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  • Cardiovascular disease in the Eastern Mediterranean region: epidemiology and risk factor burden
    Nat. Rev. Cardiol. (IF 14.299) Pub Date : 
    Karam Turk-Adawi, Nizal Sarrafzadegan, Ibtihal Fadhil, Kathryn Taubert, Masoumeh Sadeghi, Nanette K. Wenger, Nigel S. Tan, Sherry L. Grace

    The Eastern Mediterranean region (EMR) comprises 22 countries or territories spanning from Morocco in the west to Pakistan in the east, and contains a population of almost 600 million people. Like many other developing regions, the burden of disease in the EMR has shifted in the past 30 years from primarily communicable diseases to noncommunicable diseases such as cardiovascular disease (CVD). Cardiovascular mortality in the EMR, mostly attributable to ischaemic heart disease, is expected to increase more dramatically in the next decade than in any other region except Africa. The most prominent CVD risk factors in this region include tobacco consumption, physical inactivity, depression, obesity, hypertension, and diabetes mellitus. Many individuals living in the EMR are unaware of their risk factor status, and even if treated, these risk factors are often poorly controlled. Furthermore, infrequent use of emergency medical services, delays in access to care, and lack of access to cardiac catheterization affects the timely diagnosis of CVD. Treatment of CVD is also suboptimal in this region, consisting primarily of thrombolysis, with insufficient provision of timely revascularization. In this Review, we summarize what is known about CVD burden, risk factors, and treatment strategies for individuals living in the EMR. This information will hopefully aid decision-makers when devising strategies on how to improve CVD prevention and management in this region.

    更新日期:2017-09-21
  • Reverse remodelling and myocardial recovery in heart failure
    Nat. Rev. Cardiol. (IF 14.299) Pub Date : 
    Gene H. Kim, Nir Uriel, Daniel Burkhoff

    Advances in medical and device therapies have demonstrated the capacity of the heart to reverse the failing phenotype. The development of normative changes to ventricular size and function led to the concept of reverse remodelling. Among heart failure therapies, durable mechanical circulatory support is most consistently associated with the largest degree of reverse remodelling. Accordingly, research to analyse human tissue after a period of mechanical circulatory support continues to yield a wealth of information. In this Review, we summarize the latest findings on reverse remodelling and myocardial recovery. Accumulating evidence shows that the molecular changes associated with heart failure, in particular in the transcriptome, metabalome, and extracellular matrix, persist in the reverse-remodelled myocardium despite apparent normalization of macrolevel properties. Therefore, reverse remodelling should be distinguished from true myocardial recovery, in which a failing heart regains both normal function and molecular makeup. These findings have implications for future research to develop therapies to repair fully the failing myocardium. Meanwhile, recognition by society guidelines of this new clinical phenotype, which is coming to be known as a state of heart failure remission, underscores the need to accurately define and identify reverse modelled myocardium for the establishment of appropriate therapies.

    更新日期:2017-09-21
  • Cardiovascular effects of marijuana and synthetic cannabinoids: the good, the bad, and the ugly
    Nat. Rev. Cardiol. (IF 14.299) Pub Date : 2017-09-14
    Pal Pacher, Sabine Steffens, György Haskó, Thomas H. Schindler, George Kunos

    Dysregulation of the endogenous lipid mediators endocannabinoids and their G-protein-coupled cannabinoid receptors 1 and 2 (CB1R and CB2R) has been implicated in a variety of cardiovascular pathologies. Activation of CB1R facilitates the development of cardiometabolic disease, whereas activation of CB2R (expressed primarily in immune cells) exerts anti-inflammatory effects. The psychoactive constituent of marijuana, Δ9-tetrahydrocannabinol (THC), is an agonist of both CB1R and CB2R, and exerts its psychoactive and adverse cardiovascular effects through the activation of CB1R in the central nervous and cardiovascular systems. The past decade has seen a nearly tenfold increase in the THC content of marijuana as well as the increased availability of highly potent synthetic cannabinoids for recreational use. These changes have been accompanied by the emergence of serious adverse cardiovascular events, including myocardial infarction, cardiomyopathy, arrhythmias, stroke, and cardiac arrest. In this Review, we summarize the role of the endocannabinoid system in cardiovascular disease, and critically discuss the cardiovascular consequences of marijuana and synthetic cannabinoid use. With the legalization of marijuana for medicinal purposes and/or recreational use in many countries, physicians should be alert to the possibility that the use of marijuana or its potent synthetic analogues might be the underlying cause of severe cardiovascular events and pathologies.

    更新日期:2017-09-15
  • Anticoagulation therapy: Bivalirudin not superior to heparin in PCI
    Nat. Rev. Cardiol. (IF 14.299) Pub Date : 
    Gregory B. Lim

    Anticoagulation therapy: Bivalirudin not superior to heparin in PCI Nature Reviews Cardiology, Published online: 14 September 2017; doi:10.1038/nrcardio.2017.142

    更新日期:2017-09-14
  • Vascular disease: Benefits of population screening for vascular risk
    Nat. Rev. Cardiol. (IF 14.299) Pub Date : 
    Gregory B. Lim

    Vascular disease: Benefits of population screening for vascular risk Nature Reviews Cardiology, Published online: 14 September 2017; doi:10.1038/nrcardio.2017.144

    更新日期:2017-09-14
  • Coronary artery disease: Coronary artery calcium testing
    Nat. Rev. Cardiol. (IF 14.299) Pub Date : 
    Karina Huynh

    Coronary artery disease: Coronary artery calcium testing Nature Reviews Cardiology, Published online: 14 September 2017; doi:10.1038/nrcardio.2017.146

    更新日期:2017-09-14
  • Hypertension: Ibuprofen increases blood pressure in patients with arthritis
    Nat. Rev. Cardiol. (IF 14.299) Pub Date : 
    Irene Fernández-Ruiz

    Hypertension: Ibuprofen increases blood pressure in patients with arthritis Nature Reviews Cardiology, Published online: 14 September 2017; doi:10.1038/nrcardio.2017.150

