Journal: J Am Coll Cardiol

Sorted by: date / impact
Abstract

Antithrombotic Therapy in Peripheral Artery Disease: Generating and Translating Evidence Into Practice.

Jones WS, Patel MR
Atherosclerotic cardiovascular (CV) disease remains a major health concern affecting more than 200 million adults worldwide, and lower extremity peripheral artery disease (PAD) is associated with significant morbidity and mortality. Treatment strategies to reduce the burden of major adverse CV events and limb events have mainly involved the use of antiplatelet and statin medications. Unlike other types of atherosclerotic CV disease, the evidence base is not well developed for therapies in patients with PAD. Recently, studies from subgroups of patients with PAD and a large clinical trial of PAD patients have been published, signaling a burgeoning interest in studying this higher risk population. This review outlines the inherent CV risks of patients with PAD, risk reduction strategies, emerging clinical trial data, and opportunities for the CV community to generate evidence in real-world settings and translate evidence into practice as new therapies become available.

J Am Coll Cardiol: 22 Jan 2018; 71:352-362
Jones WS, Patel MR
J Am Coll Cardiol: 22 Jan 2018; 71:352-362 | PMID: 29348028
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Implications of Underlying Mechanisms for the Recognition and Management of Diabetic Cardiomyopathy.

Marwick TH, Ritchie R, Shaw JE, Kaye D
Heart failure is a complex clinical syndrome, the incidence and prevalence of which is increased in diabetes mellitus, pre-diabetes, and obesity. Although this may arise from underlying coronary artery disease, it often occurs in the absence of significant major epicardial coronary disease, and most commonly manifests as heart failure with preserved ejection fraction. Despite epidemiological evidence linking diabetes to heart failure incidence and outcome, the presence of a distinct primary \"diabetic\" cardiomyopathy has been difficult to prove, because the link between diabetes and heart failure is confounded by hypertension, microvascular dysfunction, and autonomic neuropathy. Nonetheless, several mechanistic associations at systemic, cardiac, and cellular/molecular levels explain different aspects of myocardial dysfunction, including impaired cardiac relaxation, compliance, and contractility. This review seeks to describe recent advances and limitations pertinent to integrating molecular mechanisms, clinical screening, and potential therapeutic avenues for this condition.

J Am Coll Cardiol: 22 Jan 2018; 71:339-351
Marwick TH, Ritchie R, Shaw JE, Kaye D
J Am Coll Cardiol: 22 Jan 2018; 71:339-351 | PMID: 29348027
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

NHLBI Working Group Recommendations to Reduce Lipoprotein(a)-Mediated Risk of Cardiovascular Disease and Aortic Stenosis.

Tsimikas S, Fazio S, Ferdinand KC, Ginsberg HN, ... Olive M, Liu L
Pathophysiological, epidemiological, and genetic studies provide strong evidence that lipoprotein(a) [Lp(a)] is a causal mediator of cardiovascular disease (CVD) and calcific aortic valve disease (CAVD). Specific therapies to address Lp(a)-mediated CVD and CAVD are in clinical development. Due to knowledge gaps, the National Heart, Lung, and Blood Institute organized a working group that identified challenges in fully understanding the role of Lp(a) in CVD/CAVD. These included the lack of research funding, inadequate experimental models, lack of globally standardized Lp(a) assays, and inadequate understanding of the mechanisms underlying current drug therapies on Lp(a) levels. Specific recommendations were provided to facilitate basic, mechanistic, preclinical, and clinical research on Lp(a); foster collaborative research and resource sharing; leverage expertise of different groups and centers with complementary skills; and use existing National Heart, Lung, and Blood Institute resources. Concerted efforts to understand Lp(a) pathophysiology, together with diagnostic and therapeutic advances, are required to reduce Lp(a)-mediated risk of CVD and CAVD.

J Am Coll Cardiol: 15 Jan 2018; 71:177-192
Tsimikas S, Fazio S, Ferdinand KC, Ginsberg HN, ... Olive M, Liu L
J Am Coll Cardiol: 15 Jan 2018; 71:177-192 | PMID: 29325642
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Domain Management Approach to Heart Failure in the Geriatric Patient: Present and Future.

Gorodeski EZ, Goyal P, Hummel SL, Krishnaswami A, ... Alexander KP,
Heart failure (HF) is a quintessential geriatric cardiovascular condition, with more than 50% of hospitalizations occurring in adults age 75 years or older. In older patients, HF is closely linked to processes inherent to aging, which include cellular and structural changes to the myocardium, vasculature, and skeletal muscle. In addition, HF cannot be considered in isolation of physical functioning, or without the social, psychological, and behavioral dimensions of illness. The role of frailty, depression, cognitive impairment, nutrition, and goals of care are each uniquely relevant to the implementation and success of medical therapy. In this paper, we discuss a model of caring for older adults with HF through a 4-domain framework that can address the unique multidimensional needs and vulnerabilities of this population. We believe that clinicians who embrace this approach can improve health outcomes for older adults with HF.

J Am Coll Cardiol: 30 Apr 2018; 71:1921-1936
Gorodeski EZ, Goyal P, Hummel SL, Krishnaswami A, ... Alexander KP,
J Am Coll Cardiol: 30 Apr 2018; 71:1921-1936 | PMID: 29699619
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Cerebrovascular Events After Cardiovascular Procedures: Risk Factors, Recognition, and Prevention Strategies.

Devgun JK, Gul S, Mohananey D, Jones BM, ... Tuzcu EM, Kapadia SR
Stroke has long been a devastating complication of any cardiovascular procedure that unfavorably affects survival and quality of life. Over time, strategies have been developed to substantially reduce the incidence of stroke after traditional cardiovascular procedures such as coronary artery bypass grafting, isolated valve surgery, and carotid endarterectomy. Subsequently, with the advent of minimally invasive technologies including percutaneous coronary intervention, carotid artery stenting, and transcatheter valve therapies, operators were faced with a new host of procedural risk factors, and efforts again turned toward identifying novel ways to reduce the risk of stroke. Fortunately, by understanding the procedural factors unique to these new techniques and applying many of the lessons learned from prior experiences, we are seeing significant improvements in the safety of these new technologies. In this review, the authors: 1) carefully analyze data from different cardiac procedural experiences ranging from traditional open heart surgery to percutaneous coronary intervention and transcatheter valve therapies; 2) explore the unique risk factors for stroke in each of these areas; and 3) describe how these risks can be mitigated with improved patient selection, adjuvant pharmacotherapy, procedural improvements, and novel technological advancements.

J Am Coll Cardiol: 30 Apr 2018; 71:1910-1920
Devgun JK, Gul S, Mohananey D, Jones BM, ... Tuzcu EM, Kapadia SR
J Am Coll Cardiol: 30 Apr 2018; 71:1910-1920 | PMID: 29699618
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Coronary Artery Disease in Patients ≥80 Years of Age.

Madhavan MV, Gersh BJ, Alexander KP, Granger CB, Stone GW
Coronary artery disease (CAD) is a major cause of morbidity and mortality in patients ≥80 years of age. Nonetheless, older patients have typically been under-represented in cardiovascular clinical trials. Understanding the pathophysiology, epidemiology, and optimal means of diagnosis and treatment of CAD in older adults is crucial to improving outcomes in this high-risk population. A patient-centered approach, taking into account health status, functional ability and frailty, cognitive skills, and patient preferences is essential when caring for older adults with CAD. The present systematic review focuses on the current knowledge base, gaps in understanding, and directions for future investigation pertaining to CAD in patients ≥80 years of age.

J Am Coll Cardiol: 07 May 2018; 71:2015-2040
Madhavan MV, Gersh BJ, Alexander KP, Granger CB, Stone GW
J Am Coll Cardiol: 07 May 2018; 71:2015-2040 | PMID: 29724356
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Arrhythmias in Patients ≥80 Years of Age: Pathophysiology, Management, and Outcomes.

Curtis AB, Karki R, Hattoum A, Sharma UC
Advances in medical care have led to an increase in the number of octogenarians and even older patients, forming an important and unique patient subgroup. It is clear that advancing age is an independent risk factor for the development of most arrhythmias, causing substantial morbidity and mortality. Patients ≥80 years of age have significant structural and electrical remodeling of cardiac tissue; accrue competing comorbidities; react differently to drug therapy; and may experience falls, frailty, and cognitive impairment, presenting significant therapeutic challenges. Unfortunately, very old patients are under-represented in clinical trials, leading to critical gaps in evidence to guide effective and safe treatment of arrhythmias. In this state-of-the-art review, we examine the pathophysiology of aging and arrhythmias and then present the available evidence on age-specific management of the most common arrhythmias, including drugs, catheter ablation, and cardiac implantable electronic devices.

J Am Coll Cardiol: 07 May 2018; 71:2041-2057
Curtis AB, Karki R, Hattoum A, Sharma UC
J Am Coll Cardiol: 07 May 2018; 71:2041-2057 | PMID: 29724357
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Valvular Heart Disease in Patients ≥80 Years of Age.

Kodali SK, Velagapudi P, Hahn RT, Abbott D, Leon MB
In the United States, the octogenarian population is projected to triple by 2050. With this aging population, the prevalence of valvular heart disease (VHD) is on the rise. The etiology, approach to treatment, and expected outcomes of VHD are different in the elderly compared with younger patients. Both stenotic and regurgitant lesions are associated with unfavorable outcomes if left untreated. Surgical mortality remains high due to multiple co-morbidities, and long-term survival benefit is dependent on many variables including valvular pathology. Quality of life is an important consideration in treatment decisions in this age group. Increasingly, octogenarian patients are receiving transcatheter therapies, with transcatheter aortic valve replacement having the greatest momentum. Numerous transcatheter devices for management of other valve lesions are currently in early clinical trials. This review will describe the epidemiology, etiology, diagnosis, and therapeutic options for VHD in the oldest old, with a focus on transcatheter technologies.

J Am Coll Cardiol: 07 May 2018; 71:2058-2072
Kodali SK, Velagapudi P, Hahn RT, Abbott D, Leon MB
J Am Coll Cardiol: 07 May 2018; 71:2058-2072 | PMID: 29724358
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Thyroid Hormones and Cardiovascular Function and Diseases.

Razvi S, Jabbar A, Pingitore A, Danzi S, ... Zaman A, Iervasi G
Thyroid hormone (TH) receptors are present in the myocardium and vascular tissue, and minor alterations in TH concentration can affect cardiovascular (CV) physiology. The potential mechanisms that link CV disease with thyroid dysfunction are endothelial dysfunction, changes in blood pressure, myocardial systolic and diastolic dysfunction, and dyslipidemia. In addition, cardiac disease itself may lead to alterations in TH concentrations (notably, low triiodothyronine syndrome) that are associated with higher morbidity and mortality. Experimental data and small clinical trials have suggested a beneficial role of TH in ameliorating CV disease. The aim of this review is to provide clinicians dealing with CV conditions with an overview of the current knowledge of TH perturbations in CV disease.

J Am Coll Cardiol: 23 Apr 2018; 71:1781-1796
Razvi S, Jabbar A, Pingitore A, Danzi S, ... Zaman A, Iervasi G
J Am Coll Cardiol: 23 Apr 2018; 71:1781-1796 | PMID: 29673469
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Hypertension Across a Woman\'s Life Cycle.

Wenger NK, Arnold A, Bairey Merz CN, Cooper-DeHoff RM, ... Walsh MN, Pepine CJ
Hypertension accounts for 1 in 5 deaths among American women, posing a greater burden for women than men, and is among their most important risk factors for death and development of cardiovascular and other diseases. Hypertension affects women in all phases of life, with specific characteristics relating to risk factors and management for primary prevention of hypertension in teenage and young adult women; hypertension in pregnancy; hypertension during use of oral contraceptives and assisted reproductive technologies, lactation, menopause, or hormone replacement; hypertension in elderly women; and issues of race and ethnicity. All are detailed in this review, as is information relative to women in clinical trials of hypertension and medication issues. The overarching message is that effective treatment and control of hypertension improves cardiovascular outcomes. But many knowledge gaps persist, including the contribution of hypertensive disorders of pregnancy to cardiovascular disease risk, the role of hormone replacement, blood pressure targets for elderly women, and so on.

J Am Coll Cardiol: 23 Apr 2018; 71:1797-1813
Wenger NK, Arnold A, Bairey Merz CN, Cooper-DeHoff RM, ... Walsh MN, Pepine CJ
J Am Coll Cardiol: 23 Apr 2018; 71:1797-1813 | PMID: 29673470
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Multimorbidity in Older Adults With Cardiovascular Disease.

Forman DE, Maurer MS, Boyd C, Brindis R, ... Zieman S, Rich MW
Multimorbidity occurs in adults of all ages, but the number and complexity of comorbid conditions commonly increase with advancing age such that cardiovascular disease (CVD) in older adults typically occurs in a context of multimorbidity. Current clinical practice and research mainly target single disease-specific care that does not embrace the complexities imposed by concurrent conditions. In this paper, emerging concepts regarding CVD in combination with multimorbidity are reviewed, including recommendations for incorporating multimorbidity into clinical decision making, critical knowledge gaps, and research priorities to optimize care of complex older patients.

J Am Coll Cardiol: 14 May 2018; 71:2149-2161
Forman DE, Maurer MS, Boyd C, Brindis R, ... Zieman S, Rich MW
J Am Coll Cardiol: 14 May 2018; 71:2149-2161 | PMID: 29747836
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Cardiovascular Diseases in India Compared With the United States.

