News & Comment

Novel engineered blood clots, generated via the rapid crosslinking of red blood cells into tough cytogels, are superior to native blood clots in fracture toughness and adherence to tissues, demonstrating the potential of using ‘click clotting’ technology in the management of haemorrhage, surgical bleeding and bleeding disorders.

Fractional flow reserve (FFR) estimated from an invasive coronary angiogram produces a biased estimate, overstating the severity of the lesion and leading to unnecessary revascularization without clinical or cost benefits. The validity of findings from major angiography FFR trials are limited by suboptimal trial design and the enrolment of low-risk populations. I argue for improved upstream testing as an alternative strategy.

Nguyen and Vinh discuss the insights from the Apple Heart Study on digital screening for atrial fibrillation and highlight the importance of equitable access in digital health.

Base editing therapies to silence PCSK9 have entered clinical trials, and early results show promise for a durable ‘one-and-done’ therapy to lower plasma LDL-cholesterol levels.

In the C-TRACT trial involving patients with post-thrombotic syndrome, the addition of endovascular treatment to standard care reduced the severity of symptoms and improved quality of life, but increased the risk of bleeding, compared with standard care alone.

A new generation of dual and triple receptor modulators targeting nutrient-stimulated hormone pathways are producing cardiometabolic effects that exceed any previous pharmacotherapy, with weight loss efficacy approaching that of bariatric surgery. Cardiovascular outcome trials that are planned or underway will determine whether such robust cardiometabolic potency through complementary receptor targeting translates into incremental cardiovascular protection, ideally with improved drug tolerability.

Engineered immunosuppressive and fibrosis-targeted dendritic cells protect against pathological cardiac remodelling in animal models of ischaemic and pressure-overload-induced heart failure, including a non-human primate model of myocardial infarction.

Rare cardiovascular diseases affect 5% of the world’s population. Rare disease training for clinicians is essential to suspect and diagnose underlying rare diseases and to work effectively with patients to navigate uncertain health-care journeys. To raise awareness, Nature Reviews Cardiology has partnered with Medics for Rare Disease to produce a Collection of articles on rare cardiovascular diseases.

In the HI-PEITHO trial, ultrasound-facilitated, catheter-directed fibrinolysis plus anticoagulation improved outcomes compared with anticoagulation alone in patients with acute, intermediate-risk pulmonary embolism.

In the CHIP-BCIS3 trial, elective left ventricular unloading with a microaxial flow pump did not reduce the risk of major adverse clinical outcomes in patients with severely impaired left ventricular function undergoing complex percutaneous coronary intervention.

Nam Nguyen and Urvish Jain describe the landmark study linking exposure to extremely hot and cold temperatures to excess deaths caused by ischaemic heart disease, stroke and heart failure.

Findings from the double-blind, placebo-controlled, randomized ORBITA-CTO trial show that PCI for coronary artery chronic total occlusion reduces angina symptoms beyond placebo in appropriately selected patients.

In patients with atrial fibrillation without contraindications for anticoagulation, device-based left atrial appendage closure is non-inferior to therapy with non-vitamin K antagonist oral anticoagulants (NOACs) with respect to the composite end point of stroke, systemic embolism or death from cardiovascular causes at 3 years.

Tyler Artner describes the landmark study by Fuchs and colleagues that demonstrated the role of neutrophil extracellular traps in thrombus formation.

Schuermans highlights one of the first studies that provided robust evidence supporting the inflammatory hypothesis of atherosclerosis in humans.

Laura Alonso-Herranz discusses the study that demonstrated that vascular smooth muscle cells undergo clonal expansion within atherosclerotic plaques and adopt non-canonical features, a work that laid the foundation for subsequent studies on vascular smooth muscle cell plasticity in atherosclerosis.

Apolipoprotein C-III (apoC-III) inhibition represents a major therapeutic advance in the management of severe hypertriglyceridaemia and pancreatitis. The potential role of apoC-III inhibition in preventing atherosclerotic cardiovascular disease will depend on rigorous outcomes data, appropriate patient selection and equitable implementation across healthcare systems. Beyond the lowering of triglyceride levels, meaningful clinical benefits and broad accessibility will determine the long-term success of this therapeutic approach.

In a new study, treatment with self-amplifying RNA contained in lipid nanoparticles to increase the production of atrial natriuretic peptide preserved ventricular function and reduced cardiac fibrosis in mouse and pig models of myocardial infarction.

Elevated plasma concentrations of lipoprotein(a) (Lp(a)) are an important risk factor for several cardiovascular diseases. However, to date, elevated Lp(a) levels have not been directly targeted by clinicians because Lp(a) levels are almost entirely genetically determined and are comparatively resistant to standard lipid-lowering therapies. This unmet medical need might soon be addressed with the advent of potent Lp(a)-lowering therapies.