    更新日期:2017-09-14
  • Bivalirudin for patients with STEMI at high risk of bleeding undergoing PPCI
    Nat. Rev. Cardiol. (IF 14.299) Pub Date : 
    Lu Hu, Kai Guo, Zhigang Guo

    Bivalirudin for patients with STEMI at high risk of bleeding undergoing PPCI Nature Reviews Cardiology, Published online: 14 September 2017; doi:10.1038/nrcardio.2017.141

    更新日期:2017-09-14
  • Antithrombotic therapy: COMPASS points to low-dose rivaroxaban and aspirin for secondary prevention
    Nat. Rev. Cardiol. (IF 14.299) Pub Date : 
    Gregory B. Lim

    Antithrombotic therapy: COMPASS points to low-dose rivaroxaban and aspirin for secondary prevention Nature Reviews Cardiology, Published online: 14 September 2017; doi:10.1038/nrcardio.2017.148

    更新日期:2017-09-14
  • Inflammation: Targeting inflammatory pathways to treat atherosclerosis and cancer
    Nat. Rev. Cardiol. (IF 14.299) Pub Date : 
    Karina Huynh

    Inflammation: Targeting inflammatory pathways to treat atherosclerosis and cancer Nature Reviews Cardiology, Published online: 14 September 2017; doi:10.1038/nrcardio.2017.152

    更新日期:2017-09-14
  • Acute coronary syndromes: Supplemental oxygen in myocardial infarction
    Nat. Rev. Cardiol. (IF 14.299) Pub Date : 
    Gregory B. Lim

    Acute coronary syndromes: Supplemental oxygen in myocardial infarction Nature Reviews Cardiology, Published online: 14 September 2017; doi:10.1038/nrcardio.2017.143

    更新日期:2017-09-14
  • Genetics: Human genome editing in heart disease
    Nat. Rev. Cardiol. (IF 14.299) Pub Date : 2017-08-17
    Gregory B. Lim

    Human germline genome editing with CRISPR–Cas9 can be used with high efficiency, accuracy, and safety to correct a heterozygous, autosomal dominant mutation in MYBPC3 associated with hypertrophic cardiomyopathy, according to a new study in Nature.CRISPR–Cas9 is a versatile tool for recognizing a

    更新日期:2017-09-14
  • Dyslipidaemia: No effect of PCSK9 inhibitors on cognitive function
    Nat. Rev. Cardiol. (IF 14.299) Pub Date : 2017-08-31
    Irene Fernández-Ruiz

    Use of PCSK9 inhibitors is not associated with adverse cognitive effects, even among patients who attain very low levels of LDL cholesterol, according to a study in a subgroup of 1,204 patients from the FOURIER trial, a randomized trial of the PCSK9 inhibitor evolocumab added

    更新日期:2017-09-14
  • Surgery: On-pump superior to off-pump CABG surgery
    Nat. Rev. Cardiol. (IF 14.299) Pub Date : 2017-08-31
    Irene Fernández-Ruiz

    A follow-up study including 2,203 patients from a US-based randomized trial shows that CABG surgery performed without cardiopulmonary bypass (off pump) is associated with lower rates of 5-year survival and event-free survival than CABG surgery with cardiopulmonary bypass (on pump). In all 5-year clinical outcomes

    更新日期:2017-09-14
  • Cardioprotection: Anti-ageing effects of cardiosphere-derived cells
    Nat. Rev. Cardiol. (IF 14.299) Pub Date : 2017-08-31
    Irene Fernández-Ruiz

    Cardiosphere-derived cells (CDCs) from young animals can rejuvenate old animals. New research shows that intracardiac injection of neonatal rat CDCs in old rats improves heart function (reducing cardiac stiffness, hypertrophy, fibrosis, and diastolic dysfunction), increases exercise capacity by ∼20%, and improves the levels of systemic

    更新日期:2017-09-14
  • Basic research: Minimally invasive delivery of engineered cardiac patches for heart repair
    Nat. Rev. Cardiol. (IF 14.299) Pub Date : 2017-08-31
    Karina Huynh

    A novel elastic and microfabricated scaffold created using a biodegradable polymer has been developed to produce cardiac patches for delivery via injection into the heart. These patches significantly improved cardiac function in a rat model of myocardial infarction compared with untreated controls, according to a

    更新日期:2017-09-14
  • Cardiac regeneration: Cardiomyocyte proliferation: a variable genetic trait?
    Nat. Rev. Cardiol. (IF 14.299) Pub Date : 2017-08-24
    Gregory B. Lim

    “Heart injury does not inexorably lead to a permanent loss of myocardium and diminished function,” conclude the researchers in a new study published in Nature Genetics. Their findings indicate that mononuclear diploid cardiomyocytes (MNDCMs) might have the capacity to proliferate, and that the MNDCM

    更新日期:2017-09-14
  • Genetics: From non-coding risk variant to biological mechanism in CAD
    Nat. Rev. Cardiol. (IF 14.299) Pub Date : 2017-08-10
    Linda Koch

    Analyses of the genetic architecture of complex diseases such as coronary artery disease (CAD) have revealed that most genetic variants are located in non-coding regions of the genome. As regulatory variants can act over long genomic distances, the causal gene and specific mechanism through which

    更新日期:2017-09-14
  • Antiplatelet therapy: Aspirin in the elderly — tailored approaches ahead?
    Nat. Rev. Cardiol. (IF 14.299) Pub Date : 2017-08-10
    Victor Serebruany, Elena Golukhova

    The benefits of aspirin in protecting against thrombotic occlusions are well-established. However, aspirin use has also been linked to increased gastrointestinal and fatal bleeding in elderly patients. Safer preventive approaches should be considered in the elderly population, including reductions in aspirin dose, alternative daily regimens, and individualized treatment strategies.

    更新日期:2017-09-14
  • Imaging: Perivascular fat — an unheralded informant of coronary inflammation
    Nat. Rev. Cardiol. (IF 14.299) Pub Date : 2017-08-24
    Marc R. Dweck, Zahi A. Fayad

    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.

    更新日期:2017-09-14
  • Basic research: Standardizing animal atherosclerosis studies to improve reproducibility
    Nat. Rev. Cardiol. (IF 14.299) Pub Date : 2017-09-07
    Oliver Soehnlein, Carlos Silvestre-Roig

    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.

