Articles in 2011

This paper explores the rationale for early, 'vitamin-like' use of statins to lower LDL levels in asymptomatic adults aged 35–50 years. The authors describe the features of a trial designed to determine whether this approach could dramatically reduce the burden of atherosclerosis and atherothrombotic events in the general population.

Congenital defects of the heart affect up to 10 in 1,000 neonates, but mortality has decreased with improved detection and treatment. Drs Roest and de Roos describe the various imaging modalities available to assess patients with congenital heart disease before intervention, and to evaluate systolic, diastolic, valvular, and vascular function during follow-up.

Elevated blood pressure (BP) is probably the most-important, modifiable risk factor for cardiovascular disease. Dr. Ruilope discusses current controversies and challenges in the treatment of patients with arterial hypertension, including the validity of office BP measurements, appropriateness of BP targets, use of combination therapy, and patient compliance.

Hypertrophic cardiomyopathy is the most-common form of monogenically inherited heart disease, and is associated with a high incidence of sudden cardiac death in young patients. The authors review the genetic mutations known to cause the disease, discuss potential pathological mechanisms that might lead to the clinical phenotype, and consider the implications for targeted therapies.

Cardiac remodeling encompasses structural and functional changes of the left ventricle in response to stressors, and precedes clinical heart failure. Evaluation of cardiac remodeling can help to select patients with subclinical heart failure for early treatment. Drs Gjesdal, Blumke, and Lima review population-based studies of cardiac remodeling, describing risk factors, screening strategies, and outcome measures.

Lovibond and colleagues report that ambulatory blood-pressure monitoring is the cost-effective option for the diagnosis of hypertension. Room for refining this analysis exists, but the focus on cost-saving by avoiding unnecessary treatment is compelling and should receive due consideration by guideline writers.

Anomalous origination of a coronary artery from the opposite sinus is a congenital heart defect with an uncertain prevalence and prognosis. The authors review the current understanding of the pathophysiology of the condition, the imaging modalities available to diagnose and functionally assess patients, and the medical, interventional, and surgical treatment options.

No worldwide consensus exists regarding the best way to manage patients with asymptomatic carotid artery stenosis (CAS). In this thought-provoking article, Professor A. Ross Naylor presents his argument against the use of a 'one size fits all' approach involving the costly widespread use of surgical or percutaneous interventions, a high percentage of which are unnecessary. Instead, he recommends that the medical community should increase efforts to identify those at particularly high risk for stroke, who are the only patients likely to really benefit from these interventions

In the second part of their Review on restenosis after PCI, Jukema and colleagues focus on the technological advances that have fueled revolutionary changes for optimizing outcomes of coronary stenting and the prevention and treatment of in-stent restenosis.

Indisputable evidence that coronary artery calcium score predicts cardiovascular events in asymptomatic individuals exists, even in patients with low to normal LDL cholesterol and elevated C-reactive protein. Conversely, not all studies demonstrate a predictive role for biochemical markers.

Antithrombotic therapy during percutaneous coronary intervention for ST-segment elevation myocardial infarction has evolved substantially over the past 15 years. With the results of the ATOLL trial, enoxaparin should now be considered a therapeutic alternative to unfractionated heparin in the treatment of such patients. Comparative studies of enoxaparin and bivalirudin, using standardized bleeding definitions, are warranted.