Reviews & Analysis

The VITAL trial showed that neither vitamin D nor fish oil supplementation significantly reduced the incidence of cardiovascular disease (CVD). Conversely, current evidence supports the benefits of multiple dietary patterns, especially the Mediterranean diet, in primary prevention of CVD. Health effects of low-carbohydrate diets depend on the food sources of macronutrients.

More than 150 years after acetylsalicylic acid was synthesized by French chemist Charles Frédéric Gerhardt, aspirin is still one of the most prescribed medications worldwide. In 2018, several trials have suggested that the role of aspirin in the contemporary era might be less pre-eminent than in previous decades.

The main advances in interventional cardiology in 2018 include the new European guidelines on revascularization, new developments in the treatment of cardiogenic shock, novel stent technology from Asia and clinical trial data showing no benefit of dropping aspirin after stenting.

A number of papers published in 2018 have provided important information expected to influence clinical practice, particularly for the management of functional mitral regurgitation in patients with heart failure caused by ischaemic or non-ischaemic cardiomyopathy and for the treatment of severe aortic stenosis in patients at low surgical risk.

Precision cardiology is a vision of a health-care approach that identifies the optimal course of care for each patient. Although precision cardiology is still in its nascent stage, new approaches and methodologies are being developed to achieve this goal and to overcome technical and implementation barriers. In 2018, several high-impact studies made progress in this direction.

Considerable evidence supports a role for low-grade chronic inflammation in the atherothrombotic process, from plaque initiation to acute plaque rupture preceding myocardial infarction. Publications in 2018 revealed both the promise and challenges of targeting inflammation to treat atherosclerotic cardiovascular disease and highlighted the importance of understanding the mechanistic diversity of inflammatory pathways contributing to atherosclerosis.

Fully bioresorbable scaffolds (BRS) were designed to overcome the limitations of metallic drug-eluting stents, but long-term results with these devices have been disappointing. In this Review, the authors discuss the available preclinical and clinical data for BRS and how this information can inform the development of next-generation BRS.

This Review summarizes the mechanisms of ectopic calcification processes in the cardiovascular system, with an emphasis on emerging knowledge obtained from advances in imaging methods, experimental models and multiomics-generated big data. This Review highlights the potential and challenges of artificial intelligence, machine learning and deep learning to integrate imaging and mechanistic data to identify biomarkers and effective treatments for cardiovascular calcification

Stent thrombosis is a rare but severe complication of coronary intervention and has a complex underlying pathophysiology. In this Review, Gori and colleagues describe the risk factors for stent thrombosis and discuss how a better understanding of the mechanisms underlying this complication can inform its prevention and treatment.

Cardiovascular disease (CVD) is the leading cause of death in China. In this Review, Zhao and colleagues summarize eight important features of the evolving epidemiology of CVD in China and discuss how this information can help to develop effective and timely strategies to prevent and treat CVD.

High-sensitivity cardiac troponin (hs-cTn) assays facilitate the ruling-out of myocardial infarction (MI) but identify a high number of patients with elevated troponin levels but without MI. Consequently, the term myocardial injury was included in the latest universal definition of MI. In the High-STEACS trial, use of a hs-cTnI assay was safe but had no prognostic benefit.

This Review discusses the latest findings and current theories on the pathogenesis of abdominal aortic aneurysm (AAA) and highlights potential medical therapies for AAA, summarizing previous, ongoing, and potential clinical trials of medical interventions for small AAAs. This expanding volume of research is expected to result in a range of novel medical therapies for AAA within the next decade.

This Review provides an update of the latest developments in our understanding of platelet functions and populations in normal physiology and in haemorrhagic, thrombotic, and inflammatory conditions. These advancements can aid in tailoring new strategies to target platelets in disease states while avoiding the increased risk of bleeding associated with current antiplatelet therapies.

Three cardiovascular outcome trials have now demonstrated the clinical benefit of achieving lower plasma LDL-cholesterol levels with the addition of PCSK9 inhibitors to statin therapy. In this Review, Marc Sabatine discusses the safety and efficacy data from these trials and their possible implications, such as the definition of new plasma LDL-cholesterol targets.

Metabolites produced by gut microorganisms from dietary metabolism have been linked to the pathogenesis of heart failure, suggesting that the gut microbiome functions like an endocrine organ. In this Review, Tang and colleagues discuss the gut microbial metabolic pathways involved in heart failure and propose the gut microbiome as a therapeutic target.

Antibody-producing B cells perform a unique role in responses to stress, injury, and infection. In this Review, Sage and colleagues discuss the spectrum of B cell involvement in dyslipidaemia and atherosclerotic plaque development.

This Review describes the effects of short sleep duration on cardiovascular health and diseases, and the authors discuss the main pathophysiological mechanisms involved, taking into account both experimental data and clinical evidence.

The current guidelines recommending the use of higher-intensity statin therapy to reduce the risk of cardiovascular disease have raised concerns about potential adverse effects associated with long-term statin therapy. In this Review, Adhyaru and Jacobson discuss the evidence for the efficacy and safety of statins to help clinicians and patients make informed decisions about statin therapy.

In this Review, Yacoub and McLeod summarize the rationale for monitoring patients with heart failure or pulmonary arterial hypertension to detect haemodynamic changes that predict the deterioration from subclinical to overt disease, the transition from noninvasive to implantable devices and the current and anticipated clinical use of these devices.

Computational models are increasingly used in cardiology to integrate multiple data sets from individual patients and create virtual-patient simulations. In this Review, Niederer and colleagues discuss how multi-scale models of cardiac electrophysiology and mechanics can support diagnostic assessment and clinical decision-making and pave the way to personalized cardiac care.