    更新日期:2017-09-14
  • Mendelian randomization in cardiometabolic disease: challenges in evaluating causality
    Nat. Rev. Cardiol. (IF 14.299) Pub Date : 2017-06-01
    Michael V. Holmes, Mika Ala-Korpela, George Davey Smith

    Mendelian randomization (MR) is a burgeoning field that involves the use of genetic variants to assess causal relationships between exposures and outcomes. MR studies can be straightforward; for example, genetic variants within or near the encoding locus that is associated with protein concentrations can help to assess their causal role in disease. However, a more complex relationship between the genetic variants and an exposure can make findings from MR more difficult to interpret. In this Review, we describe some of these challenges in interpreting MR analyses, including those from studies using genetic variants to assess causality of multiple traits (such as branched-chain amino acids and risk of diabetes mellitus); studies describing pleiotropic variants (for example, C-reactive protein and its contribution to coronary heart disease); and those investigating variants that disrupt normal function of an exposure (for example, HDL cholesterol or IL-6 and coronary heart disease). Furthermore, MR studies on variants that encode enzymes responsible for the metabolism of an exposure (such as alcohol) are discussed, in addition to those assessing the effects of variants on time-dependent exposures (extracellular superoxide dismutase), cumulative exposures (LDL cholesterol), and overlapping exposures (triglycerides and non-HDL cholesterol). We elaborate on the molecular features of each relationship, and provide explanations for the likely causal associations. In doing so, we hope to contribute towards more reliable evaluations of MR findings.

    更新日期:2017-09-14
  • Epidemiology of heart failure with preserved ejection fraction
    Nat. Rev. Cardiol. (IF 14.299) Pub Date : 2017-05-11
    Shannon M. Dunlay, Véronique L. Roger, Margaret M. Redfield

    Heart failure (HF) with preserved ejection fraction (HFpEF) is a clinical syndrome associated with poor quality of life, substantial health-care resource utilization, and premature mortality. We summarize the current knowledge regarding the epidemiology of HFpEF with a focus on community-based studies relevant to quantifying the population burden of HFpEF. Current data regarding the prevalence and incidence of HFpEF in the community as well as associated conditions and risk factors, risk of morbidity and mortality after diagnosis, and quality of life are presented. In the community, approximately 50% of patients with HF have HFpEF. Although the age-specific incidence of HF is decreasing, this trend is less dramatic for HFpEF than for HF with reduced ejection fraction (HFrEF). The risk of HFpEF increases sharply with age, but hypertension, obesity, and coronary artery disease are additional risk factors. After adjusting for age and other risk factors, the risk of HFpEF is fairly similar in men and women, whereas the risk of HFrEF is much lower in women. Multimorbidity is common in both types of HF, but slightly more severe in HFpEF. A majority of deaths in patients with HFpEF are cardiovascular, but the proportion of noncardiovascular deaths is higher in HFpEF than HFrEF.

    更新日期:2017-09-14
  • Epidemiology and treatment of pulmonary arterial hypertension
    Nat. Rev. Cardiol. (IF 14.299) Pub Date : 2017-06-08
    Edmund M. T. Lau, Eleni Giannoulatou, David S. Celermajer, Marc Humbert

    In the past 2 decades, major changes have occurred in the epidemiological and treatment landscape of pulmonary arterial hypertension (PAH). Previously regarded as a disease of the young and middle-aged, contemporary registries from the Western world have demonstrated an increase in the age of patients with PAH, many of whom are elderly with multiple comorbidities. Another important observation is the improvement in survival of patients with PAH in the modern treatment era compared with historical cohorts, before the availability of advanced therapy. The management of PAH has also become more complex, and numerous drugs are now approved that target the endothelin 1, nitric oxide, and prostacyclin pathways. Combining drugs from different classes is now considered the standard of care and has been demonstrated to improve outcomes. Furthermore, the current treatment paradigm is the early use of combination therapy, often at the time of diagnosis, particularly in patients with severe disease. This Review provides a comprehensive update on the epidemiology and pharmacotherapy of PAH.

    更新日期:2017-09-14
  • Matching patients with the ever-expanding range of TAVI devices
    Nat. Rev. Cardiol. (IF 14.299) Pub Date : 2017-07-06
    Brandon M. Jones, Amar Krishnaswamy, E. Murat Tuzcu, Stephanie Mick, Wael A. Jaber, Lars G. Svensson, Samir R. Kapadia

    Transcatheter aortic valve implantation (TAVI) has become a widely accepted strategy for the treatment of aortic stenosis in patients at intermediate, high, or prohibitive surgical risk. After >1 decade of innovation and clinical trial experience, the available technology for TAVI has grown enormously, and now includes a myriad of vascular access approaches and innovative valve designs. As a result, the range of patients who can benefit from these advances continues to grow rapidly. Furthermore, given the improved safety profile and clinical success of current-generation devices in randomized trials, the use of TAVI among even low-risk populations is justified in current trials. With the rapid dissemination and expansion of this technology, operators need to have a comprehensive understanding of how to select the appropriate procedural approach for each individual patient. In this Review, we detail the current evidence for TAVI among different patient populations, discuss the different vascular access approaches currently in use, and explore differences in design features among currently available and investigational valve systems. Furthermore, we provide an overview of important considerations for special patient populations, such as those with existing mitral prostheses, bicuspid aortic stenosis, isolated aortic regurgitation, or severe left ventricular outflow tract calcification.

