intensive or standard glucose control. These results indicate that intensification of glycaemic control might not be expected to mitigate the risk of cardiovascular events.
By stimulating the His–Purkinje network directly, His bundle pacing results in synchronized, physiological ventricular activation, which might improve clinical outcomes compared with the use of right ventricular apical pacing. Sharma and colleagues summarize early clinical observations, implantation techniques and outcome data with permanent His bundle pacing.
The role of aspirin for the primary prevention of cardiovascular disease is controversial. In this Review, Patrono and Baigent discuss the new randomized trials on aspirin for the primary prevention of cardiovascular disease in the context of previous evidence, and appraise whether the new evidence is likely to enable a more targeted use of aspirin
In this Review, Mallat and colleagues critically evaluate the studies on the origin, fate and functions of vascular smooth muscle cells (VSMCs) in atherosclerosis, highlighting the importance of developmental origin, clonal expansion and plasticity of VSMCs cells in atherosclerosis and summarizing the roles of VSMCs and VSMC-derived cells in plaque development and progression.
Neuromodulation therapy might be clinically useful in the management and prevention of lethal arrhythmias. In this Review, the authors discuss the neuroanatomical and neurophysiological basis for neuromodulation therapy, critically appraise the latest data on the clinical efficacy of this approach and highlight areas in the field of cardiac autonomic control that show the most promise for clinical translation.
With the increase in the availability of RNA screening tools, numerous non-coding RNAs with important functions in the heart have been identified. In this Review, Lu and Thum discuss the non-coding RNA candidates with diagnostic and therapeutic potential in cardiovascular disease.
G protein-coupled receptor (GPCR) kinases (GRKs) can desensitize and downregulate GPCRs. In this Review, Pfleger and colleagues describe the changes in GPCR and GRK signalling in the heart under disease conditions and how GRKs can be targeted to treat heart failure.
Antiretroviral therapy has transformed HIV infection into a chronic disease, and cardiovascular diseases are an important health concern in this setting. This Review discusses the clinical features of cardiovascular disease in patients with HIV infection, including the mechanisms underlying HIV-associated atherosclerosis and approaches to reduce the cardiovascular risk.
Infective endocarditis (IE) is not a common disease, but it has a poor prognosis. In this Review, contemporary findings concerning the epidemiology, diagnosis, therapeutic management and prevention of IE are highlighted, with a particular emphasis on innovations and changes in guidelines.
The use of polypills containing multiple pharmaceutical agents targeting the cardiovascular system in the primary prevention of cardiovascular disease is controversial. In this Review, Chow and Meng discuss the barriers to the use of polypills and focus in detail on the use of fixed-dose combination pills containing low doses of multiple blood pressure-lowering drugs.
Conflicting findings about the effects of testosterone replacement therapy on the risk of cardiovascular disease have been reported in various studies and clinical trials. In this Review, Gagliano-Jucá and Basaria discuss the design, outcomes and shortcomings of studies on testosterone replacement therapy, as well as studies examining the cardiovascular effects of testosterone in vitro, in animals and in humans.
The global burden of cardiovascular disease morbidity and mortality demands increased awareness of effective prevention strategies by patients, communities and health-care providers. The new 2019 ACC/AHA guidelines provide evidence-based, preventive recommendations for patients without known cardiovascular disease, focusing on risk estimation, a healthy lifestyle and selective indications for pharmacotherapy.
Dietary fats comprise heterogeneous molecules with diverse structures and complex health effects. This Review discusses the effects of different dietary fats on cell processes and cardiometabolic disease risk factors and clinical events, highlighting areas of controversy and future research directions to improve the prevention and management of cardiometabolic diseases through optimization of dietary fat intake.
The Framingham Heart Study (FHS) has been collecting epidemiological data on cardiovascular risk factors and disease for >70 years. In this Timeline Perspectives article, the authors summarize the major achievements of the FHS, highlight some of the seminal publications and discuss how epidemiological research has changed and continues to evolve.
Mutations in genes that encode components of desmosomes are the predominant cause of arrhythmogenic cardiomyopathy, a genetic disorder characterized by fibrofatty replacement of myocardial tissue and the risk of life-threatening arrhythmias. In this Review, the authors discuss the molecular mechanisms underlying the pathogenesis of this condition.
Tricuspid valve disease, particularly tricuspid regurgitation, is a highly prevalent condition with complex pathophysiology and long-term adverse consequences. In this Review, Rodés-Cabau and colleagues discuss the latest insights on the natural history and clinical and imaging assessment of tricuspid valve disease, highlighting the surgical management and emerging transcatheter therapies that are transforming clinical practice for this challenging disease.
Circular RNAs (circRNAs) are emerging as a new class of non-coding RNA molecules. In this Review, the authors discuss the current understanding of circRNA biogenesis and function, with a particular emphasis on the cardiovascular system.