Prabhakaran D, Singh K, Roth GA, Banerjee A, Pagidipati NJ, Huffman MD
This review describes trends in the burden of cardiovascular diseases (CVDs) and risk factors in India compared with the United States; provides potential explanations for these differences; and describes strategies to improve cardiovascular health behaviors, systems, and policies in India. The prevalence of CVD in India has risen over the past 2 decades due to population growth, aging, and a stable age-adjusted CVD mortality rate. Over the same time period, the United States has experienced an overall decline in age-adjusted CVD mortality, although the trend has begun to plateau. These improvements in CVD mortality in the United States are largely due to favorable population-level risk factor trends, specifically with regard to tobacco use, cholesterol, and blood pressure, although improvements in secondary prevention and acute care have also contributed. To realize similar gains in reducing premature death and disability from CVD, India needs to implement population-level policies while strengthening and integrating its local, regional, and national health systems. Achieving universal health coverage that includes financial risk protection should remain a goal to help all Indians realize their right to health.

J Am Coll Cardiol: 02 Jul 2018; 72:79-95
Prabhakaran D, Singh K, Roth GA, Banerjee A, Pagidipati NJ, Huffman MD
J Am Coll Cardiol: 02 Jul 2018; 72:79-95 | PMID: 29957235
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Mobile Health Advances in Physical Activity, Fitness, and Atrial Fibrillation: Moving Hearts.

McConnell MV, Turakhia MP, Harrington RA, King AC, Ashley EA
The growing recognition that \"health\" takes place outside of the hospital and clinic, plus recent advances in mobile and wearable devices, have propelled the field of mobile health (mHealth). Cardiovascular disease and prevention are major opportunities for mHealth, as mobile devices can monitor key physiological signals (e.g., physical activity, heart rate and rhythm) for promoting healthy behaviors, detecting disease, and aid in ongoing care. In this review, the authors provide an update on cardiovascular mHealth by highlighting recent progress and challenges with mobile and wearable devices for assessing and promoting physical activity and fitness, and for monitoring heart rate and rhythm for the detection and management of atrial fibrillation.

J Am Coll Cardiol: 11 Jun 2018; 71:2691-2701
McConnell MV, Turakhia MP, Harrington RA, King AC, Ashley EA
J Am Coll Cardiol: 11 Jun 2018; 71:2691-2701 | PMID: 29880130
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Cardiovascular Outcomes Reported in Hemodialysis Trials.

O\'Lone E, Viecelli AK, Craig JC, Tong A, ... Webster AC, Wheeler DC
Patients on long-term hemodialysis are at very high risk for cardiovascular disease but are usually excluded from clinical trials conducted in the general population or in at-risk populations. There are no universally agreed cardiovascular outcomes for trials conducted specifically in the hemodialysis population. In this review, we highlight that trials reporting cardiovascular outcomes in hemodialysis patients are usually of short duration (median 3 to 6 months) and are small (59% of trials have <100 participants). Overall, the cardiovascular outcomes are very heterogeneous and may not reflect outcomes that are meaningful to patients and clinicians in supporting decision making, as they are often surrogates of uncertain clinical importance. Composite outcomes used in different trials rarely share the same components. In a field in which a single trial is often insufficiently powered to fully assess the clinical and economic impact of interventions, differences in outcome reporting across trials make the task of meta-analysis and interpretation of all the available evidence challenging. Core outcome sets are now being established across many specialties in health care to prevent these problems. Through the global Standardized Outcomes in Nephrology-Hemodialysis initiative, cardiovascular disease was identified as a critically important core domain to be reported in all trials in hemodialysis. Informed by the current state of reporting of cardiovascular outcomes, a core outcome measure for cardiovascular disease is currently being established with involvement of patients, caregivers, and health professionals. Consistent reporting of cardiovascular outcomes that are critically important to hemodialysis patients and clinicians will strengthen the evidence base to inform care in this very high-risk population.

J Am Coll Cardiol: 18 Jun 2018; 71:2802-2810
O'Lone E, Viecelli AK, Craig JC, Tong A, ... Webster AC, Wheeler DC
J Am Coll Cardiol: 18 Jun 2018; 71:2802-2810 | PMID: 29903353
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Artificial Intelligence in Cardiology.

Johnson KW, Torres Soto J, Glicksberg BS, Shameer K, ... Ashley E, Dudley JT
Artificial intelligence and machine learning are poised to influence nearly every aspect of the human condition, and cardiology is not an exception to this trend. This paper provides a guide for clinicians on relevant aspects of artificial intelligence and machine learning, reviews selected applications of these methods in cardiology to date, and identifies how cardiovascular medicine could incorporate artificial intelligence in the future. In particular, the paper first reviews predictive modeling concepts relevant to cardiology such as feature selection and frequent pitfalls such as improper dichotomization. Second, it discusses common algorithms used in supervised learning and reviews selected applications in cardiology and related disciplines. Third, it describes the advent of deep learning and related methods collectively called unsupervised learning, provides contextual examples both in general medicine and in cardiovascular medicine, and then explains how these methods could be applied to enable precision cardiology and improve patient outcomes.

J Am Coll Cardiol: 11 Jun 2018; 71:2668-2679
Johnson KW, Torres Soto J, Glicksberg BS, Shameer K, ... Ashley E, Dudley JT
J Am Coll Cardiol: 11 Jun 2018; 71:2668-2679 | PMID: 29880128
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

The Role of Nutraceuticals in Statin Intolerant Patients.

Banach M, Patti AM, Giglio RV, Cicero AFG, ... Rizzo M,
Statins are the most common drugs administered for patients with cardiovascular disease. However, due to statin-associated muscle symptoms, adherence to statin therapy is challenging in clinical practice. Certain nutraceuticals, such as red yeast rice, bergamot, berberine, artichoke, soluble fiber, and plant sterols and stanols alone or in combination with each other, as well as with ezetimibe, might be considered as an alternative or add-on therapy to statins, although there is still insufficient evidence available with respect to long-term safety and effectiveness on cardiovascular disease prevention and treatment. These nutraceuticals could exert significant lipid-lowering activity and might present multiple non-lipid-lowering actions, including improvement of endothelial dysfunction and arterial stiffness, as well as anti-inflammatory and antioxidative properties. The aim of this expert opinion paper is to provide the first attempt at recommendation on the management of statin intolerance through the use of nutraceuticals with particular attention on those with effective low-density lipoprotein cholesterol reduction.

J Am Coll Cardiol: 02 Jul 2018; 72:96-118
Banach M, Patti AM, Giglio RV, Cicero AFG, ... Rizzo M,
J Am Coll Cardiol: 02 Jul 2018; 72:96-118 | PMID: 29957236
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Supplemental Vitamins and Minerals for CVD Prevention and Treatment.

Jenkins DJA, Spence JD, Giovannucci EL, Kim YI, ... Pichika SC, Sievenpiper JL
The authors identified individual randomized controlled trials from previous meta-analyses and additional searches, and then performed meta-analyses on cardiovascular disease outcomes and all-cause mortality. The authors assessed publications from 2012, both before and including the U.S. Preventive Service Task Force review. Their systematic reviews and meta-analyses showed generally moderate- or low-quality evidence for preventive benefits (folic acid for total cardiovascular disease, folic acid and B-vitamins for stroke), no effect (multivitamins, vitamins C, D, β-carotene, calcium, and selenium), or increased risk (antioxidant mixtures and niacin [with a statin] for all-cause mortality). Conclusive evidence for the benefit of any supplement across all dietary backgrounds (including deficiency and sufficiency) was not demonstrated; therefore, any benefits seen must be balanced against possible risks.

J Am Coll Cardiol: 04 Jun 2018; 71:2570-2584
Jenkins DJA, Spence JD, Giovannucci EL, Kim YI, ... Pichika SC, Sievenpiper JL
J Am Coll Cardiol: 04 Jun 2018; 71:2570-2584 | PMID: 29852980
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Cardiovascular Disease and Homelessness.

Baggett TP, Liauw SS, Hwang SW
Cardiovascular disease (CVD) is a major cause of death among homeless adults, at rates that exceed those in nonhomeless individuals. A complex set of factors contributes to this disparity. In addition to a high prevalence of cigarette smoking and suboptimal control of traditional CVD risk factors such as hypertension and diabetes, a heavy burden of nontraditional psychosocial risk factors like chronic stress, depression, heavy alcohol use, and cocaine use may confer additional risk for adverse CVD outcomes beyond that predicted by conventional risk estimation methods. Poor health care access and logistical challenges to cardiac testing may lead to delays in presentation and diagnosis. The management of established CVD may be further challenged by barriers to medication adherence, communication, and timely follow-up. The authors present practical, patient-centered strategies for addressing these challenges, emphasizing the importance of multidisciplinary collaboration and partnership with homeless-tailored clinical programs to improve CVD outcomes in this population.

J Am Coll Cardiol: 04 Jun 2018; 71:2585-2597
Baggett TP, Liauw SS, Hwang SW
J Am Coll Cardiol: 04 Jun 2018; 71:2585-2597 | PMID: 29852981
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Transcatheter Tricuspid Valve Interventions: Landscape, Challenges, and Future Directions.

Asmarats L, Puri R, Latib A, Navia JL, Rodés-Cabau J
Tricuspid regurgitation is a common finding in patients with left-sided valvular or myocardial disease, often being a marker for late-stage chronic heart failure with a grim prognosis. However, isolated tricuspid valve surgery remains infrequent and is associated with the highest mortality among all valve procedures. Hence, a largely unmet clinical need exists for less invasive therapeutic options in these patients. In recent times, multiple percutaneous therapies have been developed for treating severe tricuspid regurgitation, including tricuspid valve repair and, more recently replacement, opening an entirely new venue for managing tricuspid regurgitation. The aim of this review is to provide an updated overview and a clinical perspective on novel transcatheter tricuspid valve therapies, highlighting potential challenges and future directions.

J Am Coll Cardiol: 25 Jun 2018; 71:2935-2956
Asmarats L, Puri R, Latib A, Navia JL, Rodés-Cabau J
J Am Coll Cardiol: 25 Jun 2018; 71:2935-2956 | PMID: 29929618
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Epicardial Adipose Tissue May Mediate Deleterious Effects of Obesity and Inflammation on the Myocardium.

Packer M
Epicardial adipose tissue has unique properties that distinguish it from other depots of visceral fat. Rather than having distinct boundaries, the epicardium shares an unobstructed microcirculation with the underlying myocardium, and in healthy conditions, produces cytokines that nourish the heart. However, in chronic inflammatory disorders (especially those leading to heart failure with preserved ejection fraction), the epicardium becomes a site of deranged adipogenesis, leading to the secretion of proinflammatory adipokines that can cause atrial and ventricular fibrosis. Accordingly, in patients at risk of heart failure with preserved ejection fraction, drugs that promote the accumulation or inflammation of epicardial adipocytes may lead to heart failure, whereas treatments that ameliorate the proinflammatory characteristics of epicardial fat may reduce the risk of heart failure. These observations suggest that epicardial adipose tissue is a transducer of the adverse effects of systemic inflammation and metabolic disorders on the heart, and thus, represents an important target for therapeutic interventions.

J Am Coll Cardiol: 21 May 2018; 71:2360-2372
Packer M
J Am Coll Cardiol: 21 May 2018; 71:2360-2372 | PMID: 29773163
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

The Changing Landscape of Diabetes Therapy for Cardiovascular Risk Reduction: JACC State-of-the-Art Review.

Newman JD, Vani AK, Aleman JO, Weintraub HS, Berger JS, Schwartzbard AZ
Type 2 diabetes mellitus (T2D) is a major risk factor for cardiovascular disease (CVD), the most common cause of death in T2D. Despite improved risk factor control, however, adults with T2D continue to experience substantial excess CVD risk. Until recently, however, improved glycemic control has not been associated with robust macrovascular benefit. The advent of 2 new classes of antihyperglycemic agents, the sodium-glucose cotransporter-2 inhibitors and the glucagon-like peptide-1 receptor agonists, and their respective large cardiovascular outcome trials, has led to a paradigm shift in how cardiologists and heath care practitioners conceptualize T2D treatment. Herein, the authors review the recent trial evidence, the potential mechanisms of action of the sodium-glucose cotransporter-2 inhibitors and the glucagon-like peptide-1 receptor agonists, safety concerns, and their use for the primary prevention of CVD as well as in diabetic patients with impaired renal function and heart failure.

J Am Coll Cardiol: 08 Oct 2018; 72:1856-1869
Newman JD, Vani AK, Aleman JO, Weintraub HS, Berger JS, Schwartzbard AZ
J Am Coll Cardiol: 08 Oct 2018; 72:1856-1869 | PMID: 30286929
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Psychopharmacology and Cardiovascular Disease.

Piña IL, Di Palo KE, Ventura HO
This review discusses common mental health disorders and their associations with cardiovascular disease risks. Commonly found mental health disorders include depression, anxiety, and personality types. The link between depression and cardiovascular disease mortality has been established. Depression is also common in patients with heart failure. In addition to discussing psychological disorders, a review of psychotropic drugs is also included. Drugs are described for therapy for depression and anxiety, as well as associations with cardiovascular drug-drug interactions. Drug-drug interactions are more common and potentially dangerous in elderly patients, in whom the conditions often coexist. The most common drug-drug interactions involve the P450 system of enzymes.

J Am Coll Cardiol: 21 May 2018; 71:2346-2359
Piña IL, Di Palo KE, Ventura HO
J Am Coll Cardiol: 21 May 2018; 71:2346-2359 | PMID: 29773162
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Blood Sugar Regulation for Cardiovascular Health Promotion and Disease Prevention: JACC Health Promotion Series.

Schwarz PEH, Timpel P, Harst L, Greaves CJ, ... Almedawar MM, Morawietz H
The primary objective of this study was to analyze the most up-to-date evidence regarding whether and how blood sugar regulation influences cardiovascular health promotion and disease prevention by carrying out an umbrella review. Three separate, systematic literature searches identified 2,343 papers in total. Overall, 44 studies were included for data extraction and analysis. The included systematic reviews and meta-analyses published between January 1, 2016, and December 31, 2017, were of good to very good quality (median Overview Quality Assessment Questionnaire score = 17). Identified evidence suggests that cardiovascular disease (CVD) prevention services should consider regulation of blood glucose as a key target for intervention. Furthermore, the recommendations for effective intervention and service development/training described here for prevention of CVD should be adopted into evidence-based practice guidelines. Multidisciplinary teams should be formed to deliver multicomponent interventions in community-based settings. There may be substantial opportunities for integrating CVD and diabetes prevention services.