    更新日期:2017-09-14
  • Bivalirudin for patients with STEMI at high risk of bleeding undergoing PPCI
    Nat. Rev. Cardiol. (IF 14.299) Pub Date : 2017-09-14
    Lu Hu, Kai Guo, Zhigang Guo

    We read the Review by Franchi et al. (Antithrombotic therapy for patients with STEMI undergoing primary PCI. Nat. Rev. Cardiol.14, 361–379; 2017) with great interest. We wish to discuss the role of bivalirudin for patients with ST-segment elevation myocardial

    更新日期:2017-09-14
  • Dyslipidaemia: Monoclonal antibody targeting lipoprotein-bound human apoC-III
    Nat. Rev. Cardiol. (IF 14.299) Pub Date : 
    Karina Huynh

    Dyslipidaemia: Monoclonal antibody targeting lipoprotein-bound human apoC-III Nature Reviews Cardiology, Published online: 7 September 2017; doi:10.1038/nrcardio.2017.140

    更新日期:2017-09-07
  • Expert consensus document: A 'diamond' approach to personalized treatment of angina
    Nat. Rev. Cardiol. (IF 14.299) Pub Date : 2017-09-07
    Roberto Ferrari, Paolo G. Camici, Filippo Crea, Nicolas Danchin, Kim Fox, Aldo P. Maggioni, Athanasios J. Manolis, Mario Marzilli, Giuseppe M. C. Rosano, José L. Lopez-Sendon

    Expert consensus document: A 'diamond' approach to personalized treatment of angina Nature Reviews Cardiology, Published online: 7 September 2017; doi:10.1038/nrcardio.2017.131 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.

    更新日期:2017-09-07
  • Sudden infant death syndrome and inherited cardiac conditions
    Nat. Rev. Cardiol. (IF 14.299) Pub Date : 2017-09-07
    Alban-Elouen Baruteau, David J. Tester, Jamie D. Kapplinger, Michael J. Ackerman, Elijah R. Behr

    Sudden infant death syndrome (SIDS) is the leading cause of post-neonatal infant mortality in developed countries, characterized by the death of infants for no obvious reason and without prior warning. The complex interaction of multiple factors in the pathogenesis of SIDS is illustrated by the 'triple risk hypothesis', which proposed that SIDS results from a convergence of three overlapping risk factors: a critical developmental period, an exogenous stressor, and underlying genetic and/or nongenetic vulnerability in the infant. Rare variants in genes associated with inherited arrhythmia syndromes and cardiomyopathies have been proposed as the substrate for an infant's critical vulnerability in a small subset of SIDS cases. Given the potential risk of inherited cardiac disease, current guidelines recommend post-mortem genetic testing (molecular autopsy) and cardiological investigation of the surviving family, complemented by targeted genetic testing if appropriate. In this Review, we highlight the latest developments in understanding the spectrum and prevalence of cardiac-mediated SIDS, and discuss the clinical implications of SIDS in the surviving family and the general population.

    更新日期:2017-09-07
  • Basic research: Standardizing animal atherosclerosis studies to improve reproducibility
    Nat. Rev. Cardiol. (IF 14.299) Pub Date : 2017-09-07
    Oliver Soehnlein, Carlos Silvestre-Roig

    Basic research: Standardizing animal atherosclerosis studies to improve reproducibility Nature Reviews Cardiology, Published online: 7 September 2017; doi:10.1038/nrcardio.2017.132 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.

    更新日期:2017-09-07
  • Antiplatelet therapy: Aspirin in the elderly — tailored approaches ahead?
    Nat. Rev. Cardiol. (IF 14.299) Pub Date : 2017-08-10
    Victor Serebruany, Elena Golukhova

    The benefits of aspirin in protecting against thrombotic occlusions are well-established. However, aspirin use has also been linked to increased gastrointestinal and fatal bleeding in elderly patients. Safer preventive approaches should be considered in the elderly population, including reductions in aspirin dose, alternative daily regimens, and individualized treatment strategies.

    更新日期:2017-09-04
  • New and revisited approaches to preserving the reperfused myocardium
    Nat. Rev. Cardiol. (IF 14.299) Pub Date : 2017-07-27
    Robert A. Kloner, David A. Brown, Marie Csete, Wangde Dai, James M. Downey, Roberta A. Gottlieb, Sharon L. Hale, Jianru Shi

    Early coronary artery reperfusion improves outcomes for patients with ST-segment elevation myocardial infarction (STEMI), but morbidity and mortality after STEMI remain unacceptably high. The primary deficits seen in these patients include inadequate pump function, owing to rapid infarction of muscle in the first few hours of treatment, and adverse remodelling of the heart in the months that follow. Given that attempts to further reduce myocardial infarct size beyond early reperfusion in clinical trials have so far been disappointing, effective therapies are still needed to protect the reperfused myocardium. In this Review, we discuss several approaches to preserving the reperfused heart, such as therapies that target the mechanisms involved in mitochondrial bioenergetics, pyroptosis, and autophagy, as well as treatments that harness the cardioprotective properties of inhaled anaesthetic agents. We also discuss potential therapies focused on correcting the no-reflow phenomenon and its effect on healing and adverse left ventricular remodelling.

    更新日期:2017-09-04
  • Interventional and surgical occlusion of the left atrial appendage
    Nat. Rev. Cardiol. (IF 14.299) Pub Date : 2017-08-10
    Etem Caliskan, James L. Cox, David R. Holmes, Bernhard Meier, Dhanunjaya R. Lakkireddy, Volkmar Falk, Sacha P. Salzberg, Maximilian Y. Emmert

    With a steadily increasing prevalence, atrial fibrillation (AF) is the most common sustained cardiac arrhythmia worldwide and an independent risk factor for stroke caused by thromboembolic events. The left atrial appendage (LAA) is the primary source of thromboemboli in patients with nonvalvular AF who have a stroke. Novel strategies (such as mechanical and nonpharmacological intervention) targeting the LAA in patients with AF for stroke prevention have become a major focus during the past decade. Some devices for percutaneous LAA occlusion are supported by robust clinical data obtained from randomized trials or large registries, and are a valid alternative to pharmacological stroke prevention. However, the incidence of periprocedural complications and the presence of device-related thrombi or residual LAA leaks, whose long-term clinical implications are still unknown, are limiting factors in wider acceptability of these techniques. In this Review, we discuss the available techniques for LAA occlusion in patients with nonvalvular AF at high risk of stroke. We describe the pharmacological and mechanical approaches to LAA occlusion, and provide the current clinical evidence for various strategies. We particularly focus on the current management of the LAA, and discuss the challenges and future implications of the available approaches to LAA occlusion.

