Reviews & Analysis

Catheter ablation for atrial fibrillation (AF) in patients with concomitant AF and heart failure (HF) is associated with significantly lower HF hospitalizations and all-cause mortality compared with medical therapy, according to the CASTLE-AF trial. This trial, along with previous trials such as AATAC, highlights the important role of AF ablation in the management of patients with HF and AF.

Novel antisense oligonucleotide and small interfering RNA technology can be used to reduce levels of lipoproteins that cause cardiovascular disease. In this Review, Nordestgaard and colleagues describe the principles of these gene-silencing approaches and summarize the trials that have tested the efficacy of these approaches in patients at risk of cardiovascular disease.

Nitric oxide (NO) signalling has pleiotropic roles in biology and a crucial function in cardiovascular homeostasis. In this Review, Balligand and colleagues summarize the updated paradigms on NO synthase regulation, NO interaction with reactive oxidant species in specific subcellular compartments, and downstream effects of NO in target cardiovascular tissues under both physiological and pathological conditions.

Heart failure has emerged as the most common cardiovascular complication among patients with type 2 diabetes mellitus. In this Review, Nassif and Kosiborod describe the detrimental, neutral, or even beneficial effects of different classes of glucose-lowering medications on heart failure outcomes.

The non-vitamin K antagonist oral anticoagulants (NOACs) include direct inhibitors of factor Xa or thrombin. In this Review, Levy and colleagues describe the mechanism of action of the NOAC-reversal strategies, provide guidance on potential indications for reversal, and offer a management approach for patients treated with NOACs who present with serious bleeding or require urgent surgery.

Important milestones in cardiac regenerative medicine that will define future research were reached in 2017: demonstration of adult cardiomyocyte renewal capacity, recognition of the importance of the extracellular matrix and the higher regenerative efficacy of repetitive dose protocols, and the publication of human data supporting paracrine effects of stem cell therapies and guidelines from TACTICS, the first international alliance on cardiac regenerative medicine.

Research on dyslipidaemias in 2017 reaffirmed the central role of reducing the levels of atherogenic apolipoprotein B-containing lipoproteins, predominantly LDL, in preventing ischaemic cardiovascular events. However, whether increasing HDL-cholesterol levels in isolation can reduce cardiovascular risk remains to be determined.

The radical new US hypertension guidelines, released 3 years after the previous scientific statement, have implications far beyond their intended recipients. They include a new definition for hypertension, lower treatment targets, and extended guidance on the implementation of multidisciplinary care, including self-monitoring of blood pressure. Some recommendations are likely to generate controversy.

In 2017, several high-impact studies in thrombosis were published. Refinements were made in the optimal therapy for patients with stable atherosclerosis or with atrial fibrillation undergoing percutaneous coronary intervention. Risk scores to determine duration of antiplatelet therapy were developed. The potential risk of subclinical valve leaflet thrombosis was identified.

Antiplatelet drugs are routinely used for the prevention and treatment of thrombosis, but also carry an inherent increased risk of bleeding. In this Review, McFadyen and colleagues assess the differences between thrombosis and haemostasis in the context of currently available antiplatelet drugs as well as novel antiplatelet agents that are entering preclinical and early-phase clinical testing.