J Am Coll Cardiol: 08 Oct 2018; 72:1829-1844
Schwarz PEH, Timpel P, Harst L, Greaves CJ, ... Almedawar MM, Morawietz H
J Am Coll Cardiol: 08 Oct 2018; 72:1829-1844 | PMID: 30286928
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Stress Cardiomyopathy Diagnosis and Treatment: JACC State-of-the-Art Review.

Medina de Chazal H, Del Buono MG, Keyser-Marcus L, Ma L, ... Berrocal D, Abbate A
Stress cardiomyopathy is an acute reversible heart failure syndrome initially believed to represent a benign condition due to its self-limiting clinical course, but now recognized to be associated with a non-negligible rate of serious complications such as ventricular arrhythmias, systemic thromboembolism, and cardiogenic shock. Due to an increased awareness and recognition, the incidence of stress cardiomyopathy has been rising (15-30 cases per 100,000 per year), although the true incidence is unknown as the condition is likely underdiagnosed. Stress cardiomyopathy represents a form of neurocardiogenic myocardial stunning, and while the link between the brain and the heart is established, the exact pathophysiological mechanisms remain unclear. We herein review the proposed risk factors and triggers for the syndrome and discuss a practical approach to diagnosis and treatment of the patients with stress cardiomyopathy, highlighting potential challenges and unresolved questions.

J Am Coll Cardiol: 15 Oct 2018; 72:1955-1971
Medina de Chazal H, Del Buono MG, Keyser-Marcus L, Ma L, ... Berrocal D, Abbate A
J Am Coll Cardiol: 15 Oct 2018; 72:1955-1971 | PMID: 30309474
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Cardiac Shock Care Centers: JACC Review Topic of the Week.

Rab T, Ratanapo S, Kern KB, Basir MB, ... King SB, O\'Neill W
Despite advances over the past decade, the incidence of cardiogenic shock secondary to acute myocardial infarction has increased, with an unchanged mortality near 50%. Recent trials have not clarified the best strategies in treatment. While dedicated cardiac shock centers are being established, there are no standardized agreements on the utilization of mechanical circulatory support and the timeliness of percutaneous coronary intervention strategies. In some centers and prospective registries, outcomes after placement of advanced mechanical circulatory support prior to reperfusion therapy with percutaneous coronary intervention have been encouraging with improved survival. Here, we suggest systems of care with a treatment pathway for patients with acute myocardial infarction complicated by cardiogenic shock.

J Am Coll Cardiol: 15 Oct 2018; 72:1972-1980
Rab T, Ratanapo S, Kern KB, Basir MB, ... King SB, O'Neill W
J Am Coll Cardiol: 15 Oct 2018; 72:1972-1980 | PMID: 30309475
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Coronary Calcium Score and Cardiovascular Risk.

Greenland P, Blaha MJ, Budoff MJ, Erbel R, Watson KE
Coronary artery calcium (CAC) is a highly specific feature of coronary atherosclerosis. On the basis of single-center and multicenter clinical and population-based studies with short-term and long-term outcomes data (up to 15-year follow-up), CAC scoring has emerged as a widely available, consistent, and reproducible means of assessing risk for major cardiovascular outcomes, especially useful in asymptomatic people for planning primary prevention interventions such as statins and aspirin. CAC testing in asymptomatic populations is cost effective across a broad range of baseline risk. This review summarizes evidence concerning CAC, including its pathobiology, modalities for detection, predictive role, use in prediction scoring algorithms, CAC progression, evidence that CAC changes the clinical approach to the patient and patient behavior, novel applications of CAC, future directions in scoring CAC scans, and new CAC guidelines.

J Am Coll Cardiol: 23 Jul 2018; 72:434-447
Greenland P, Blaha MJ, Budoff MJ, Erbel R, Watson KE
J Am Coll Cardiol: 23 Jul 2018; 72:434-447 | PMID: 30025580
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Antithrombotic Therapy for Peripheral Artery Disease: Recent Advances.

Hussain MA, Al-Omran M, Creager MA, Anand SS, Verma S, Bhatt DL
Peripheral artery disease (PAD) affects over 200 million people globally and is a cause of significant morbidity, mortality, and disability due to limb loss. Although secondary prevention with antithrombotic therapy is a mainstay of treatment to prevent adverse cardiovascular events, PAD patients are often undertreated with antithrombotic agents. Furthermore, there is a paucity of high-quality data from randomized controlled trials of PAD patients, leading to wide variations in clinical practice and guideline recommendations. Recently, there have been important advances that have further increased the number of antiplatelet and anticoagulant choices potentially available for patients with PAD. In this context, this paper aims to summarize the current available evidence for the safety and efficacy of various antithrombotic agents in PAD, and discuss how to integrate this emerging evidence into actual clinical practice. An evidenced-based approach to PAD patients is essential to achieve optimal outcomes, weighing cardiovascular and limb benefits against bleeding risks.

J Am Coll Cardiol: 28 May 2018; 71:2450-2467
Hussain MA, Al-Omran M, Creager MA, Anand SS, Verma S, Bhatt DL
J Am Coll Cardiol: 28 May 2018; 71:2450-2467 | PMID: 29793635
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Restenosis, Stent Thrombosis, and Bleeding Complications: Navigating Between Scylla and Charybdis.

Torrado J, Buckley L, Durán A, Trujillo P, ... Biondi-Zoccai G, Guzmán LA
The field of interventional cardiology has significantly evolved over 40 years by overcoming several challenges. The introduction of first-generation drug-eluting stents significantly reduced the rates of restenosis, but at the expense of an increase of late stent thrombosis. Prolonged antithrombotic therapy reduced rates of stent thrombosis, but at the cost of increased bleeding. Although the advent of second-generation drug-eluting stents subsequently reduced the incidence of late stent thrombosis, its permanent nature prevents full recovery of vascular structure and function with accordant risk of very late stent failure. In the present era of interventional cardiology, the tradeoff between stent thrombosis, restenosis, and bleeding presents as a particularly complex challenge. In this review, the authors highlight major contributors of late/very late stent thrombosis while targeting stent restenosis, and they discuss evolutionary advances in stent technology and antiplatelet therapy, to further improve upon the care of patients with coronary artery disease.

J Am Coll Cardiol: 16 Apr 2018; 71:1676-1695
Torrado J, Buckley L, Durán A, Trujillo P, ... Biondi-Zoccai G, Guzmán LA
J Am Coll Cardiol: 16 Apr 2018; 71:1676-1695 | PMID: 29650125
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

The Evolving Future of PCSK9 Inhibitors.

Rosenson RS, Hegele RA, Fazio S, Cannon CP
Variants in proprotein convertase subtilisin/kexin type 9 (PCSK9) provide insights into mechanisms regulating low-density lipoprotein (LDL) levels. Human monoclonal antibodies that target PCSK9 lower LDL cholesterol (LDL-C) levels by 55% to 72% in different high-risk patient groups. Clinical trials with PCSK9 inhibitors have demonstrated reductions in atherosclerotic cardiovascular disease events, particularly in patients with recent acute coronary syndrome, multivessel coronary artery disease, or peripheral arterial disease. Commonly observed profound reductions in LDL-C to levels <25 mg/dl have been accompanied by even lower rates of atherosclerotic cardiovascular disease events, thus supporting the concept that there may be no lower limit for LDL-C. Aggressive LDL-C lowering with fully human PCSK9 monoclonal antibodies has been accompanied by a safety profile that has been very favorable. On the basis of clinical trial evidence, LDL lowering with PCSK9 inhibitors is recommended for high-risk patients with LDL-C levels ≥70 mg/dl on maximally tolerated oral therapies including statins and/or ezetimibe.

J Am Coll Cardiol: 16 Jul 2018; 72:314-329
Rosenson RS, Hegele RA, Fazio S, Cannon CP
J Am Coll Cardiol: 16 Jul 2018; 72:314-329 | PMID: 30012326
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Myocardial Interstitial Fibrosis in Heart Failure: Biological and Translational Perspectives.

González A, Schelbert EB, Díez J, Butler J
Myocardial interstitial fibrosis contributes to left ventricular dysfunction leading to the development of heart failure. Basic research has provided abundant evidence for the cellular and molecular mechanisms behind this lesion and the pathways by which it imparts a detrimental impact on cardiac function. Translation of this knowledge, however, to improved diagnostics and therapeutics for patients with heart failure has not been as robust. This is partly related to the paucity of biomarkers to accurately identify myocardial interstitial fibrosis and to the lack of personalized antifibrotic strategies to treat it in an effective manner. This paper summarizes current knowledge of the mechanisms and detrimental consequences of myocardial interstitial fibrosis, discusses the potential of circulating and imaging biomarkers available to recognize different phenotypes of this lesion and track their clinical evolution, and reviews the currently available and potential future therapies that allow its individualized management in heart failure patients.

J Am Coll Cardiol: 16 Apr 2018; 71:1696-1706
González A, Schelbert EB, Díez J, Butler J
J Am Coll Cardiol: 16 Apr 2018; 71:1696-1706 | PMID: 29650126
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Rheumatic Heart Disease Worldwide: JACC Scientific Expert Panel.

Watkins DA, Beaton AZ, Carapetis JR, Karthikeyan G, ... Yacoub MH, Zühlke LJ
Rheumatic heart disease (RHD) is a preventable heart condition that remains endemic among vulnerable groups in many countries. After a period of relative neglect, there has been a resurging interest in RHD worldwide over the past decade. In this Scientific Expert Panel, the authors summarize recent advances in the science of RHD and sketch out priorities for current action and future research. Key questions for laboratory research into disease pathogenesis and epidemiological research on the burden of disease are identified. The authors present a variety of pressing clinical research questions on optimal RHD prevention and advanced care. In addition, they propose a policy and implementation research agenda that can help translate current evidence into tangible action. The authors maintain that, despite knowledge gaps, there is sufficient evidence for national and global action on RHD, and they argue that RHD is a model for strengthening health systems to address other cardiovascular diseases in limited-resource countries.

J Am Coll Cardiol: 17 Sep 2018; 72:1397-1416
Watkins DA, Beaton AZ, Carapetis JR, Karthikeyan G, ... Yacoub MH, Zühlke LJ
J Am Coll Cardiol: 17 Sep 2018; 72:1397-1416 | PMID: 30213333
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

A Clinician\'s Guide for Trending Cardiovascular Nutrition Controversies: Part II.

Freeman AM, Morris PB, Aspry K, Gordon NF, ... White B, Kris-Etherton P
The potential cardiovascular (CV) benefits of many trending foods and dietary patterns are still incompletely understood, and scientific inquiry continues to evolve. In the meantime, however, a number of controversial dietary patterns, foods, and nutrients have received significant media attention and are mired by \"hype.\" This second review addresses some of the more recent popular foods and dietary patterns that are recommended for CV health to provide clinicians with current information for patient discussions in the clinical setting. Specifically, this paper delves into dairy products, added sugars, legumes, coffee, tea, alcoholic beverages, energy drinks, mushrooms, fermented foods, seaweed, plant and marine-derived omega-3-fatty acids, and vitamin B12.

J Am Coll Cardiol: 30 Jul 2018; 72:553-568
Freeman AM, Morris PB, Aspry K, Gordon NF, ... White B, Kris-Etherton P
J Am Coll Cardiol: 30 Jul 2018; 72:553-568 | PMID: 30049315
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Positive Psychological Well-Being and Cardiovascular Disease: JACC Health Promotion Series.

Kubzansky LD, Huffman JC, Boehm JK, Hernandez R, ... Seligman MEP, Labarthe DR
Facets of positive psychological well-being, such as optimism, have been identified as positive health assets because they are prospectively associated with the 7 metrics of cardiovascular health (CVH) and improved outcomes related to cardiovascular disease. Connections between psychological well-being and cardiovascular conditions may be mediated through biological, behavioral, and psychosocial pathways. Individual-level interventions, such as mindfulness-based programs and positive psychological interventions, have shown promise for modifying psychological well-being. Further, workplaces are using well-being-focused interventions to promote employee CVH, and these interventions represent a potential model for expanding psychological well-being programs to communities and societies. Given the relevance of psychological well-being to promoting CVH, this review outlines clinical recommendations to assess and promote well-being in encounters with patients. Finally, a research agenda is proposed. Additional prospective observational studies are needed to understand mechanisms underlying the connection between psychological well-being and cardiovascular outcomes. Moreover, rigorous intervention trials are needed to assess whether psychological well-being-promoting programs can improve cardiovascular outcomes.

J Am Coll Cardiol: 17 Sep 2018; 72:1382-1396
Kubzansky LD, Huffman JC, Boehm JK, Hernandez R, ... Seligman MEP, Labarthe DR
J Am Coll Cardiol: 17 Sep 2018; 72:1382-1396 | PMID: 30213332
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

The Macrophage in Cardiac Homeostasis and Disease: JACC Macrophage in CVD Series (Part 4).

Lavine KJ, Pinto AR, Epelman S, Kopecky BJ, ... Rosenthal N, Kovacic JC
Macrophages are integral components of cardiac tissue and exert profound effects on the healthy and diseased heart. Paradigm shifting studies using advanced molecular techniques have revealed significant complexity within these macrophage populations that reside in the heart. In this final of a 4-part review series covering the macrophage in cardiovascular disease, the authors review the origins, dynamics, cell surface markers, and respective functions of each cardiac macrophage subset identified to date, including in the specific scenarios of myocarditis and after myocardial infarction. Looking ahead, a deeper understanding of the diverse and often dichotomous functions of cardiac macrophages will be essential for the development of targeted therapies to mitigate injury and orchestrate recovery of the diseased heart. Moreover, as macrophages are critical for cardiac healing, they are an emerging focus for therapeutic strategies aimed at minimizing cardiomyocyte death, ameliorating pathological cardiac remodeling, and for treating heart failure and after myocardial infarction.

