Reviews & Analysis

In 2017, genetic research on cardiovascular disease (CVD) produced seemingly paradoxical findings. Thanks to the continuous upscaling of genotyping and sequencing data, researchers have discovered that whereas numerous genetic variants among the general population can increase CVD risk, an individual can tolerate most severe genetic alterations.

In 2017, a cluster of papers have provided strong evidence in favour of the inflammation hypothesis in cardiovascular disease. From fundamental observations on clonal haematopoiesis to clinical evidence indicating that blocking an inflammatory cytokine mitigates heart disease, 2017 has been a watershed year.

The past year provided strong evidence on the use of the instantaneous wave-free ratio to determine the severity of coronary artery disease, the improving outcomes of contemporary percutaneous coronary intervention, the increased risk of thrombosis with bioresorbable vascular scaffolds, and the benefits of a simple revascularization strategy in cardiogenic shock.

The most common genetic predisposition to dilated cardiomyopathy (DCM) is truncating variation in the giant sarcomeric protein, titin. Ware and Cook review the molecular mechanisms ofTTNgene variation in the pathogenesis of DCM, strategies for clinical interpretation of genetic variants for diagnosis, and the role of genetic stratification as a predictor of outcome and treatment response.

In this Review, Kivimäki and Steptoe assess the current evidence on the association between stress and cardiovascular disease, covering the multiple roles of stress in the development and triggering of disease and as a determinant of prognosis and outcome. In addition, they discuss the clinical and public health importance of major stressors and the implications for prevention and treatment of cardiovascular disease.

Cardiovascular disease is the world's leading cause of death, with a disproportionate burden in low-income and middle-income countries. The Resolve initiative — eliminating artificial trans fats, reducing dietary sodium, and improving treatment of elevated blood pressure — is a substantial step in the right direction, but more combined efforts will be required.

Ischaemic injury during an acute myocardial infarction (AMI) event is followed by an intense inflammatory response that occurs after reperfusion. The inflammasome is a protein complex involved in the regulation of this inflammatory response. In this Review, Toldo and Abbate summarize evidence supporting the therapeutic value of inflammasome-targeted strategies in the context of AMI.

Conduction system disorders lead to slow heart rates that are insufficient to support the circulation, necessitating implantation of electronic pacemakers. Current pacemakers, although effective, have limitations including lead malfunction, lack of autonomic responsiveness, and device-related infections. In this Review, Marbán and colleagues discuss next-generation electronic devices designed to address current limitations, as well as biological pacemakers as alternatives to implantable hardware.

The gut microbiota has been associated with many different disorders, including cardiovascular diseases. A new study by Jie and colleagues is the first large case–control study to examine directly the enrichment of certain communities of gut bacteria in patients with atherosclerotic cardiovascular disease compared with control individuals.

The effects of microgravity and cosmic rays on the cardiovascular system are major health concerns for astronauts in space. In this Review, Hughson and colleagues summarize the current evidence on risk estimation and dysfunction of the cardiovascular system in space, and discuss potential countermeasures, including physical exercise, antioxidants, nutraceuticals, and radiation shielding.

Increased arterial stiffness influences pulse pressure, wave reflections, kidney function, and cardiovascular risk. In this Review, Safar describes the importance of arterial stiffness in the diagnosis and management of hypertension, using historical perspectives to emphasize the need for new treatment approaches in patients with essential hypertension.

In the past 2 decades, an increasing prevalence of risk factors for cardiovascular disease, such as obesity, physical inactivity, and diabetes mellitus, has been observed among young adults (aged 18–45 years) living in developed countries. In their Review, Andersson and Vasan discuss the evolving risk factor burden and available epidemiological data on cardiovascular disease in young adults.

Initial randomized trials of cholesteryl ester transfer protein (CETP) inhibitors were terminated early owing to adverse effects or futility. The REVEAL trial now shows the benefit of CETP inhibition in coronary heart disease. Despite raising HDL-cholesterol levels, the cardiovascular effect of CETP inhibitors is probably due to lowering of non-HDL-cholesterol levels.

Cardiovascular mortality among the almost 600 million people living in the Eastern Mediterranean region (EMR) has been proposed to increase more dramatically in the next decade than in any other region except Africa. Turk-Adawi and colleagues summarize the available data on cardiovascular disease burden, risk factors, and treatment modalities for the EMR population.

This Review summarizes the latest findings on heart reverse remodelling, which demonstrate that despite apparent normalization of function, the molecular changes associated with heart failure persist in the reverse-remodelled heart. This myocardial remission is distinct from true recovery, in which both function and molecular makeup are normalized. These findings have implications for developing therapies to repair the failing heart.

Over the past decade, marijuana has been legalized for medicinal purposes or recreational use in many countries, and the potency of marijuana and synthetic cannabinoids has substantially increased. In this Review, Pacher and colleagues summarize the role of the endocannabinoid system in cardiovascular health and disease, and critically discuss the beneficial and detrimental cardiovascular effects of marijuana and synthetic cannabinoid use.

Contradictory results in animal atherosclerosis studies might partly explain limited translational efficacy, and also undermine the confidence of funding agencies, politicians, and the public in scientists and their research. A new guideline paper provides recommendations aimed at standardization of animal atherosclerosis studies to improve the reproducibility of this research.

A range of drugs is available for symptomatic angina, but the optimal choice or combination of therapies is often uncertain, and contemporary guidelines do not necessarily provide definite recommendations. In this Consensus Statement, Ferrari and colleagues propose an individualized approach to angina treatment, which takes into consideration the patient, their comorbidities, and the underlying mechanism of disease.

Sudden infant death syndrome (SIDS) is the leading cause of infant mortality in developed countries. In this Review, Behr and colleagues provide an update on the spectrum and prevalence of the subset of SIDS mediated by cardiogenetic factors, and the clinical implications of SIDS in the surviving family and general population.

A novel image-analysis method using standard CT imaging demonstrates that changes in the CT signal of coronary perivascular adipose tissue are associated with the degree of inflammation in adjacent coronary plaques. This exciting development might become a useful adjuvant clinical tool, although further validation and prospective outcome studies are required.