Reviews & Analysis

Why is aspirin so popular in the management of cardiovascular disease? Few therapies in cardiovascular medicine have been studied so intently and adopted so widely as aspirin. In this Viewpoint, John Cleland discusses why he believes that the use of aspirin should be reviewed and withdrawn in many patients in whom it fails to show long-term benefit.

Many changes are taking place in terms of the devices and techniques available to perform heart valve repair and replacement. Advances have meant that interest has been raised in percutaneous and minimally invasive valvular interventions. This review outlines the evolution of and possible future for this subspecialty.

Atrial fibrillation is the most common cause of arrhythmia, but the reason it occurs is not always apparent. Despite many efforts, the molecular basis for atrial fibrillation is still unclear. Genetic features of the disorder are, however, being elucidated. Robert Roberts provides here an overview of the major mutation findings so far.

An accurate, noninvasive method of imaging the heart and coronary arteries has long been elusive. Multidetector row CT, however, seems a likely candidate to fill this gap. This modality can be safely used to obtain high-quality images in seconds. Michael Poon provides an update on the advances in the development of this technology.

Could the presence of a patent foramen ovale be associated with the occurrence of migraine headaches? In this the first of two Viewpoints on patent foramen ovales, Jeremy Orr and Jonathan Tobis discuss the possibility that the majority of migraine headache could be treated by closing this patent foramen ovale passageway though the heart.

Here, Hans-Christoph Diener and Christian Weimar argue that patent foramen ovale closure should not be used for the prophylaxis of migraine until further evidence is obtained from properly conducted, prospective studies.

Left ventricular dyssynchrony can lead to adverse cardiac effects, particularly if left untreated. Dyssynchrony can be improved by cardiac resynchronization therapy, but accurate diagnosis of the disorder is essential to obtain good results. Here, Bleeker et al. present an overview of the causes, diagnostic techniques and management in heart failure patients.

Angiotensin-converting-enzyme blockade therapy is useful in many cardiovascular disorders. Since atrial fibrillation is frequently associated with such disorders, these drugs might also be beneficial in its primary and secondary prevention. The available data for these indications are, however, supportive rather than definitive. This review summarizes the major findings and calls for randomized, placebo-controlled trials.

Despite major advances in immunosuppressive regimens, which have greatly improved heart-transplant outcomes, drugs are still being developed and tested. In this review, data for the various available drugs and combined regimens are discussed, as well as those for novel drugs, in terms of efficacy and safety and cardiac allograft vasculopathy.

Major sex-based differences for coronary heart disease remain inadequately appreciated by physicians. Nanette Wenger draws together information on some of the major issues that have arisen in 2 years since the coronary prevention guidelines for women were published and highlights that their application is likely to improve outcomes for women.

Studies have found that one of the most widely used illicit drugs, marijuana, could hold great therapeutic promise for the treatment of obesity, dyslipidemia, insulin resistance and atherosclerosis. Paul Szmitko and Subodh Verma discuss how modulation of the endocannabinoid system might form the basis of new therapeutic strategies for these pathophysiologically linked conditions.

The main surveillance method for allograft rejection after heart transplantation is endomyocardial biopsy, but this method's invasive nature and poor uniformity of results pose problems. Noninvasive, reliable monitoring methods are, therefore, sought. In this review, protein-based and gene-based targets for the testing of allograft function to fulfill this role are discussed.

Although coronary angiography is an established technique in the assessment of atherosclerosis, it is limited by 2-dimensional imaging and poor differentiation between plaque types. Optical coherence tomography enables visualization of plaque architecture at the microscopic level, and in this review the possibilities of its use as an alternative modality are discussed.

Small, dense HDL possesses potent antioxidative activity but this is compromised under conditions of atherogenic dyslipidemia. The raising of HDL cholesterol levels might, however, improve functionality. In this review, Kontush and Chapman explore the mechanisms behind the antiatherogenic effects of small HDL, and the possible roles of these particles as therapeutic targets.

The implementation of guidelines into everyday practice does not always seem straightforward. In this primer article, Eagle and colleagues provide a summary of efforts to improve care for acute coronary syndromes in the Guidelines Applied in Practice program in Michigan, highlighting particularly methods that could be transferable to other cardiovascular subspecialties.

Cardiac transplantation research has focused on predicting risk and determining pathogenic pathways, and hence finding targets for intervention. As the Human Genome Project is now ready to provide the information required for personalized treatment, this Viewpoint discusses genetic association studies and their potential application at different stages before and after cardiac transplantation.

The integrity of the endothelium can be damaged in various ways, making the formation of atherosclerotic lesions possible. The source of cells involved in endothelial repair and smooth-muscle accumulation in lesions has been debated, but data suggest progenitor cells as a likely origin. Their role in the pathogenesis of atherosclerosis is discussed here.