J Am Coll Cardiol: 29 Oct 2018; 72:2213-2230
Lavine KJ, Pinto AR, Epelman S, Kopecky BJ, ... Rosenthal N, Kovacic JC
J Am Coll Cardiol: 29 Oct 2018; 72:2213-2230 | PMID: 30360829
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Macrophage Trafficking, Inflammatory Resolution, and Genomics in Atherosclerosis: JACC Macrophage in CVD Series (Part 2).

Moore KJ, Koplev S, Fisher EA, Tabas I, ... Doran AC, Kovacic JC
Atherosclerosis is characterized by the retention of modified lipoproteins in the arterial wall. These modified lipoproteins activate resident macrophages and the recruitment of monocyte-derived cells, which differentiate into mononuclear phagocytes that ingest the deposited lipoproteins to become \"foam cells\": a hallmark of this disease. In this Part 2 of a 4-part review series covering the macrophage in cardiovascular disease, we critically review the contributions and relevant pathobiology of monocytes, macrophages, and foam cells as relevant to atherosclerosis. We also review evidence that via various pathways, a failure of the resolution of inflammation is an additional key aspect of this disease process. Finally, we consider the likely role played by genomics and biological networks in controlling the macrophage phenotype in atherosclerosis. Collectively, these data provide substantial insights on the atherosclerotic process, while concurrently offering numerous molecular and genomic candidates that appear to hold great promise for selective targeting as clinical therapies.

J Am Coll Cardiol: 29 Oct 2018; 72:2181-2197
Moore KJ, Koplev S, Fisher EA, Tabas I, ... Doran AC, Kovacic JC
J Am Coll Cardiol: 29 Oct 2018; 72:2181-2197 | PMID: 30360827
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Monocyte and Macrophage Dynamics in the Cardiovascular System: JACC Macrophage in CVD Series (Part 3).

Fayad ZA, Swirski FK, Calcagno C, Robbins CS, Mulder W, Kovacic JC
It has long been recognized that the bone marrow is the primary site of origin for circulating monocytes that may later become macrophages in atherosclerotic lesions. However, only in recent times has the complex relationship among the bone marrow, monocytes/macrophages, and atherosclerotic plaques begun to be understood. Moreover, the systemic nature of these interactions, which also involves additional compartments such as extramedullary hematopoietic sites (i.e., spleen), is only just becoming apparent. In parallel, progressive advances in imaging and cell labeling techniques have opened new opportunities for in vivo imaging of monocyte/macrophage trafficking in atherosclerotic lesions and at the systemic level. In this Part 3 of a 4-part review series covering the macrophage in cardiovascular disease, the authors intersect systemic biology with advanced imaging techniques to explore monocyte and macrophage dynamics in the cardiovascular system, with an emphasis on how events at the systemic level might affect local atherosclerotic plaque biology.

J Am Coll Cardiol: 29 Oct 2018; 72:2198-2212
Fayad ZA, Swirski FK, Calcagno C, Robbins CS, Mulder W, Kovacic JC
J Am Coll Cardiol: 29 Oct 2018; 72:2198-2212 | PMID: 30360828
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Unmet Need for Adjunctive Dyslipidemia Therapy in Hypertriglyceridemia Management.

Ganda OP, Bhatt DL, Mason RP, Miller M, Boden WE
Despite the important role of high-intensity statins in reducing atherosclerotic cardiovascular disease events in secondary and primary prevention, substantial residual risk persists, particularly among high-risk patients with type 2 diabetes mellitus, metabolic syndrome, and obesity. Considerable attention is currently directed to the role that elevated triglycerides (TGs) and non-high-density lipoprotein cholesterol levels play as important mediators of residual atherosclerotic cardiovascular disease risk, which is further strongly supported by genetic linkage studies. Previous trials with fibrates, niacin, and most cholesterol ester transfer protein inhibitors that targeted high-density lipoprotein cholesterol raising, and/or TG lowering, have failed to show conclusive evidence of incremental event reduction after low-density lipoprotein cholesterol levels were \"optimally controlled\" with statins. Although omega-3 fatty acids are efficacious in lowering TG levels and may have pleiotropic effects such as reducing plaque instability and proinflammatory mediators of atherogenesis, clinical outcomes data are currently lacking. Several ongoing randomized controlled trials of TG-lowering strategies with an optimal dosage of omega-3 fatty acids are nearing completion.

J Am Coll Cardiol: 15 Jun 2018; epub ahead of print
Ganda OP, Bhatt DL, Mason RP, Miller M, Boden WE
J Am Coll Cardiol: 15 Jun 2018; epub ahead of print | PMID: 29935936
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Macrophage Biology, Classification, and Phenotype in Cardiovascular Disease: JACC Macrophage in CVD Series (Part 1).

Williams JW, Giannarelli C, Rahman A, Randolph GJ, Kovacic JC
Macrophages represent one of the most numerous and diverse leukocyte types in the body. Furthermore, they are important regulators and promoters of many cardiovascular disease programs. Their functions range from sensing pathogens to digesting cell debris, modulating inflammation, and producing key cytokines and other regulatory factors throughout the body. Macrophage research has undergone a renaissance in recent years, which has propelled a newfound interest in their heterogeneity as well as a new understanding of ontological differences in their development. In addition, recent technological advances such as single-cell mass-cytometry by time-of-flight have enabled phenotype and functional analyses of individual immune myeloid cells, including macrophages, at unprecedented resolution. In this Part 1 of a 4-part review series covering the macrophage in cardiovascular disease, we focus on the basic principles of macrophage development, heterogeneity, phenotype, tissue-specific differentiation, and functionality as a basis to understand their role in cardiovascular disease.

J Am Coll Cardiol: 29 Oct 2018; 72:2166-2180
Williams JW, Giannarelli C, Rahman A, Randolph GJ, Kovacic JC
J Am Coll Cardiol: 29 Oct 2018; 72:2166-2180 | PMID: 30360826
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Inflammation, Immunity, and Infection in Atherothrombosis: JACC Review Topic of the Week.

Libby P, Loscalzo J, Ridker PM, Farkouh ME, ... Hasan AA, Amar S
Observations on human and experimental atherosclerosis, biomarker studies, and now a large-scale clinical trial support the operation of immune and inflammatory pathways in this disease. The factors that incite innate and adaptive immune responses implicated in atherogenesis and in lesion complication include traditional risk factors such as protein and lipid components of native and modified low-density lipoprotein, angiotensin II, smoking, visceral adipose tissue, and dysmetabolism. Infectious processes and products of the endogenous microbiome might also modulate atherosclerosis and its complications either directly, or indirectly by eliciting local and systemic responses that potentiate disease expression. Trials with antibiotics have not reduced recurrent cardiovascular events, nor have vaccination strategies yet achieved clinical translation. However, anti-inflammatory interventions such as anticytokine therapy and colchicine have begun to show efficacy in this regard. Thus, inflammatory and immune mechanisms can link traditional and emerging risk factors to atherosclerosis, and offer novel avenues for therapeutic intervention.

J Am Coll Cardiol: 22 Oct 2018; 72:2071-2081
Libby P, Loscalzo J, Ridker PM, Farkouh ME, ... Hasan AA, Amar S
J Am Coll Cardiol: 22 Oct 2018; 72:2071-2081 | PMID: 30336831
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Healthy Weight and Obesity Prevention: JACC Health Promotion Series.

Lavie CJ, Laddu D, Arena R, Ortega FB, Alpert MA, Kushner RF
Overweight and obesity have reached epidemic levels in the United States and worldwide, and this has contributed to substantial cardiovascular and other health risks. However, controversy exists concerning the causes of obesity and effective modalities for its prevention and treatment. There is also controversy related to the concept of metabolically healthy obesity phenotype, the \"obesity paradox,\" and on the importance of fitness to protect individuals who are overweight or obese from cardiovascular diseases. In this state-of-the-art review, the authors focus on \"healthy weight\" with the emphasis on the pathophysiologic effects of weight gain on the cardiovascular system; mechanistic/triggering factors; and the role of preventive actions through personal, education/environment, and societal/authoritative factors, as well as factors to provide guidance for caregivers of health promotion. Additionally, the authors briefly review metabolically healthy obesity, the obesity paradox, and issues beyond lifestyle consideration for weight loss with medications and bariatric surgery.

J Am Coll Cardiol: 24 Sep 2018; 72:1506-1531
Lavie CJ, Laddu D, Arena R, Ortega FB, Alpert MA, Kushner RF
J Am Coll Cardiol: 24 Sep 2018; 72:1506-1531 | PMID: 30236314
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Positive Pressure Ventilation in the Cardiac Intensive Care Unit.

Alviar CL, Miller PE, McAreavey D, Katz JN, ... Morrow DA,
Contemporary cardiac intensive care units (CICUs) provide care for an aging and increasingly complex patient population. The medical complexity of this population is partly driven by an increased proportion of patients with respiratory failure needing noninvasive or invasive positive pressure ventilation (PPV). PPV often plays an important role in the management of patients with cardiogenic pulmonary edema, cardiogenic shock, or cardiac arrest, and those undergoing mechanical circulatory support. Noninvasive PPV, when appropriately applied to selected patients, may reduce the need for invasive mechanical PPV and improve survival. Invasive PPV can be lifesaving, but has both favorable and unfavorable interactions with left and right ventricular physiology and carries a risk of complications that influence CICU mortality. Effective implementation of PPV requires an understanding of the underlying cardiac and pulmonary pathophysiology. Cardiologists who practice in the CICU should be proficient with the indications, appropriate selection, potential cardiopulmonary interactions, and complications of PPV.

J Am Coll Cardiol: 24 Sep 2018; 72:1532-1553
Alviar CL, Miller PE, McAreavey D, Katz JN, ... Morrow DA,
J Am Coll Cardiol: 24 Sep 2018; 72:1532-1553 | PMID: 30236315
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Air Pollution and Cardiovascular Disease: JACC State-of-the-Art Review.

Rajagopalan S, Al-Kindi SG, Brook RD
Fine particulate matter <2.5 μm (PM) air pollution is the most important environmental risk factor contributing to global cardiovascular (CV) mortality and disability. Short-term elevations in PM increase the relative risk of acute CV events by 1% to 3% within a few days. Longer-term exposures over several years increase this risk by a larger magnitude (∼10%), which is partially attributable to the development of cardiometabolic conditions (e.g., hypertension and diabetes mellitus). As such, ambient PM poses a major threat to global public health. In this review, the authors provide an overview of air pollution and health, including assessment of exposure, impact on CV outcomes, mechanistic underpinnings, and impact of air pollution reduction strategies to mitigate CV risk. The review concludes with future challenges, including the inextricable link between air pollution and climate change, and calls for large-scale trials to allow the promulgation of formal evidence-based recommendations to lower air pollution-induced health risks.

J Am Coll Cardiol: 22 Oct 2018; 72:2054-2070
Rajagopalan S, Al-Kindi SG, Brook RD
J Am Coll Cardiol: 22 Oct 2018; 72:2054-2070 | PMID: 30336830
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Ejection Fraction Pros and Cons: JACC State-of-the-Art Review.

Marwick TH
Ejection fraction (EF) reflects both cardiac function and remodeling, and is widely recognized as a valuable diagnostic and prognostic tool. Its use in a variety of settings, ranging from heart failure and myocardial infarction to valvular heart disease, has made it a cornerstone of modern cardiology, pervading guidelines and practice. However, the development of the test was in another era, with younger patients and a lower prevalence of heart failure with preserved EF. The performance expectations of EF in the current era are also demanding-in relation to detection of subclinical LV dysfunction, and especially relating to recognition of changes in LV function on sequential testing-for example in patients taking cardiotoxic drugs. This review discusses whether the impressive evidence base for EF justifies its ongoing use in the context of newer markers of LV function, and the sophisticated questions posed by modern cardiology.

J Am Coll Cardiol: 05 Nov 2018; 72:2360-2379
Marwick TH
J Am Coll Cardiol: 05 Nov 2018; 72:2360-2379 | PMID: 30384893
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Lifestyle Modifications for Preventing and Treating Heart Failure.

Aggarwal M, Bozkurt B, Panjrath G, Aggarwal B, ... Litwin SE,
Continued improvement in medical and device therapy for heart failure (HF) has led to better survival with this disease. Longer survival and increasing numbers of unhealthy lifestyle factors and behaviors leading to occurrence of HF at younger ages are both contributors to an increase in the overall prevalence of HF. Clinicians treating this complex disease tend to focus on pharmacological and device therapies, but often fail to capitalize on the significant opportunities to prevent or treat HF through lifestyle modification. Herein, the authors review the evidence behind weight management, exercise, nutrition, dietary composition, supplements, and mindfulness and their potential to influence the epidemiology, pathophysiology, etiology, and management of stage A HF.

J Am Coll Cardiol: 05 Nov 2018; 72:2391-2405
Aggarwal M, Bozkurt B, Panjrath G, Aggarwal B, ... Litwin SE,
J Am Coll Cardiol: 05 Nov 2018; 72:2391-2405 | PMID: 30384895
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Artificial Lungs for Lung Failure: JACC Technology Corner.

Naito N, Cook K, Toyoda Y, Shigemura N
Although lung transplantation is an effective treatment for end-stage lung failure, its limitations have led to renewed interest in artificial lung support for patients with lung failure. The use of ventricular assist devices has significantly improved the quality of life and survival of patients with end-stage heart failure. In contrast, there are no devices that can be used long term as destination therapy for end-stage lung failure, and there is a strong need for them. Extracorporeal membrane oxygenation is widely used as a temporary treatment for acute lung failure and as a bridge to lung transplant. Many patients with advanced lung failure cannot return home with good quality of life once they are hospitalized. In this review, the authors discuss the history, status, and future of artificial lungs, focusing on long-term artificial respiratory support as a destination therapy. Respiratory assist devices, such as artificial lungs, could eventually become analogous to ventricular assist devices.