    更新日期:2017-09-04
  • Management of cardiovascular diseases in patients with obesity
    Nat. Rev. Cardiol. (IF 14.299) Pub Date : 2017-07-27
    Carl J. Lavie, Ross Arena, Martin A. Alpert, Richard V. Milani, Hector O. Ventura

    The management of cardiovascular diseases (CVD) in patients with obesity presents numerous challenges. Obesity has a negative effect on almost all of the major CVD risk factors, and adversely influences cardiovascular structure and function. Patients who are overweight or obese have a higher incidence of almost all CVDs compared with patients who are of normal weight. However, those who are overweight or obese seem to have a better short-term and medium-term prognosis after major CVD events and interventional procedures or cardiac surgeries than leaner patients, a phenomenon termed the 'obesity paradox'. In considering the mechanisms underlying this paradox, we review evidence of the deleterious consequences of obesity in patients with coronary heart disease, and the limited data on the benefits of weight loss in patients with CVD. Additional studies are needed on the efficacy of purposeful weight loss on cardiovascular outcomes to determine the ideal body composition for patients with CVD.

    更新日期:2017-09-04
  • HDL and atherosclerotic cardiovascular disease: genetic insights into complex biology
    Nat. Rev. Cardiol. (IF 14.299) Pub Date : 2017-08-10
    Robert S. Rosenson, H. Bryan Brewer, Philip J. Barter, Johan L. M. Björkegren, M. John Chapman, Daniel Gaudet, Daniel Seung Kim, Eric Niesor, Kerry-Anne Rye, Frank M. Sacks, Jean-Claude Tardif, Robert A. Hegele

    Plasma levels of HDL cholesterol (HDL-C) predict the risk of cardiovascular disease at the epidemiological level, but a direct causal role for HDL in cardiovascular disease remains controversial. Studies in animal models and humans with rare monogenic disorders link only particular HDL-associated mechanisms with causality, including those mechanisms related to particle functionality rather than cholesterol content. Mendelian randomization studies indicate that most genetic variants that affect a range of pathways that increase plasma HDL-C levels are not usually associated with reduced risk of cardiovascular disease, with some exceptions, such as cholesteryl ester transfer protein variants. Furthermore, only a fraction of HDL-C variation has been explained by known loci from genome-wide association studies (GWAS), suggesting the existence of additional pathways and targets. Systems genetics can enhance our understanding of the spectrum of HDL pathways, particularly those pathways that involve new and non-obvious GWAS loci. Bioinformatic approaches can also define new molecular interactions inferred from both large-scale genotypic data and RNA sequencing data to reveal biologically meaningful gene modules and networks governing HDL metabolism with direct relevance to disease end points. Targeting these newly recognized causal networks might inform the development of novel therapeutic strategies to reduce the risk of cardiovascular disease.

    更新日期:2017-09-04
  • Hypertension as a cardiovascular risk factor in autoimmune rheumatic diseases
    Nat. Rev. Cardiol. (IF 14.299) Pub Date : 2017-08-24
    Elena Bartoloni, Alessia Alunno, Roberto Gerli

    Evidence for the increased risk of cardiovascular morbidity and mortality in patients with chronic inflammatory and systemic autoimmune diseases has accumulated during the past 15 years. In these patients, an interplay between several mechanisms, including premature acceleration of subclinical atherosclerotic damage, inflammation, and dysregulation of the immune system, is involved in the induction and progression of atherosclerosis. Moreover, traditional cardiovascular risk factors are also likely to contribute, at least in part, to the excess cardiovascular risk. Among traditional cardiovascular risk factors, hypertension is an important predictor of cardiovascular events in the general population and in patients with chronic inflammatory and autoimmune diseases. Evidence supports the idea that the pathogenic mechanisms underlying the increased blood pressure in these diseases are multifactorial and not only related to the mechanical injury of the arterial wall. In particular, chronic inflammation and immune-mediated mechanisms have been demonstrated to affect blood-pressure control in patients with systemic autoimmune disease. In this Review, we discuss the available evidence on the relationship between hypertension and autoimmune diseases, and describe the multiple factors that might affect blood-pressure control in patients with chronic inflammatory and systemic autoimmune diseases. We also discuss the effect of hypertension and antirheumatic therapies on cardiovascular outcome.

    更新日期:2017-09-04
  • Epidemiology of heart failure with preserved ejection fraction
    Nat. Rev. Cardiol. (IF 14.299) Pub Date : 2017-05-11
    Shannon M. Dunlay, Véronique L. Roger, Margaret M. Redfield

    Heart failure (HF) with preserved ejection fraction (HFpEF) is a clinical syndrome associated with poor quality of life, substantial health-care resource utilization, and premature mortality. We summarize the current knowledge regarding the epidemiology of HFpEF with a focus on community-based studies relevant to quantifying the population burden of HFpEF. Current data regarding the prevalence and incidence of HFpEF in the community as well as associated conditions and risk factors, risk of morbidity and mortality after diagnosis, and quality of life are presented. In the community, approximately 50% of patients with HF have HFpEF. Although the age-specific incidence of HF is decreasing, this trend is less dramatic for HFpEF than for HF with reduced ejection fraction (HFrEF). The risk of HFpEF increases sharply with age, but hypertension, obesity, and coronary artery disease are additional risk factors. After adjusting for age and other risk factors, the risk of HFpEF is fairly similar in men and women, whereas the risk of HFrEF is much lower in women. Multimorbidity is common in both types of HF, but slightly more severe in HFpEF. A majority of deaths in patients with HFpEF are cardiovascular, but the proportion of noncardiovascular deaths is higher in HFpEF than HFrEF.

