Articles in 2011

Ectopic foci in pulmonary veins can trigger episodes of atrial fibrillation, but how these foci arise remains unclear. Dr Mark Shen and colleagues review the role of the autonomous nervous system in the induction and maintenance of atrial arrhythmias, and discuss neural modulation as a treatment strategy for patients with atrial fibrillation.

The true prognostic implication of carotid intima–media thickness (CIMT) remains a major question for clinicians and the preventive cardiology community. The merits of using CIMT for assessing asymptomatic individuals at risk for developing cardiovascular disease are discussed, together with the potential issues arising from an analysis of CIMT measurement in the Framingham Offspring Study cohort.

Metabolomics is emerging as a powerful tool for the investigation of the molecular mechanisms of cardiovascular disease, including atherosclerosis, ischemia, myocardial infarction, and heart failure. In this Review, the authors discuss advances in the use of NMR spectroscopy and mass spectrometry, particularly in field of lipidomics, and in the search for novel biomarkers of cardiac disease.

Antiplatelet agents effectively reduce the incidence of ischemic events associated with plaque rupture but can cause adverse effects, most notably hemorrhage. Drs Kalyanasundaram and Lincoff address key adverse effects that are associated with antiplatelet agents and discuss potential interactions between these drugs and other medications.

Restenosis of atherosclerotic lesions after initial treatment with angioplasty and stenting occurs in around 15% of patients. Although this condition is complex and the causative mechanisms have not yet been fully identified, they are thought to include inflammation, proliferation, and matrix remodeling with some patients being more 'predisposed' to developing restenosis than others. In this Review, Jukema and colleagues evaluate the available evidence on the pathophysiology of restenosis and provide an overview of the various risk factors for this disease.

The appropriateness of percutaneous coronary intervention in the US has been examined from a large database of more than 500,000 procedures. The findings are surprising and, given their potential to be applied to quality-improvement initiatives, peer-review, and possibly reimbursement decisions, the proper interpretation of these results is essential.

Drs. Chaitman and Laddu review the various approved and experimental pharmacological approaches to treating angina in the context of data from clinical trials, and discuss ongoing and future studies. They also compare the merits of optimal medical therapy with prompt or delayed revascularization by percutaneous coronary intervention or CABG surgery as antianginal strategies.