J Am Coll Cardiol: 01 Oct 2018; 72:1640-1652
Naito N, Cook K, Toyoda Y, Shigemura N
J Am Coll Cardiol: 01 Oct 2018; 72:1640-1652 | PMID: 30261966
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Promoting Physical Activity and Exercise: JACC Health Promotion Series.

Fletcher GF, Landolfo C, Niebauer J, Ozemek C, Arena R, Lavie CJ
Physical inactivity is one of the leading modifiable risk factors for global mortality, with an estimated 20% to 30% increased risk of death compared with those who are physically active. The \"behavior\" of physical activity (PA) is multifactorial, including social, environmental, psychological, and genetic factors. Abundant scientific evidence has demonstrated that physically active people of all age groups and ethnicities have higher levels of cardiorespiratory fitness, health, and wellness, and a lower risk for developing several chronic medical illnesses, including cardiovascular disease, compared with those who are physically inactive. Although more intense and longer durations of PA correlate directly with improved outcomes, even small amounts of PA provide protective health benefits. In this state-of-the-art review, the authors focus on \"healthy PA\" with the emphasis on the pathophysiological effects of physical inactivity and PA on the cardiovascular system, mechanistic/triggering factors, the role of preventive actions through personal, education/environment, and societal/authoritative factors, as well as factors to provide guidance for caregivers of health promotion regarding PA. Sustainable and comprehensive programs to increase PA among all individuals need to be developed and implemented at local, regional, national, and international levels to effect positive changes and improve global health, especially the reduction of cardiovascular disease.

J Am Coll Cardiol: 01 Oct 2018; 72:1622-1639
Fletcher GF, Landolfo C, Niebauer J, Ozemek C, Arena R, Lavie CJ
J Am Coll Cardiol: 01 Oct 2018; 72:1622-1639 | PMID: 30261965
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Long Noncoding RNAs in Atherosclerosis: JACC Review Topic of the Week.

Zhang Z, Salisbury D, Sallam T
Atherosclerosis is a complex and chronic disease characterized by lipid deposition in the vessel wall that leads to an inflammatory and proliferative cascade involving smooth muscle, endothelial, and immune cells. Despite substantial improvements in our understanding of mechanisms contributing to atherosclerosis and overall reduction in cardiovascular mortality, the absolute disease burden remains substantially high. The recent discovery of a new group of mediators known as long noncoding ribonucleic acids (lncRNAs) offers a unique opportunity for the development of novel diagnostic and therapeutic tools in atherothrombotic disease. A number of studies suggest that lncRNAs are important mediators in health and disease, and rapidly accumulating evidence implicates lncRNAs in regulatory circuits controlling atherosclerosis. In this review, the authors outline important contributions of lncRNAs to atherosclerosis and its associated risk factors, including hypercholesterolemia, diabetes, hypertension, and obesity.

J Am Coll Cardiol: 05 Nov 2018; 72:2380-2390
Zhang Z, Salisbury D, Sallam T
J Am Coll Cardiol: 05 Nov 2018; 72:2380-2390 | PMID: 30384894
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Mechanical Unloading in Heart Failure.

Uriel N, Sayer G, Annamalai S, Kapur NK, Burkhoff D
Myocardial injury induces significant changes in ventricular structure and function at both the cellular and anatomic level, leading to ventricular remodeling and subsequent heart failure. Unloading left ventricular pressure has been studied in both the short-term and long-term settings, as a means of preventing or reversing cardiac remodeling. In acute myocardial infarction, cardiac unloading is used to reduce oxygen demand and limit infarct size. Research has demonstrated the benefits of short-term unloading with mechanical circulatory support devices before reperfusion in the context of acute myocardial infarction with cardiogenic shock, and a confirmatory trial is ongoing. In chronic heart failure, ventricular unloading using mechanical circulatory support can reverse many of the cellular and anatomic changes that accompany ventricular remodeling. Ongoing research is evaluating the ability of left ventricular assist devices to promote myocardial recovery and remission from clinical heart failure.

J Am Coll Cardiol: 30 Jul 2018; 72:569-580
Uriel N, Sayer G, Annamalai S, Kapur NK, Burkhoff D
J Am Coll Cardiol: 30 Jul 2018; 72:569-580 | PMID: 30056830
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Primary Prevention With Statins in the Elderly.

Mortensen MB, Falk E
The burden of atherosclerotic cardiovascular disease (ASCVD) in high-income countries is mostly borne by the elderly. With increasing life expectancy, clear guidance on sensible use of statin therapy to prevent a first and potentially devastating ASCVD event is critically important to ensure a healthy aging population. Since 2013, 5 major North American and European guidelines on statin use in primary prevention of ASCVD have been released by the American College of Cardiology/American Heart Association, the UK National Institute for Health and Care Excellence, the Canadian Cardiovascular Society, U.S. Preventive Services Task Force, and the European Society of Cardiology/European Atherosclerosis Society. Guidance on using statin therapy in primary ASCVD prevention in the growing elderly population (>65 years of age) differs markedly. The authors discuss the discrepant recommendations, place them into the context of available evidence, and identify circumstances in which uncertainty may hamper the appropriate use of statins in the elderly.

J Am Coll Cardiol: 01 Jan 2018; 71:85-94
Mortensen MB, Falk E
J Am Coll Cardiol: 01 Jan 2018; 71:85-94 | PMID: 29301631
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Obesity: Pathophysiology and Management.

Gadde KM, Martin CK, Berthoud HR, Heymsfield SB
Obesity continues to be among the top health concerns across the globe. Despite our failure to contain the high prevalence of obesity, we now have a better understanding of its pathophysiology, and how excess adiposity leads to type 2 diabetes, hypertension, and cardiovascular disease. Lifestyle modification is recommended as the cornerstone of obesity management, but many patients do not achieve long-lasting benefits due to difficulty with adherence as well as physiological and neurohormonal adaptation of the body in response to weight loss. Fortunately, 5 drug therapies-orlistat, lorcaserin, liraglutide, phentermine/topiramate, and naltrexone/bupropion-are available for long-term weight management. Additionally, several medical devices are available for short-term and long-term use. Bariatric surgery yields substantial and sustained weight loss with resolution of type 2 diabetes, although due to the high cost and a small risk of serious complications, it is generally recommended for patients with severe obesity. Benefit-to-risk balance should guide treatment decisions.

J Am Coll Cardiol: 01 Jan 2018; 71:69-84
Gadde KM, Martin CK, Berthoud HR, Heymsfield SB
J Am Coll Cardiol: 01 Jan 2018; 71:69-84 | PMID: 29301630
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Anatomy, Function, and Dysfunction of the Right Ventricle: JACC State-of-the-Art Review.

Sanz J, Sánchez-Quintana D, Bossone E, Bogaard HJ, Naeije R
There is increasing recognition of the crucial role of the right ventricle (RV) in determining functional status and prognosis in multiple conditions. The normal RV is anatomically and functionally different from the left ventricle, which precludes direct extrapolation of our knowledge of left-sided physiopathology to the right heart. RV adaptation is largely determined by the level of exposure to hemodynamic overload (both preload and afterload) as well as its intrinsic contractile function. These 3 processes (pressure overload, volume overload, and RV cardiomyopathy) are associated with distinct clinical course and therapeutic approach, although in reality they often coexist in various degrees. The close relationship between the RV and left ventricle (ventricular interdependence) and its coupling to the pulmonary circulation further modulate RV behavior in different clinical scenarios. In this review, the authors summarize current knowledge of RV anatomic, structural, metabolic, functional, and hemodynamic characteristics in both health and disease.

J Am Coll Cardiol: 01 May 2019; 73:1463-1482
Sanz J, Sánchez-Quintana D, Bossone E, Bogaard HJ, Naeije R
J Am Coll Cardiol: 01 May 2019; 73:1463-1482 | PMID: 30922478
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Present Status of Brugada Syndrome: JACC State-of-the-Art Review.

Brugada J, Campuzano O, Arbelo E, Sarquella-Brugada G, Brugada R
The Brugada syndrome is an inherited disorder associated with risk of ventricular fibrillation and sudden cardiac death in a structurally normal heart. Diagnosis is based on a characteristic electrocardiographic pattern (coved type ST-segment elevation ≥2 mm followed by a negative T-wave in ≥1 of the right precordial leads V to V), observed either spontaneously or during a sodium-channel blocker test. The prevalence varies among regions and ethnicities, affecting mostly males. The risk stratification and management of patients, principally asymptomatic, still remains challenging. The current main therapy is an implantable cardioverter-defibrillator, but radiofrequency catheter ablation has been recently reported as an effective new treatment. Since its first description in 1992, continuous achievements have expanded our understanding of the genetics basis and electrophysiological mechanisms underlying the disease. Currently, despite several genes identified, SCN5A has attracted most attention, and in approximately 30% of patients, a genetic variant may be implicated in causation after a comprehensive analysis.

J Am Coll Cardiol: 27 Aug 2018; 72:1046-1059
Brugada J, Campuzano O, Arbelo E, Sarquella-Brugada G, Brugada R
J Am Coll Cardiol: 27 Aug 2018; 72:1046-1059 | PMID: 30139433
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Clinical Diagnosis, Imaging, and Genetics of Arrhythmogenic Right Ventricular Cardiomyopathy/Dysplasia: JACC State-of-the-Art Review.

Gandjbakhch E, Redheuil A, Pousset F, Charron P, Frank R
Arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D) is an inherited cardiomyopathy that can lead to sudden cardiac death and heart failure. Our understanding of its pathophysiology and clinical expressivity is continuously evolving. The diagnosis of ARVC/D remains particularly challenging due to the absence of specific unique diagnostic criteria, its variable expressivity, and incomplete penetrance. Advances in genetics have enlarged the clinical spectrum of the disease, highlighting possible phenotypes that overlap with arrhythmogenic dilated cardiomyopathy and channelopathies. The principal challenges for ARVC/D diagnosis include the following: earlier detection of the disease, particularly in cases of focal right ventricular involvement; differential diagnosis from other arrhythmogenic diseases affecting the right ventricle; and the development of new objective electrocardiographic and imaging criteria for diagnosis. This review provides an update on the diagnosis of ARVC/D, focusing on the contribution of emerging imaging techniques, such as echocardiogram/magnetic resonance imaging strain measurements or computed tomography scanning, new electrocardiographic parameters, and high-throughput sequencing.

J Am Coll Cardiol: 13 Aug 2018; 72:784-804
Gandjbakhch E, Redheuil A, Pousset F, Charron P, Frank R
J Am Coll Cardiol: 13 Aug 2018; 72:784-804 | PMID: 30092956
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Impact of Lipids on Cardiovascular Health: JACC Health Promotion Series.

Ference BA, Graham I, Tokgozoglu L, Catapano AL
People who maintain ideal cardiovascular heath have a low lifetime risk of cardiovascular disease. Therefore, encouraging people to achieve ideal cardiovascular health represents an important opportunity to improve the prevention of cardiovascular disease. However, preventing cardiovascular disease by promoting ideal cardiovascular health requires shifting the focus from treating disease after it develops to preventing cardiovascular events before they happen by slowing the progression of atherosclerosis. Because atherogenic lipoproteins play a central causal role in the initiation and progression of atherosclerosis, maintaining optimal lipid levels is necessary to achieve ideal cardiovascular health. This review describes the cumulative effect of lipid-carrying lipoproteins on the risk of cardiovascular disease, estimates the magnitude of the clinical benefit that can be achieved by maintaining optimal lipid levels, identifies the most effective timing for implementing strategies designed to achieve optimal lipid levels, and provides a clinical pathway to help people achieve the lipid levels necessary for ideal cardiovascular health.

J Am Coll Cardiol: 03 Sep 2018; 72:1141-1156
Ference BA, Graham I, Tokgozoglu L, Catapano AL
J Am Coll Cardiol: 03 Sep 2018; 72:1141-1156 | PMID: 30165986
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Exercise Training for Patients With Hypertrophic Cardiomyopathy: JACC Review Topic of the Week.

Dias KA, Link MS, Levine BD
Current guidelines recommend that patients with hypertrophic cardiomyopathy (HCM) not partake in high-intensity exercise due to the increased risk of sudden cardiac death. But individuals with genetic cardiomyopathies are not immune from cardiometabolic diseases, and inactivity is common in patients with HCM, likely due to fear of exercise-induced adverse events. The RESET-HCM trial (Study of Exercise Training in Hypertrophic Cardiomyopathy) illustrated that although moderate-intensity exercise may be safe in this population, the increase in cardiorespiratory fitness achieved with this training paradigm is modest. High-intensity exercise is an efficacious stimulus for increasing cardiorespiratory fitness in chronic disease populations. Such increases in fitness are associated with substantial reductions in cardiovascular mortality and may outweigh the theoretical risks associated with exercise in patients with HCM. The goal of this review is to examine the evidence supporting the safety and efficacy of different intensities of exercise training in HCM, and consider novel strategies to improve fitness.

J Am Coll Cardiol: 03 Sep 2018; 72:1157-1165
Dias KA, Link MS, Levine BD
J Am Coll Cardiol: 03 Sep 2018; 72:1157-1165 | PMID: 30165987
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Prevention and Treatment of Tobacco Use: JACC Health Promotion Series.

Kalkhoran S, Benowitz NL, Rigotti NA
Tobacco use is the leading preventable cause of death worldwide and is a major risk factor for cardiovascular disease (CVD). Both prevention of smoking initiation among youth and smoking cessation among established smokers are key for reducing smoking prevalence and the associated negative health consequences. Proven tobacco cessation treatment includes pharmacotherapy and behavioral support, which are most effective when provided together. First-line medications (varenicline, bupropion, and nicotine replacement) are effective and safe for patients with CVD. Clinicians who care for patients with CVD should give as high a priority to treating tobacco use as to managing other CVD risk factors. Broader tobacco control efforts to raise tobacco taxes, adopt smoke-free laws, conduct mass media campaigns, and restrict tobacco marketing enhance clinicians\' actions working with individual smokers.