    更新日期:2017-09-04
  • Seasonal variations in cardiovascular disease
    Nat. Rev. Cardiol. (IF 14.299) Pub Date : 2017-05-18
    Simon Stewart, Ashley K. Keates, Adele Redfern, John J. V. McMurray

    Cardiovascular disease (CVD) follows a seasonal pattern in many populations. Broadly defined winter peaks and clusters of all subtypes of CVD after 'cold snaps' are consistently described, with corollary peaks linked to heat waves. Individuals living in milder climates might be more vulnerable to seasonality. Although seasonal variation in CVD is largely driven by predictable changes in weather conditions, a complex interaction between ambient environmental conditions and the individual is evident. Behavioural and physiological responses to seasonal change modulate susceptibility to cardiovascular seasonality. The heterogeneity in environmental conditions and population dynamics across the globe means that a definitive study of this complex phenomenon is unlikely. However, given the size of the problem and a range of possible targets to reduce seasonal provocation of CVD in vulnerable individuals, scope exists for both greater recognition of the problem and application of multifaceted interventions to attenuate its effects. In this Review, we identify the physiological and environmental factors that contribute to seasonality in nearly all forms of CVD, highlight findings from large-scale population studies of this phenomenon across the globe, and describe the potential strategies that might attenuate peaks in cardiovascular events during cold and hot periods of the year.

    更新日期:2017-09-04
  • Mendelian randomization in cardiometabolic disease: challenges in evaluating causality
    Nat. Rev. Cardiol. (IF 14.299) Pub Date : 2017-06-01
    Michael V. Holmes, Mika Ala-Korpela, George Davey Smith

    Mendelian randomization (MR) is a burgeoning field that involves the use of genetic variants to assess causal relationships between exposures and outcomes. MR studies can be straightforward; for example, genetic variants within or near the encoding locus that is associated with protein concentrations can help to assess their causal role in disease. However, a more complex relationship between the genetic variants and an exposure can make findings from MR more difficult to interpret. In this Review, we describe some of these challenges in interpreting MR analyses, including those from studies using genetic variants to assess causality of multiple traits (such as branched-chain amino acids and risk of diabetes mellitus); studies describing pleiotropic variants (for example, C-reactive protein and its contribution to coronary heart disease); and those investigating variants that disrupt normal function of an exposure (for example, HDL cholesterol or IL-6 and coronary heart disease). Furthermore, MR studies on variants that encode enzymes responsible for the metabolism of an exposure (such as alcohol) are discussed, in addition to those assessing the effects of variants on time-dependent exposures (extracellular superoxide dismutase), cumulative exposures (LDL cholesterol), and overlapping exposures (triglycerides and non-HDL cholesterol). We elaborate on the molecular features of each relationship, and provide explanations for the likely causal associations. In doing so, we hope to contribute towards more reliable evaluations of MR findings.

    更新日期:2017-09-04
  • Matching patients with the ever-expanding range of TAVI devices
    Nat. Rev. Cardiol. (IF 14.299) Pub Date : 2017-07-06
    Brandon M. Jones, Amar Krishnaswamy, E. Murat Tuzcu, Stephanie Mick, Wael A. Jaber, Lars G. Svensson, Samir R. Kapadia

    Transcatheter aortic valve implantation (TAVI) has become a widely accepted strategy for the treatment of aortic stenosis in patients at intermediate, high, or prohibitive surgical risk. After >1 decade of innovation and clinical trial experience, the available technology for TAVI has grown enormously, and now includes a myriad of vascular access approaches and innovative valve designs. As a result, the range of patients who can benefit from these advances continues to grow rapidly. Furthermore, given the improved safety profile and clinical success of current-generation devices in randomized trials, the use of TAVI among even low-risk populations is justified in current trials. With the rapid dissemination and expansion of this technology, operators need to have a comprehensive understanding of how to select the appropriate procedural approach for each individual patient. In this Review, we detail the current evidence for TAVI among different patient populations, discuss the different vascular access approaches currently in use, and explore differences in design features among currently available and investigational valve systems. Furthermore, we provide an overview of important considerations for special patient populations, such as those with existing mitral prostheses, bicuspid aortic stenosis, isolated aortic regurgitation, or severe left ventricular outflow tract calcification.

    更新日期:2017-09-04
  • Epidemiology and treatment of pulmonary arterial hypertension
    Nat. Rev. Cardiol. (IF 14.299) Pub Date : 2017-06-08
    Edmund M. T. Lau, Eleni Giannoulatou, David S. Celermajer, Marc Humbert

    In the past 2 decades, major changes have occurred in the epidemiological and treatment landscape of pulmonary arterial hypertension (PAH). Previously regarded as a disease of the young and middle-aged, contemporary registries from the Western world have demonstrated an increase in the age of patients with PAH, many of whom are elderly with multiple comorbidities. Another important observation is the improvement in survival of patients with PAH in the modern treatment era compared with historical cohorts, before the availability of advanced therapy. The management of PAH has also become more complex, and numerous drugs are now approved that target the endothelin 1, nitric oxide, and prostacyclin pathways. Combining drugs from different classes is now considered the standard of care and has been demonstrated to improve outcomes. Furthermore, the current treatment paradigm is the early use of combination therapy, often at the time of diagnosis, particularly in patients with severe disease. This Review provides a comprehensive update on the epidemiology and pharmacotherapy of PAH.

    更新日期:2017-09-04
  • Reperfusion strategies in acute myocardial infarction and multivessel disease
    Nat. Rev. Cardiol. (IF 14.299) Pub Date : 2017-06-29
    Birgit Vogel, Shamir R. Mehta, Roxana Mehran

    Approximately 50% of patients with ST-segment elevation myocardial infarction (STEMI) have multivessel disease. The optimal reperfusion strategy in these patients is still uncertain. Whether percutaneous coronary intervention (PCI) of only the culprit vessel or a strategy of complete revascularization, either in a simultaneous or staged multivessel PCI approach, should be performed remains unclear. Although a large number of observational studies have mostly shown worse clinical outcomes associated with a multivessel PCI approach, increasing evidence from randomized controlled trials suggests that multivessel PCI is safe, while reducing the need for revascularization in selected patients, compared with culprit vessel-only PCI. However, adequately-powered studies are still needed to determine the best treatment strategy in patients with STEMI and multivessel disease, particularly to demonstrate a reduction in the hard end point of death or myocardial infarction. In this Review, we provide a comprehensive summary of current evidence on the different treatment options for patients with STEMI and multivessel disease, highlighting current guideline recommendations and providing future directions on reperfusion strategies in these patients.

