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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.


Antiplatelet therapy: Aspirin in the elderly — tailored approaches ahead?


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.

New and revisited approaches to preserving the reperfused myocardium


Strategies to reduce myocardial infarct size beyond early reperfusion have thus far yielded disappointing results in clinical trials. In this Review, Kloner and co-workers discuss several new approaches to preserve the reperfused myocardium, including those that target mitochondrial bioenergetics and autophagy.

Interventional and surgical occlusion of the left atrial appendage


The left atrial appendage is known to be a source of thromboemboli in patients with nonvalvular atrial fibrillation, and the interventional or surgical occlusion or exclusion of this anatomical structure is an alternative approach to anticoagulation therapy for the prevention of stroke. In this Review, Caliskan et al. discuss the various methods for occlusion of the left atrial appendage, and provide an overview of the clinical studies investigating these techniques.

Management of cardiovascular diseases in patients with obesity


Obesity is a risk factor for the development of cardiovascular diseases. In their Review, Lavie and colleagues summarize the deleterious consequences of obesity in patients with cardiovascular disease, review the available data on the benefits of weight loss, and explain the 'obesity paradox' phenomenon in this setting.

HDL and atherosclerotic cardiovascular disease: genetic insights into complex biology


HDL-cholesterol levels in plasma predict the risk of cardiovascular disease, but a direct causal role for HDL in cardiovascular disease remains controversial. In this Review, Rosenson et al. discuss the opportunities afforded by an integrated approach that combines human genetic studies with systems biology to understand the complex metabolism of HDL and its potential atheroprotective properties.

Epidemiology of heart failure with preserved ejection fraction


Heart failure with preserved ejection fraction (HFpEF) is a clinical syndrome associated with poor quality of life, substantial health-care resource utilization, and premature mortality. Dunlay and colleagues summarize the epidemiological data on HFpEF, with a focus on the prevalence and incidence of HFpEF in the community as well as associated conditions and risk factors, morbidity and mortality after diagnosis, and quality of life.

Seasonal variations in cardiovascular disease


Cardiovascular disease (CVD) follows a seasonal pattern in many populations, often peaking after 'cold snaps'. In this Review, Stewart and colleagues identify the physiological and environmental factors that contribute to seasonality in nearly all forms of CVD, and describe the potential strategies that might attenuate peaks in cardiovascular events during cold and hot periods of the year.

Mendelian randomization in cardiometabolic disease: challenges in evaluating causality


Mendelian randomization (MR) is an increasingly common tool that involves the use of genetic variants to evaluate causal relationships between exposures and outcomes. In this Review, Holmes et al. describe some of the scenarios in which findings from MR analyses can be challenging to evaluate, using examples from studies on cardiometabolic diseases.

Matching patients with the ever-expanding range of TAVI devices


Since the introduction of transcatheter aortic valve implantation (TAVI) as a treatment for inoperable patients with aortic stenosis >1 decade ago, the range of patients who can benefit from this technology has continued to grow. In this Review, Jones and colleagues discuss the current evidence for TAVI in different patient populations, and describe the differences in design features in currently available valve systems.

Epidemiology and treatment of pulmonary arterial hypertension


The epidemiology of pulmonary arterial hypertension (PAH) has evolved considerably in the past 2 decades. In this Review, Lau and colleagues describe how this evolving epidemiology has influenced the treatment and management of PAH.

Reperfusion strategies in acute myocardial infarction and multivessel disease


The optimal reperfusion strategy in patients with ST-segment elevation myocardial infarction (STEMI) and multivessel disease is still uncertain. In this Review, Mehran and colleagues discuss the available 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.

Proteostasis in cardiac health and disease


Derailment of cellular protein homeostasis (proteostasis) and loss of protein quality control (PQC) are central factors in ageing and contribute to cardiovascular disease. In this Review, Henning and Brundel describe the mechanisms by which PQC can fail. Targeting PQC to maintain cardiac proteostasis offers a novel therapeutic strategy to promote cardiac health and combat cardiac disease.

Management of atrial high-rate episodes detected by cardiac implanted electronic devices


Cardiac implanted electronic devices (CIEDs) frequently detect subclinical atrial high-rate episodes (AHREs), but the relevance and appropriate clinical response to these episodes is uncertain. In this Review, Freedman and colleagues discuss the relationship between AHREs, atrial fibrillation, and risk of stroke, and propose a management algorithm for patients with CIED-detected AHREs.

Unmasking the molecular link between arrhythmogenic cardiomyopathy and Brugada syndrome


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.