J Am Coll Cardiol: 27 Aug 2018; 72:1030-1045
Kalkhoran S, Benowitz NL, Rigotti NA
J Am Coll Cardiol: 27 Aug 2018; 72:1030-1045 | PMID: 30139432
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Prevention and Control of Hypertension: JACC Health Promotion Series.

Carey RM, Muntner P, Bosworth HB, Whelton PK
Hypertension, the leading risk factor for cardiovascular disease, originates from combined genetic, environmental, and social determinants. Environmental factors include overweight/obesity, unhealthy diet, excessive dietary sodium, inadequate dietary potassium, insufficient physical activity, and consumption of alcohol. Prevention and control of hypertension can be achieved through targeted and/or population-based strategies. For control of hypertension, the targeted strategy involves interventions to increase awareness, treatment, and control in individuals. Corresponding population-based strategies involve interventions designed to achieve a small reduction in blood pressure (BP) in the entire population. Having a usual source of care, optimizing adherence, and minimizing therapeutic inertia are associated with higher rates of BP control. The Chronic Care Model, a collaborative partnership among the patient, provider, and health system, incorporates a multilevel approach for control of hypertension. Optimizing the prevention, recognition, and care of hypertension requires a paradigm shift to team-based care and the use of strategies known to control BP.

J Am Coll Cardiol: 10 Sep 2018; 72:1278-1293
Carey RM, Muntner P, Bosworth HB, Whelton PK
J Am Coll Cardiol: 10 Sep 2018; 72:1278-1293 | PMID: 30190007
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Telomere Length as Cardiovascular Aging Biomarker: JACC Review Topic of the Week.

De Meyer T, Nawrot T, Bekaert S, De Buyzere ML, Rietzschel ER, Andrés V
Telomeres shorten with age, the major risk factor for atherosclerotic cardiovascular disease (aCVD). The observation of shorter telomeres in aCVD patients thus suggested that critical telomere shortening may contribute to premature biological aging and aCVD. Therefore, telomere length often is suggested as a causal aCVD risk factor, a proposal supported by recent Mendelian randomization studies; however, epidemiological research has shown disappointingly low effect sizes. It therefore remains uncertain whether telomere shortening is a cause of aCVD or merely a consequence. The authors argue that elucidating the mechanistic foundation of these findings is essential for any possible translation of telomere biology to the clinic. Here, they critically evaluate evidence for causality in animal models and human studies, and review popular hypotheses and discuss their clinical implications. The authors identify 4 key questions that any successful mechanistic theory should address, and they discuss how atherosclerosis-associated local telomere attrition may provide the answers.

J Am Coll Cardiol: 13 Aug 2018; 72:805-813
De Meyer T, Nawrot T, Bekaert S, De Buyzere ML, Rietzschel ER, Andrés V
J Am Coll Cardiol: 13 Aug 2018; 72:805-813 | PMID: 30092957
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Cardiovascular Disease Prevention by Diet Modification: JACC Health Promotion Series.

Yu E, Malik VS, Hu FB
Reduction in excess calories and improvement in dietary composition may prevent many primary and secondary cardiovascular events. Current guidelines recommend diets high in fruits, vegetables, whole grains, nuts, and legumes; moderate in low-fat dairy and seafood; and low in processed meats, sugar-sweetened beverages, refined grains, and sodium. Supplementation can be useful for some people but cannot replace a good diet. Factors that influence individuals to consume a low-quality diet are myriad and include lack of knowledge, lack of availability, high cost, time scarcity, social and cultural norms, marketing of poor-quality foods, and palatability. Governments should focus on cardiovascular disease as a global threat and enact policies that will reach all levels of society and create a food environment wherein healthy foods are accessible, affordable, and desirable. Health professionals should be proficient in basic nutritional knowledge to promote a sustainable pattern of healthful eating for cardiovascular disease prevention for both healthy individuals and those at higher risk.

J Am Coll Cardiol: 20 Aug 2018; 72:914-926
Yu E, Malik VS, Hu FB
J Am Coll Cardiol: 20 Aug 2018; 72:914-926 | PMID: 30115231
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

His Bundle Pacing.

Vijayaraman P, Chung MK, Dandamudi G, Upadhyay GA, ... Lakkireddy D,
Traditional right ventricular (RV) pacing for the management of bradyarrhythmias has been pursued successfully for decades, although there remains debate regarding optimal pacing site with respect to both hemodynamic and clinical outcomes. The deleterious effects of long-term RV apical pacing have been well recognized. This has generated interest in approaches providing more physiological stimulation, namely, His bundle pacing (HBP). This paper reviews the anatomy of the His bundle, early clinical observations, and current approaches to permanent HBP. By stimulating the His-Purkinje network, HBP engages electrical activation of both ventricles and may avoid marked dyssynchrony. Recent studies have also demonstrated the potential of HBP in patients with underlying left bundle branch block and cardiomyopathy. HBP holds promise as an attractive mode to achieve physiological pacing. Widespread adaptation of this technique is dependent on enhancements in technology, as well as further validation of efficacy in large randomized clinical trials.

J Am Coll Cardiol: 20 Aug 2018; 72:927-947
Vijayaraman P, Chung MK, Dandamudi G, Upadhyay GA, ... Lakkireddy D,
J Am Coll Cardiol: 20 Aug 2018; 72:927-947 | PMID: 30115232
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Clinical Genetic Testing for Familial Hypercholesterolemia: JACC Scientific Expert Panel.

Sturm AC, Knowles JW, Gidding SS, Ahmad ZS, ... Rader DJ,
Although awareness of familial hypercholesterolemia (FH) is increasing, this common, potentially fatal, treatable condition remains underdiagnosed. Despite FH being a genetic disorder, genetic testing is rarely used. The Familial Hypercholesterolemia Foundation convened an international expert panel to assess the utility of FH genetic testing. The rationale includes the following: 1) facilitation of definitive diagnosis; 2) pathogenic variants indicate higher cardiovascular risk, which indicates the potential need for more aggressive lipid lowering; 3) increase in initiation of and adherence to therapy; and 4) cascade testing of at-risk relatives. The Expert Consensus Panel recommends that FH genetic testing become the standard of care for patients with definite or probable FH, as well as for their at-risk relatives. Testing should include the genes encoding the low-density lipoprotein receptor (LDLR), apolipoprotein B (APOB), and proprotein convertase subtilisin/kexin 9 (PCSK9); other genes may also need to be considered for analysis based on patient phenotype. Expected outcomes include greater diagnoses, more effective cascade testing, initiation of therapies at earlier ages, and more accurate risk stratification.

J Am Coll Cardiol: 06 Aug 2018; 72:662-680
Sturm AC, Knowles JW, Gidding SS, Ahmad ZS, ... Rader DJ,
J Am Coll Cardiol: 06 Aug 2018; 72:662-680 | PMID: 30071997
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

A Changing Landscape in Cardiovascular Research Publication Output: Bridging the Translational Gap.

Gal D, Thijs B, Glänzel W, Sipido KR
The concern about predominance of basic discovery research and lack of translation into clinical medicine, and segregation between these research communities, led the authors to study these research communities through mapping networks of publications and cross-references. Cardiovascular research from 1993 to 2013 was published in 565 journals, including 104 new journals. Only 50% were published in core cardiovascular journals, such as the Journal of the American College of Cardiology, whereas one-half of cardiovascular publications were found in broader biomedical/multidisciplinary journals. The growth of the clinical journal community and merging into one broad journal community suggests a decreasing dichotomy between basic/preclinical and clinical research, potentially contributing to bridging the translational gap.

J Am Coll Cardiol: 09 Apr 2018; 71:1584-1589
Gal D, Thijs B, Glänzel W, Sipido KR
J Am Coll Cardiol: 09 Apr 2018; 71:1584-1589 | PMID: 29622166
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Respiratory Syncytial Virus and Associations With Cardiovascular Disease in Adults.

Ivey KS, Edwards KM, Talbot HK
Respiratory syncytial virus (RSV) is historically known for causing respiratory illness in young children, but the appreciation of its impact on older adults is growing. Studies have shown that hospitalization for respiratory illness due to RSV is complicated by cardiovascular events in 14% to 22% of adult patients, including worsening congestive heart failure, acute coronary syndrome, and arrhythmias. Additionally, underlying cardiovascular disease is associated with hospitalization in 45% to 63% of adults with confirmed RSV. In summary, patients with cardiopulmonary disease have higher rates of health care utilization for RSV-related illness and worse outcomes. Patients with cardiovascular disease likely represent an important target population for the rapidly developing field of RSV vaccines.

J Am Coll Cardiol: 09 Apr 2018; 71:1574-1583
Ivey KS, Edwards KM, Talbot HK
J Am Coll Cardiol: 09 Apr 2018; 71:1574-1583 | PMID: 29622165
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Coronary Microvascular Disease Pathogenic Mechanisms and Therapeutic Options: JACC State-of-the-Art Review.

Taqueti VR, Di Carli MF
Coronary microvascular disease (CMD) refers to the subset of disorders affecting the structure and function of the coronary microcirculation, is prevalent in patients across a broad spectrum of cardiovascular risk factors, and is associated with an increased risk of adverse events. Contemporary evidence supports that most patients with CMD also have macrovessel atherosclerosis, which has important implications for their prognosis and management. In this state-of-the-art review, the authors summarize the pathophysiology of CMD, provide an update of diagnostic testing strategies, and classify CMD into phenotypes according to severity and coexistence with atherosclerosis. They examine emerging data highlighting the significance of CMD in specific populations, including obesity and insulin resistance, myocardial injury and heart failure with preserved ejection fraction, and nonobstructive and obstructive coronary artery disease. Finally, they discuss the role of CMD as a potential target for novel interventions beyond conventional approaches, representing a new frontier in cardiovascular disease reduction.

J Am Coll Cardiol: 26 Nov 2018; 72:2625-2641
Taqueti VR, Di Carli MF
J Am Coll Cardiol: 26 Nov 2018; 72:2625-2641 | PMID: 30466521
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Echocardiographic Screening for Pulmonary Hypertension in Congenital Heart Disease: JACC Review Topic of the Week.

Dimopoulos K, Condliffe R, Tulloh RMR, Clift P, ... Wort SJ,
Echocardiography is the mainstay in screening for pulmonary hypertension (PH). International guidelines suggest echocardiographic parameters for suspecting PH, but these may not apply to many adults with congenital heart disease (ACHD). PH is relatively common in ACHD patients and can significantly affect their exercise capacity, quality of life, and prognosis. Identification of patients who have developed PH and who may benefit from further investigations (including cardiac catheterization) and treatment is thus extremely important. A systematic review and survey of experts from the United Kingdom and Ireland were performed to assess current knowledge and practice on echocardiographic screening for PH in ACHD. This paper presents the findings of the review and expert statements on the optimal approaches when using echocardiography to assess ACHD patients for PH, with particular focus on major subgroups: patients with right ventricular outflow tract obstruction, patients with systemic right ventricles, patients with unrepaired univentricular circulation, and patients with tetralogy of Fallot with pulmonary atresia.

J Am Coll Cardiol: 03 Dec 2018; 72:2778-2788
Dimopoulos K, Condliffe R, Tulloh RMR, Clift P, ... Wort SJ,
J Am Coll Cardiol: 03 Dec 2018; 72:2778-2788 | PMID: 30497564
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Coronary Physiology Beyond Coronary Flow Reserve in Microvascular Angina: JACC State-of-the-Art Review.

Gould KL, Johnson NP
Angina with no angiographic stenosis, commonly called \"microvascular angina,\" encompasses a wide continuum of coronary pathophysiology in conflicting published reports. Comprehensive quantitative myocardial perfusion offers new insights beyond overly simplistic coronary flow reserve. Integrating regional absolute stress flow, relative stress flow, coronary flow reserve, and qualitative subendocardial perfusion gradient on tomograms of relative images, provides correct diagnosis, quantitative physiological classification, and potential treatment. Angina without angiographic stenosis is associated with abnormal quantitative perfusion with rare, but instructive, exceptions. However, microvascular dysfunction without angina is common, particularly associated with risk factors. Reduced subendocardial/epicardial relative activity is common with diffuse coronary artery disease without focal stenosis with or without angina depending on the severity of reduced subendocardial perfusion. Precision quantitative myocardial perfusion in 5,900 cases objectively classifies angina with no angiographic stenosis into 4 categories: subendocardial ischemia due to diffuse coronary artery disease (most common), overlooked stenosis, diffuse microvascular dysfunction due to risk factors or specific microvasculopathies, and nonischemic cardiac pain mechanisms (rare), or some mix of these prototypes, of which 95% associate with risk factors, or subclinical or clinically manifest coronary atherosclerosis needing vigorous risk factor treatment.

J Am Coll Cardiol: 26 Nov 2018; 72:2642-2662
Gould KL, Johnson NP
J Am Coll Cardiol: 26 Nov 2018; 72:2642-2662 | PMID: 30466522
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

ACC/AHA Versus ESC Guidelines for Diagnosis and Management of Peripheral Artery Disease: JACC Guideline Comparison.

Kithcart AP, Beckman JA
Peripheral artery disease is a common yet underdiagnosed cause of morbidity worldwide. Significant recent advances in management have resulted in new guideline creation for the diagnosis and management of peripheral artery disease in the United States and Europe. Here, we analyze each set of guidelines with special attention to those areas where the 2 groups disagree. Both groups emphasize the importance of risk factor reduction, including smoking cessation, lipid lowering, blood pressure management, and glucose control. The U.S. guidelines place additional attention on lifestyle factors, including regular physical activity and supervised exercise. The European guidelines offer a number of recommendations for revascularization in patients with limb-threatening ischemia. Both agree that more evidence is needed to understand which patients are at highest risk for tissue loss. A consistent charge to each committee fostering a similar approach to available data and more randomized studies would align recommendations across both organizations.