    更新日期:2017-09-04
  • Proteostasis in cardiac health and disease
    Nat. Rev. Cardiol. (IF 14.299) Pub Date : 2017-06-29
    Robert H. Henning, Bianca J. J. M. Brundel

    The incidence and prevalence of cardiac diseases, which are the main cause of death worldwide, are likely to increase because of population ageing. Prevailing theories about the mechanisms of ageing feature the gradual derailment of cellular protein homeostasis (proteostasis) and loss of protein quality control as central factors. In the heart, loss of protein patency, owing to flaws in genetically-determined design or because of environmentally-induced 'wear and tear', can overwhelm protein quality control, thereby triggering derailment of proteostasis and contributing to cardiac ageing. Failure of protein quality control involves impairment of chaperones, ubiquitin–proteosomal systems, autophagy, and loss of sarcomeric and cytoskeletal proteins, all of which relate to induction of cardiomyocyte senescence. Targeting protein quality control to maintain cardiac proteostasis offers a novel therapeutic strategy to promote cardiac health and combat cardiac disease. Currently marketed drugs are available to explore this concept in the clinical setting.

    更新日期:2017-09-04
  • Management of atrial high-rate episodes detected by cardiac implanted electronic devices
    Nat. Rev. Cardiol. (IF 14.299) Pub Date : 2017-07-06
    Ben Freedman, Giuseppe Boriani, Taya V. Glotzer, Jeff S. Healey, Paulus Kirchhof, Tatjana S. Potpara

    Cardiac implanted electronic devices (CIEDs), including pacemakers and implantable defibrillators that perform atrial sensing typically using an atrial electrode, frequently detect subclinical atrial high-rate episodes (AHREs). When the intracardiac electrograms are carefully examined, the majority of AHREs are atrial fibrillation (AF) or other atrial tachyarrhythmias, which have been shown to be associated with both an increased risk of stroke, and subsequent development of clinical AF. However, the absolute risk of stroke among patients with AHREs is less than might be expected for clinically diagnosed paroxysmal AF. In addition, a close temporal relationship between AHREs and stroke is seen in only 15% of strokes in patients with a CIED: the majority have either no AHREs before the stroke, or AHREs very distant from incident stroke, suggesting that AHREs might be more of a risk marker than a risk factor for stroke. Management of AHREs should not be the same as for clinical AF, and a degree of uncertainty underpins the rationale for much-needed, ongoing, randomized trials of oral anticoagulation in patients with CIED-detected AHREs. We propose a management algorithm that takes into account both the stroke risk and the AHRE burden, but highlights the current uncertainty and evidence gaps for this condition.

    更新日期:2017-09-04
  • Unmasking the molecular link between arrhythmogenic cardiomyopathy and Brugada syndrome
    Nat. Rev. Cardiol. (IF 14.299) Pub Date : 2017-07-13
    Javier Moncayo-Arlandi, Ramon Brugada

    Several macromolecular structures coexist in the intercalated discs, which connect cardiomyocytes and control cell-to-cell communication. In this Perspectives article, Moncayo-Arlandi and Brugada suggest that the structures of the intercalated disc form an interactive 'connexome'. They also propose a link between arrhythmogenic cardiomyopathy and Brugada syndrome on the basis of overlapping genetic, molecular, and pathophysiological mechanisms.

    更新日期:2017-09-04
  • Cardioprotection: Anti-ageing effects of cardiosphere-derived cells
    Nat. Rev. Cardiol. (IF 14.299) Pub Date : 
    Irene Fernández-Ruiz

    Cardioprotection: Anti-ageing effects of cardiosphere-derived cells Nature Reviews Cardiology, Published online: 31 August 2017; doi:10.1038/nrcardio.2017.136

    更新日期:2017-09-04
  • Surgery: On-pump superior to off-pump CABG surgery
    Nat. Rev. Cardiol. (IF 14.299) Pub Date : 
    Irene Fernández-Ruiz

    Surgery: On-pump superior to off-pump CABG surgery Nature Reviews Cardiology, Published online: 31 August 2017; doi:10.1038/nrcardio.2017.135

    更新日期:2017-09-04
  • Basic research: Minimally invasive delivery of engineered cardiac patches for heart repair
    Nat. Rev. Cardiol. (IF 14.299) Pub Date : 
    Karina Huynh

    Basic research: Minimally invasive delivery of engineered cardiac patches for heart repair Nature Reviews Cardiology, Published online: 31 August 2017; doi:10.1038/nrcardio.2017.137

    更新日期:2017-09-04
  • Dyslipidaemia: No effect of PCSK9 inhibitors on cognitive function
    Nat. Rev. Cardiol. (IF 14.299) Pub Date : 
    Irene Fernández-Ruiz

    Dyslipidaemia: No effect of PCSK9 inhibitors on cognitive function Nature Reviews Cardiology, Published online: 31 August 2017; doi:10.1038/nrcardio.2017.134

    更新日期:2017-09-04
  • Imaging: Perivascular fat — an unheralded informant of coronary inflammation
    Nat. Rev. Cardiol. (IF 14.299) Pub Date : 2017-08-24
    Marc R. Dweck, Zahi A. Fayad

    Imaging: Perivascular fat — an unheralded informant of coronary inflammation Nature Reviews Cardiology, Published online: 24 August 2017; doi:10.1038/nrcardio.2017.127 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.

    更新日期:2017-09-04
  • Cardiac regeneration: Cardiomyocyte proliferation: a variable genetic trait?
    Nat. Rev. Cardiol. (IF 14.299) Pub Date : 
    Gregory B. Lim

    Cardiac regeneration: Cardiomyocyte proliferation: a variable genetic trait? Nature Reviews Cardiology, Published online: 24 August 2017; doi:10.1038/nrcardio.2017.133

    更新日期:2017-09-04
  • Future of transcatheter aortic valve implantation — evolving clinical indications
    Nat. Rev. Cardiol. (IF 14.299) Pub Date : 2017-08-24
    Rishi Puri, Chekrallah Chamandi, Tania Rodriguez-Gabella, Josep Rodés-Cabau

    Future of transcatheter aortic valve implantation — evolving clinical indications Nature Reviews Cardiology, Published online: 24 August 2017; doi:10.1038/nrcardio.2017.116 In this Perspectives article, Rodés-Cabau and colleagues discuss the evolving indications and future applications of transcatheter aortic valve implantation (TAVI). The steady improvement in prosthetic heart valves and the development of novel devices have enabled the continued expansion of TAVI indications, including the use of this procedure in low-risk patients or in aortic pathologies such as pure aortic regurgitation and bicuspid valve disease.

