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Nature Reviews Cardiology

Nature Reviews Cardiology provides physicians and academics with authoritative and topical discussions of key developments in the field.


Dyslipidaemia: ANGPTL3: a therapeutic target for atherosclerosis


Genetic and preliminary intervention studies published in two papers in NEJM indicate that angiopoietin-related protein 3 (ANGPTL3) is a promising therapeutic target in patients with dyslipidaemia who are at risk of atherosclerotic cardiovascular disease. Together, the papers show that naturally occurring loss-of-function variants in

Dyslipidaemia: HDL-related biomarkers of cardiovascular risk


HDL particle number outperforms HDL-cholersterol level, apolipoprotein A-I level, and cholesterol efflux capacity as a predictor of cardiovascular events. This finding comes from a nested case–control study of the JUPITER trial, involving individuals with a normal LDL-cholesterol level and an increased C-reactive protein level. Of

Genetics: Smoking reduces genetic protection against CHD


An allele variant upstream of the ADAMTS7 gene locus is associated with reduced expression of the ADAMTS7 metalloproteinase and protects against coronary heart disease (CHD); however, cigarette smoking attenuates this protective effect by 60%. Researchers analysed data from 29 studies involving 60,919 patients

Cardiac resuscitation: Benefit of bystander CPR and defibrillation


In a long-term study of out-of-hospital cardiac arrest in Denmark, bystander cardiopulmonary resuscitation (CPR) or defibrillation was associated with lower risks of brain damage or admission to a nursing home compared with no bystander resuscitation. The investigators studied 2,855 patients who survived for >30 days

Heart failure: BRD4 inhibition slows HF progression


Inhibition of the epigenetic regulator bromodomain-containing protein 4 (BRD4) using the small molecule JQ1 attenuates the progression of heart failure (HF) in mice, according to a new study published in Science Translational Medicine. “A dominant mechanism of action of JQ1 is that it is

Dyslipidaemia: Is CETP inhibition a viable therapeutic strategy?


The rationale for targeting cholesteryl ester transfer protein (CETP), an enzyme that promotes the transfer of cholesteryl esters from HDL to very low-density lipoprotein and LDL, to reduce the risk of cardiovascular disease is that CETP inhibition raises HDL-cholesterol (HDL-C) levels and decreases LDL-cholesterol (LDL-C)

Peripheral artery disease: Drug-coated balloon superior to standard balloon angioplasty


Although endovascular therapy is the preferred treatment modality for patients with peripheral artery disease (PAD), the optimal revascularization strategy remains unclear. Two new randomized, controlled trials published in Circulation now report that drug-coated balloon (DCB) angioplasty is superior to uncoated balloon angioplasty for the

Acute coronary syndromes: Risk of acute MI with NSAID use


Oral nonsteroidal anti-inflammatory drug (NSAID) use is associated with an increased risk of acute myocardial infarction (MI) according to a meta-analysis published in the BMJ. “Risk was greatest during the first month of NSAID use and with higher doses,” report the researchers.The Bayesian

Heart failure: HF-induced diaphragmatic atrophy and weakness


A central neurohormonal pathway that activates ventilatory overdrive triggers the development of diaphragmatic atrophy and weakness in the setting of heart failure (HF), independently of pulmonary oedema or lung remodelling. This finding was reported by Foster and coworkers in Sci. Transl. Med., and emphasizes

Pharmacotherapy: Angiotensin II — a new tool in vasodilatory shock


Patients with vasodilatory shock, characterized by peripheral vasodilatation and low arterial blood pressure, who do not respond to vasopressors (catecholamines or vasopressin) have a poor prognosis. In addition, current vasopressors have toxic effects at high doses. A new clinical trial now shows that in patients

Dyslipidaemia: PCSK9 inhibitors and foamy monocytes in familial hypercholesterolaemia


Accumulation of foam cells — macrophages with intracellular lipid droplets — in arterial walls is a hallmark of atherosclerosis. Bernelot Moens and colleagues report increases in circulating monocytes with intracellular lipid accumulation, associated CCR2 expression, and enhanced monocyte migration in patients with familial hypercholesterolaemia. These changes could be reversed by PCSK9-inhibitor treatment.

Effects of dyslipidaemia on monocyte production and function in cardiovascular disease


Monocytes are heterogeneous effector cells involved in the maintenance and restoration of tissue integrity. Monocytes and macrophages are involved in cardiovascular disease progression, and are associated with the development of unstable atherosclerotic plaques. Hyperlipidaemia can accelerate cardiovascular disease progression. However, monocyte responses to hyperlipidaemia are

Hypertriglyceridaemia and risk of coronary artery disease


An elevated serum level of LDL cholesterol is a well-known risk factor for cardiovascular disease (CVD), but the role of elevated triglyceride levels is debated. Controversies regarding hypertriglyceridaemia as an independent risk factor for CVD have occurred partly because elevated triglyceride levels are often a

Myocardial stress and autophagy: mechanisms and potential therapies


Autophagy is a ubiquitous cellular catabolic process responsive to energy stress. Research over the past decade has revealed that cardiomyocyte autophagy is a prominent homeostatic pathway, important in adaptation to altered myocardial metabolic demand. The cellular machinery of autophagy involves targeted direction of macromolecules and

Expert consensus document: Echocardiography and lung ultrasonography for the assessment and management of acute heart failure


Echocardiography is increasingly recommended for the diagnosis and assessment of patients with severe cardiac disease, including acute heart failure. Although previously considered to be within the realm of cardiologists, the development of ultrasonography technology has led to the adoption of echocardiography by acute care clinicians