J Am Coll Cardiol: 03 Dec 2018; 72:2789-2801
Kithcart AP, Beckman JA
J Am Coll Cardiol: 03 Dec 2018; 72:2789-2801 | PMID: 30497565
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Idiopathic/Iatrogenic Left Bundle Branch Block-Induced Reversible Left Ventricle Dysfunction: JACC State-of-the-Art Review.

Auffret V, Martins RP, Daubert C, Leclercq C, ... Mabo P, Donal E
Idiopathic or iatrogenic left bundle branch block (LBBB) is a unique model of electro-mechanical ventricular dyssynchrony with concordant changes in electrical activation sequence and mechanical ventricle synchronization. In chronic animal models, isolated LBBB induces structural remodeling with progressive left ventricular (LV) dysfunction. Most abnormalities can be reverted after cardiac resynchronization therapy (CRT). In humans, 2 principal models of LBBB dyssynchronopathy can be observed: the chronic model of isolated LBBB and an acute iatrogenic model of new-onset LBBB after aortic valve interventions. Although epidemiological evidence and clinical data need to be strengthened, there is a strong presumption that they may lead to LBBB-induced cardiomyopathy and benefit from CRT to prevent progression to heart failure. A large cohort study with prospective follow-up would be required to better define actual incidence, evolution over time, and predisposing factors. Parallel randomized CRT clinical trials should be conducted in selected at-risk populations: namely, patients with persistent LBBB after transcatheter aortic valve replacement.

J Am Coll Cardiol: 17 Dec 2018; 72:3177-3188
Auffret V, Martins RP, Daubert C, Leclercq C, ... Mabo P, Donal E
J Am Coll Cardiol: 17 Dec 2018; 72:3177-3188 | PMID: 30545456
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Cardiovascular Magnetic Resonance in Nonischemic Myocardial Inflammation: Expert Recommendations.

Ferreira VM, Schulz-Menger J, Holmvang G, Kramer CM, ... Liu P, Friedrich MG
This JACC Scientific Expert Panel provides consensus recommendations for an update of the cardiovascular magnetic resonance (CMR) diagnostic criteria for myocardial inflammation in patients with suspected acute or active myocardial inflammation (Lake Louise Criteria) that include options to use parametric mapping techniques. While each parameter may indicate myocardial inflammation, the authors propose that CMR provides strong evidence for myocardial inflammation, with increasing specificity, if the CMR scan demonstrates the combination of myocardial edema with other CMR markers of inflammatory myocardial injury. This is based on at least one T2-based criterion (global or regional increase of myocardial T2 relaxation time or an increased signal intensity in T2-weighted CMR images), with at least one T1-based criterion (increased myocardial T1, extracellular volume, or late gadolinium enhancement). While having both a positive T2-based marker and a T1-based marker will increase specificity for diagnosing acute myocardial inflammation, having only one (i.e., T2-based OR T1-based) marker may still support a diagnosis of acute myocardial inflammation in an appropriate clinical scenario, albeit with less specificity. The update is expected to improve the diagnostic accuracy of CMR further in detecting myocardial inflammation.

J Am Coll Cardiol: 17 Dec 2018; 72:3158-3176
Ferreira VM, Schulz-Menger J, Holmvang G, Kramer CM, ... Liu P, Friedrich MG
J Am Coll Cardiol: 17 Dec 2018; 72:3158-3176 | PMID: 30545455
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Transcatheter Valve Replacement in Asia Pacific: Current Practice and Perspectives.

Giannini F, Baldetti L, Gallone G, Tzanis G, Latib A, Colombo A
Although the field of transcatheter therapies for valvular heart disease (VHD) is continuously expanding in western countries, uptake of this treatment in Asia has been slow, mainly due to the high cost of devices, need for specific training programs, and lack of specialized heart teams and dedicated structures. Moreover, anatomic considerations of the Asian population, such as smaller aorta and peripheral vessel size, high prevalence of bicuspid aortic valves, high calcium burden of stenotic aortic valve leaflets, low coronary ostia, and high prevalence of rheumatic etiology, might raise concerns about feasibility, risk of procedural complications, prosthesis durability, and long-term outcomes after transcatheter treatment of VHD. Asia Pacific and China\'s medical communities and manufacturer companies are setting up to address this unmet clinical need. The aim of this review is to summarize the landscape of currently available devices for transcatheter valve interventions and the clinical experience to date in China and Asian Pacific countries, with a specific focus on new, locally designed, and/or manufactured devices.

J Am Coll Cardiol: 17 Dec 2018; 72:3189-3199
Giannini F, Baldetti L, Gallone G, Tzanis G, Latib A, Colombo A
J Am Coll Cardiol: 17 Dec 2018; 72:3189-3199 | PMID: 30545457
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Cardiac Phenotypes in Hereditary Muscle Disorders: JACC State-of-the-Art Review.

Arbustini E, Di Toro A, Giuliani L, Favalli V, Narula N, Grasso M
Hereditary muscular diseases commonly involve the heart. Cardiac manifestations encompass a spectrum of phenotypes, including both cardiomyopathies and rhythm disorders. Common biomarkers suggesting cardiomuscular diseases include increased circulating creatine kinase and/or lactic acid levels or disease-specific metabolic indicators. Cardiac and extra-cardiac traits, imaging tests, family studies, and genetic testing provide precise diagnoses. Cardiac phenotypes are mainly dilated and hypokinetic in dystrophinopathies, Emery-Dreifuss muscular dystrophies, and limb girdle muscular dystrophies; hypertrophic in Friedreich ataxia, mitochondrial diseases, glycogen storage diseases, and fatty acid oxidation disorders; and restrictive in myofibrillar myopathies. Left ventricular noncompaction is variably associated with the different myopathies. Conduction defects and arrhythmias constitute a major phenotype in myotonic dystrophies and skeletal muscle channelopathies. Although the actual cardiac management is rarely based on the cause, the cardiac phenotypes need precise characterization because they are often the only or the predominant manifestations and the prognostic determinants of many hereditary muscle disorders.

J Am Coll Cardiol: 12 Nov 2018; 72:2485-2506
Arbustini E, Di Toro A, Giuliani L, Favalli V, Narula N, Grasso M
J Am Coll Cardiol: 12 Nov 2018; 72:2485-2506 | PMID: 30442292
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Developing a Mobile Application for Global Cardiovascular Education.

Bhatheja S, Fuster V, Chamaria S, Kakkar S, ... Sharma SK, Kini AS
Technological revolution in the field of medical education is here, and it is time to embrace it. Adoption of on-the-go learning style, portability of smartphones, and expression of concepts with interactive illustrations and their global reach have made application (app)-based learning an effective medium. An educational mobile app, BIFURCAID, was developed to simplify and teach complex coronary bifurcation intervention. This app has been downloaded worldwide. The survey results revealed its widespread acceptance and success. The authors believe that educational apps can have a significant impact on shaping the future of cardiovascular education in the 21st century. This experience with developing and testing the app could work as a template for other medical educators.

J Am Coll Cardiol: 12 Nov 2018; 72:2518-2527
Bhatheja S, Fuster V, Chamaria S, Kakkar S, ... Sharma SK, Kini AS
J Am Coll Cardiol: 12 Nov 2018; 72:2518-2527 | PMID: 30442294
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Operational Efficiency and Effective Management in the Catheterization Laboratory: JACC Review Topic of the Week.

Reed GW, Tushman ML, Kapadia SR
Operational efficiency is a core business principle in which organizations strive to deliver high-quality goods or services in a cost-effective manner. This concept has become increasingly relevant to cardiac catheterization laboratories, as insurers move away from fee-for-service reimbursement and toward payment determined by quality measures bundled per episode of care. Accordingly, this review provides a framework for optimizing efficiency in the cardiac cath lab. The authors outline a management method based on the Nadler-Tushman Congruence Model, a commonly used business tool by which a company can assess whether its key elements are aligned with its strategy. Standardized metrics of cath lab efficiency are proposed, which can be used in public reports on this topic moving forward. Attention is paid to understanding balance sheets to track the financial health of the cath lab. Specific cost-saving measures are described, and examples of strategies used to save supply expenses are provided.

J Am Coll Cardiol: 12 Nov 2018; 72:2507-2517
Reed GW, Tushman ML, Kapadia SR
J Am Coll Cardiol: 12 Nov 2018; 72:2507-2517 | PMID: 30442293
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Future of Personalized Cardiovascular Medicine: JACC State-of-the-Art Review.

Califf RM
Previous decades have seen significant progress in the biological understanding of cardiovascular disease, as well as major advances in computational and information technologies. However, anticipated improvements in outcomes, quality, and cost of cardiovascular medicine at the individual and population levels from these advances have lagged expectations. Further, trends showing widening gaps in the pace of technological development and its successful uptake and application in practice suggests that substantial systemic changes are needed. Recent declines in key U.S. health outcomes have added further urgency to seek scalable approaches that deliver the right treatment to the right patient and to develop information-driven policies that improve health. The clinical care and research enterprises are currently in the midst of assimilating changes entrained by a \"fourth industrial revolution\" marked by the convergence of biology, physical sciences, and information science. These changes, if managed appropriately, can simultaneously enable cost-effective personalized medical care as well as more effective and targeted population health interventions. In this paper derived from a lecture in honor of cardiologist Paul Dudley White, the author explores how White\'s prescient insights into prevention and treatment continue to resonate today as we seek to assimilate ubiquitous computing, sophisticated sensor technologies, and bidirectional digital communication into the practice of cardiology. How the ongoing acceleration in basic science and information technologies can be wedded to the principles articulated by White as we pursue scalable approaches to personalized medicine is also examined.

J Am Coll Cardiol: 24 Dec 2018; 72:3301-3309
Califf RM
J Am Coll Cardiol: 24 Dec 2018; 72:3301-3309 | PMID: 30573033
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Reprint of: Positive Psychological Well-Being and Cardiovascular Disease: JACC Health Promotion Series.

Kubzansky LD, Huffman JC, Boehm JK, Hernandez R, ... Seligman MEP, Labarthe DR
Facets of positive psychological well-being, such as optimism, have been identified as positive health assets because they are prospectively associated with the 7 metrics of cardiovascular health (CVH) and improved outcomes related to cardiovascular disease. Connections between psychological well-being and cardiovascular conditions may be mediated through biological, behavioral, and psychosocial pathways. Individual-level interventions, such as mindfulness-based programs and positive psychological interventions, have shown promise for modifying psychological well-being. Further, workplaces are using well-being-focused interventions to promote employee CVH, and these interventions represent a potential model for expanding psychological well-being programs to communities and societies. Given the relevance of psychological well-being to promoting CVH, this review outlines clinical recommendations to assess and promote well-being in encounters with patients. Finally, a research agenda is proposed. Additional prospective observational studies are needed to understand mechanisms underlying the connection between psychological well-being and cardiovascular outcomes. Moreover, rigorous intervention trials are needed to assess whether psychological well-being-promoting programs can improve cardiovascular outcomes.

J Am Coll Cardiol: 10 Dec 2018; 72:3012-3026
Kubzansky LD, Huffman JC, Boehm JK, Hernandez R, ... Seligman MEP, Labarthe DR
J Am Coll Cardiol: 10 Dec 2018; 72:3012-3026 | PMID: 30522634
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Cardiac and Renal Effects of Sodium-Glucose Co-Transporter 2 Inhibitors in Diabetes: JACC State-of-the-Art Review.

Zelniker TA, Braunwald E
Patients with type 2 diabetes mellitus have an increased risk for the development of cardiac and other vascular events, heart failure (HF), and decline in renal function. After several large cardiovascular outcome trials with mostly neutral results, 2 studies of the sodium-glucose co-transporter 2 inhibitors (SGLT2is), empagliflozin and canagliflozin, reported favorable effects on the primary endpoint, a composite of myocardial infarction, stroke, and cardiovascular death. In addition, reductions of hospitalizations for HF were observed; in the case of empagliflozin, reductions in both cardiovascular mortality and total mortality occurred. These findings prompted several analyses to elucidate the mechanisms of action of SGLT2is and have initiated several large clinical trials in patients with HF without type 2 diabetes mellitus. This review summarizes known and possible mechanisms that contribute to these salutary effects of SGLT2is. Also discussed is the interplay between cardiac and renal function, as well as safety issues associated with this class of drugs.

J Am Coll Cardiol: 23 Jul 2018; epub ahead of print
Zelniker TA, Braunwald E
J Am Coll Cardiol: 23 Jul 2018; epub ahead of print | PMID: 30075873
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Arrhythmic Mitral Valve Prolapse: JACC Review Topic of the Week.

Miller MA, Dukkipati SR, Turagam M, Liao SL, Adams DH, Reddy VY
There is an increasing awareness of the association between mitral valve prolapse and sudden cardiac death. There are several clinical risk factors associated with an increased risk of mitral valve prolapse-related sudden cardiac death, most of which can be evaluated with noninvasive diagnostic modalities. For example, characteristic changes on the electrocardiogram (T-wave inversions in the inferior leads), complex ventricular ectopy, a spiked configuration of the lateral annular velocities by echocardiography, and evidence of myocardial fibrosis by cardiac magnetic resonance imaging have all been implicated as markers of risk. Herein, the authors review the reported incidence of sudden death to mitral valve prolapse, the clinical profile of at-risk patients, and the basic components necessary to initiate and perpetuate ventricular arrhythmias (substrate and trigger) as well as potential interventions to consider for those at highest risk.

J Am Coll Cardiol: 10 Dec 2018; 72:2904-2914
Miller MA, Dukkipati SR, Turagam M, Liao SL, Adams DH, Reddy VY
J Am Coll Cardiol: 10 Dec 2018; 72:2904-2914 | PMID: 30522653
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

ACC/AHA Versus ESC Guidelines on Dual Antiplatelet Therapy: JACC Guideline Comparison.