    更新日期:2017-09-04
  • Beyond gut feelings: how the gut microbiota regulates blood pressure
    Nat. Rev. Cardiol. (IF 14.299) Pub Date : 2017-08-24
    Francine Z. Marques, Charles R. Mackay, David M. Kaye

    Hypertension is the leading risk factor for heart disease and stroke, and is estimated to cause 9.4 million deaths globally every year. The pathogenesis of hypertension is complex, but lifestyle factors such as diet are important contributors to the disease. High dietary intake of fruit and vegetables is associated with reduced blood pressure and lower cardiovascular mortality. A critical relationship between dietary intake and the composition of the gut microbiota has been described in the literature, and a growing body of evidence supports the role of the gut microbiota in the regulation of blood pressure. In this Review, we describe the mechanisms by which the gut microbiota and its metabolites, including short-chain fatty acids, trimethylamine N-oxide, and lipopolysaccharides, act on downstream cellular targets to prevent or contribute to the pathogenesis of hypertension. These effects have a direct influence on tissues such as the kidney, the endothelium, and the heart. Finally, we consider the role of the gut microbiota in resistant hypertension, the possible intergenerational effect of the gut microbiota on blood pressure regulation, and the promising therapeutic potential of gut microbiota modification to improve health and prevent disease.

    更新日期:2017-09-04
  • Arrhythmias: Safety backups to keep the pace
    Nat. Rev. Cardiol. (IF 14.299) Pub Date : 2017-08-16
    Irene Fernández-Ruiz

    The human sinoatrial node (SAN), the main pacemaker of the heart, has redundant, fail-safe mechanisms that maintain a consistent heart rhythm and protect the heart from rhythm failure even under stress conditions, according to a new study published in Science Translational Medicine. “[We found

    更新日期:2017-08-24
  • Developmental biology: Formation of hybrid myocardial zone
    Nat. Rev. Cardiol. (IF 14.299) Pub Date : 2017-08-16
    Karina Huynh

    Left ventricular noncompaction cardiomyopathy is characterized by the presence of excessive recesses in the trabecular network that can result in heart failure, arrhythmia, and thromboembolism. Using genetic lineage tracing, Tian and colleagues found that inhibition of Hey2+ cell expansion results in the formation

    更新日期:2017-08-24
  • Arrhythmias: Long working hours and risk of atrial fibrillation
    Nat. Rev. Cardiol. (IF 14.299) Pub Date : 2017-08-03
    Gregory B. Lim

    Working long hours is associated with an increased risk of developing atrial fibrillation (AF), according to a new study published in European Heart Journal. Whether the relationship is causal remains to be determined.Members of the IPD-Work Consortium conducted a prospective, multicohort study involving

    更新日期:2017-08-24
  • Growth and development: Poly(A) tail-based regulation of cardiac hypertrophy
    Nat. Rev. Cardiol. (IF 14.299) Pub Date : 2017-07-20
    Irene Fernández-Ruiz

    Protein synthesis in the heart is a dynamic process, characterized by low synthesis rates in the adult heart that can increase substantially in periods of hypertrophy; however the regulatory mechanisms involved are unclear. New research now reveals that the dynamic regulation of PABPC1 translation,

    更新日期:2017-08-24
  • Dyslipidaemia: Effect of hypercholesterolaemia on HDL particle remodelling
    Nat. Rev. Cardiol. (IF 14.299) Pub Date : 2017-07-20
    Gregory B. Lim

    Hypercholesterolaemia induces lipidomic and proteomic changes in HDL particles, which impair the functionality of the HDL particles and reduce their cardioprotective properties. This finding comes from a study on ischaemia–reperfusion injury in pigs, in which the beneficial effects of HDL were abolished by hypercholesterolaemia.Pigs

    更新日期:2017-08-24
  • Basic research: New cardiomyocyte formation in adult mouse hearts
    Nat. Rev. Cardiol. (IF 14.299) Pub Date : 2017-07-13
    Karina Huynh

    Previous studies have shown that new cardiomyocytes can be generated in the adult mammalian heart, but the source of these new cardiomyocytes was unclear. In a new study published in Circulation, Zeng and colleagues report that existing adult cardiomyocytes can re-enter the cell cycle

    更新日期:2017-08-24
  • Demystifying rotors and their place in clinical translation of atrial fibrillation mechanisms
    Nat. Rev. Cardiol. (IF 14.299) Pub Date : 2017-04-06
    Stanley Nattel, Feng Xiong, Martin Aguilar

    Treatment of atrial fibrillation (AF), the most common arrhythmia in clinical practice, remains challenging. Improved understanding of underlying mechanisms is needed to improve therapy. Functional re-entry is central to AF maintenance. The first detailed, quantitative theory of functional re-entry, the 'leading circle' model, was developed 40 years ago. Subsequently, an alternative paradigm based on 'spiral waves' has evolved. Spiral-wave generators, or 'rotors', have been identified using advanced mapping methods in experimental and clinical AF. A central tool in the analysis of spiral-wave rotors is the phase transformation, allowing for easier visualization of rotors and tracking of 'phase singularity' points at the rotor tip. In contrast to leading circle theory, which is expressed in terms familiar to (and easily understood by) cardiologists, the ideas needed to understand rotors are much more theoretical and harder for clinicians to apply. In this Review, we summarize the basic notions of phase mapping and spiral-wave rotors, and the ways in which rotor sources might be involved in AF maintenance. We discuss competing observations about the role of spatially confined rotors, short-lived rotors clustered at the edge of fibrotic zones, endocardial–epicardial interactive breeder properties and transmural re-entry, as well as studies underway to resolve them. We conclude with consideration of the clinical relevance of the issues discussed and their potential implications for the management of patients with AF.

    更新日期:2017-08-24
Some contents have been Reproduced with permission of the American Chemical Society.
Some contents have been Reproduced by permission of The Royal Society of Chemistry.
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