Capodanno D, Alfonso F, Levine GN, Valgimigli M, Angiolillo DJ
Dual antiplatelet therapy (DAPT) is the cornerstone of pharmacological treatment aimed at preventing the atherothrombotic complications in patients with a variety of coronary artery disease (CAD) manifestations. Prescribers of DAPT are confronted with a number of challenges that include selecting the appropriate P2Y inhibitor and determining the optimal duration of DAPT with the scope of minimizing the risk of ischemic and bleeding complications in light of each patient\'s clinical characteristic and circumstance. Recently, a guideline writing committee from the American College of Cardiology/American Heart Association (ACC/AHA) and a task force from the European Society of Cardiology (ESC) released their respective focused update recommendations on \"Duration of DAPT in Patients with CAD\" (ACC/AHA) and \"DAPT in CAD\" (ESC). This paper aims to review the ACC/AHA and ESC updates for DAPT to delineate common domains, consistent messages, and differences in recommended management strategies across the Atlantic.

J Am Coll Cardiol: 10 Dec 2018; 72:2915-2931
Capodanno D, Alfonso F, Levine GN, Valgimigli M, Angiolillo DJ
J Am Coll Cardiol: 10 Dec 2018; 72:2915-2931 | PMID: 30522654
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Reprint of: Blood Sugar Regulation for Cardiovascular Health Promotion and Disease Prevention: JACC Health Promotion Series.

Schwarz PEH, Timpel P, Harst L, Greaves CJ, ... Almedawar MM, Morawietz H
The primary objective of this study was to analyze the most up-to-date evidence regarding whether and how blood sugar regulation influences cardiovascular health promotion and disease prevention by carrying out an umbrella review. Three separate, systematic literature searches identified 2,343 papers in total. Overall, 44 studies were included for data extraction and analysis. The included systematic reviews and meta-analyses published between January 1, 2016, and December 31, 2017, were of good to very good quality (median Overview Quality Assessment Questionnaire score = 17). Identified evidence suggests that cardiovascular disease (CVD) prevention services should consider regulation of blood glucose as a key target for intervention. Furthermore, the recommendations for effective intervention and service development/training described here for prevention of CVD should be adopted into evidence-based practice guidelines. Multidisciplinary teams should be formed to deliver multicomponent interventions in community-based settings. There may be substantial opportunities for integrating CVD and diabetes prevention services.

J Am Coll Cardiol: 10 Dec 2018; 72:3071-3086
Schwarz PEH, Timpel P, Harst L, Greaves CJ, ... Almedawar MM, Morawietz H
J Am Coll Cardiol: 10 Dec 2018; 72:3071-3086 | PMID: 30522637
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Medical Therapy for Long-Term Prevention of Atherothrombosis Following an Acute Coronary Syndrome: JACC State-of-the-Art Review.

Gallone G, Baldetti L, Pagnesi M, Latib A, ... Libby P, Giannini F
Following an acute coronary syndrome (ACS), heightened predisposition to atherothrombotic events may persist for years. Advances in understanding the pathobiology that underlies this elevated risk furnish a mechanistic basis for devising long-term secondary prevention strategies. Recent progress in ACS pathophysiology has challenged the focus on single \"vulnerable plaques\" and shifted toward a more holistic consideration of the \"vulnerable patient,\" thus highlighting the primacy of medical therapy in secondary prevention. Despite current guideline-directed medical therapy, a consistent proportion of post-ACS patients experience recurrent atherothrombosis due to unaddressed \"residual risk\": contemporary clinical trials underline the pivotal role of platelets, coagulation, cholesterol, and systemic inflammation and provide a perspective on a personalized, targeted approach. Emerging data sheds new light on heretofore unrecognized residual risk factors. This review aims to summarize evolving evidence relative to secondary prevention of atherothrombosis, with a focus on recent advances that promise to transform the management of the post-ACS patient.

J Am Coll Cardiol: 10 Dec 2018; 72:2886-2903
Gallone G, Baldetti L, Pagnesi M, Latib A, ... Libby P, Giannini F
J Am Coll Cardiol: 10 Dec 2018; 72:2886-2903 | PMID: 30522652
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Reprint of: Impact of Lipids on Cardiovascular Health: JACC Health Promotion Series.

Ference BA, Graham I, Tokgozoglu L, Catapano AL
People who maintain ideal cardiovascular heath have a low lifetime risk of cardiovascular disease. Therefore, encouraging people to achieve ideal cardiovascular health represents an important opportunity to improve the prevention of cardiovascular disease. However, preventing cardiovascular disease by promoting ideal cardiovascular health requires shifting the focus from treating disease after it develops to preventing cardiovascular events before they happen by slowing the progression of atherosclerosis. Because atherogenic lipoproteins play a central causal role in the initiation and progression of atherosclerosis, maintaining optimal lipid levels is necessary to achieve ideal cardiovascular health. This review describes the cumulative effect of lipid-carrying lipoproteins on the risk of cardiovascular disease, estimates the magnitude of the clinical benefit that can be achieved by maintaining optimal lipid levels, identifies the most effective timing for implementing strategies designed to achieve optimal lipid levels, and provides a clinical pathway to help people achieve the lipid levels necessary for ideal cardiovascular health.

J Am Coll Cardiol: 10 Dec 2018; 72:2980-2995
Ference BA, Graham I, Tokgozoglu L, Catapano AL
J Am Coll Cardiol: 10 Dec 2018; 72:2980-2995 | PMID: 30522632
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Reprint of: Healthy Weight and Obesity Prevention: JACC Health Promotion Series.

Lavie CJ, Laddu D, Arena R, Ortega FB, Alpert MA, Kushner RF
Overweight and obesity have reached epidemic levels in the United States and worldwide, and this has contributed to substantial cardiovascular and other health risks. However, controversy exists concerning the causes of obesity and effective modalities for its prevention and treatment. There is also controversy related to the concept of metabolically healthy obesity phenotype, the \"obesity paradox,\" and on the importance of fitness to protect individuals who are overweight or obese from cardiovascular diseases. In this state-of-the-art review, the authors focus on \"healthy weight\" with the emphasis on the pathophysiologic effects of weight gain on the cardiovascular system; mechanistic/triggering factors; and the role of preventive actions through personal, education/environment, and societal/authoritative factors, as well as factors to provide guidance for caregivers of health promotion. Additionally, the authors briefly review metabolically healthy obesity, the obesity paradox, and issues beyond lifestyle consideration for weight loss with medications and bariatric surgery.

J Am Coll Cardiol: 10 Dec 2018; 72:3027-3052
Lavie CJ, Laddu D, Arena R, Ortega FB, Alpert MA, Kushner RF
J Am Coll Cardiol: 10 Dec 2018; 72:3027-3052 | PMID: 30522635
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Reprint of: Cardiovascular Disease Prevention by Diet Modification: JACC Health Promotion Series.

Yu E, Malik VS, Hu FB
Reduction in excess calories and improvement in dietary composition may prevent many primary and secondary cardiovascular events. Current guidelines recommend diets high in fruits, vegetables, whole grains, nuts, and legumes; moderate in low-fat dairy and seafood; and low in processed meats, sugar-sweetened beverages, refined grains, and sodium. Supplementation can be useful for some people but cannot replace a good diet. Factors that influence individuals to consume a low-quality diet are myriad and include lack of knowledge, lack of availability, high cost, time scarcity, social and cultural norms, marketing of poor-quality foods, and palatability. Governments should focus on cardiovascular disease as a global threat and enact policies that will reach all levels of society and create a food environment wherein healthy foods are accessible, affordable, and desirable. Health professionals should be proficient in basic nutritional knowledge to promote a sustainable pattern of healthful eating for cardiovascular disease prevention for both healthy individuals and those at higher risk.

J Am Coll Cardiol: 10 Dec 2018; 72:2951-2963
Yu E, Malik VS, Hu FB
J Am Coll Cardiol: 10 Dec 2018; 72:2951-2963 | PMID: 30522630
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Reprint of: Promoting Physical Activity and Exercise: JACC Health Promotion Series.

Fletcher GF, Landolfo C, Niebauer J, Ozemek C, Arena R, Lavie CJ
Physical inactivity is one of the leading modifiable risk factors for global mortality, with an estimated 20% to 30% increased risk of death compared with those who are physically active. The \"behavior\" of physical activity (PA) is multifactorial, including social, environmental, psychological, and genetic factors. Abundant scientific evidence has demonstrated that physically active people of all age groups and ethnicities have higher levels of cardiorespiratory fitness, health, and wellness, and a lower risk for developing several chronic medical illnesses, including cardiovascular disease, compared with those who are physically inactive. Although more intense and longer durations of PA correlate directly with improved outcomes, even small amounts of PA provide protective health benefits. In this state-of-the-art review, the authors focus on \"healthy PA\" with the emphasis on the pathophysiological effects of physical inactivity and PA on the cardiovascular system, mechanistic/triggering factors, the role of preventive actions through personal, education/environment, and societal/authoritative factors, as well as factors to provide guidance for caregivers of health promotion regarding PA. Sustainable and comprehensive programs to increase PA among all individuals need to be developed and implemented at local, regional, national, and international levels to effect positive changes and improve global health, especially the reduction of cardiovascular disease.

J Am Coll Cardiol: 10 Dec 2018; 72:3053-3070
Fletcher GF, Landolfo C, Niebauer J, Ozemek C, Arena R, Lavie CJ
J Am Coll Cardiol: 10 Dec 2018; 72:3053-3070 | PMID: 30522636
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Reprint of: Prevention and Control of Hypertension: JACC Health Promotion Series.

Carey RM, Muntner P, Bosworth HB, Whelton PK
Hypertension, the leading risk factor for cardiovascular disease, originates from combined genetic, environmental, and social determinants. Environmental factors include overweight/obesity, unhealthy diet, excessive dietary sodium, inadequate dietary potassium, insufficient physical activity, and consumption of alcohol. Prevention and control of hypertension can be achieved through targeted and/or population-based strategies. For control of hypertension, the targeted strategy involves interventions to increase awareness, treatment, and control in individuals. Corresponding population-based strategies involve interventions designed to achieve a small reduction in blood pressure (BP) in the entire population. Having a usual source of care, optimizing adherence, and minimizing therapeutic inertia are associated with higher rates of BP control. The Chronic Care Model, a collaborative partnership among the patient, provider, and health system, incorporates a multilevel approach for control of hypertension. Optimizing the prevention, recognition, and care of hypertension requires a paradigm shift to team-based care and the use of strategies known to control BP.

J Am Coll Cardiol: 10 Dec 2018; 72:2996-3011
Carey RM, Muntner P, Bosworth HB, Whelton PK
J Am Coll Cardiol: 10 Dec 2018; 72:2996-3011 | PMID: 30522633
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Clinician\'s Guide to Reducing Inflammation to Reduce Atherothrombotic Risk: JACC Review Topic of the Week.

Ridker PM
Life-threatening cardiovascular events occur despite control of conventional risk factors. Inflammation, as measured by high-sensitivity C-reactive protein (hsCRP) concentration, is associated with future vascular events in both primary and secondary prevention, independent of usual risk markers. Statins are powerful lipid-lowering agents with clinically relevant anti-inflammatory effects. Recent data support targeting the interleukin (IL)-1-to-IL-6-to-CRP signaling pathway as an adjunctive method for atheroprotection. The CANTOS (Canakinumab Anti-inflammatory Thrombosis Outcomes Study) trial showed that reducing inflammation through IL-1β inhibition significantly reduced vascular risk, beyond that achievable with lipid lowering. CANTOS further demonstrated a 31% reduction in cardiovascular mortality and all-cause mortality among patients treated with canakinumab who achieved the largest reductions in hsCRP, as well as efficacy in high-risk patients with chronic kidney disease and diabetes. This review outlines the clinical implications of CANTOS for patients with \"residual inflammatory risk,\" the potential benefits and risks associated with anti-inflammatory therapy, and the importance of CANTOS for future drug development.

J Am Coll Cardiol: 01 Nov 2018; epub ahead of print
Ridker PM
J Am Coll Cardiol: 01 Nov 2018; epub ahead of print | PMID: 30415883
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Reprint of: Prevention and Treatment of Tobacco Use: JACC Health Promotion Series.

Kalkhoran S, Benowitz NL, Rigotti NA
Tobacco use is the leading preventable cause of death worldwide and is a major risk factor for cardiovascular disease (CVD). Both prevention of smoking initiation among youth and smoking cessation among established smokers are key for reducing smoking prevalence and the associated negative health consequences. Proven tobacco cessation treatment includes pharmacotherapy and behavioral support, which are most effective when provided together. First-line medications (varenicline, bupropion, and nicotine replacement) are effective and safe for patients with CVD. Clinicians who care for patients with CVD should give as high a priority to treating tobacco use as to managing other CVD risk factors. Broader tobacco control efforts to raise tobacco taxes, adopt smoke-free laws, conduct mass media campaigns, and restrict tobacco marketing enhance clinicians\' actions working with individual smokers.

J Am Coll Cardiol: 10 Dec 2018; 72:2964-2979
Kalkhoran S, Benowitz NL, Rigotti NA
J Am Coll Cardiol: 10 Dec 2018; 72:2964-2979 | PMID: 30522631
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Use of Medication for Cardiovascular Disease During Pregnancy: JACC State-of-the-Art Review.

Halpern DG, Weinberg CR, Pinnelas R, Mehta-Lee S, Economy KE, Valente AM
Cardiovascular disease complicating pregnancy is rising in prevalence secondary to advanced maternal age, cardiovascular risk factors, and the successful management of congenital heart disease conditions. The physiological changes of pregnancy may alter drug properties affecting both mother and fetus. Familiarity with both physiological and pharmacological attributes is key for the successful management of pregnant women with cardiac disease. This review summarizes the published data, available guidelines, and recommendations for use of cardiovascular medications during pregnancy. Care of the pregnant woman with cardiovascular disease requires a multidisciplinary team approach with members from cardiology, maternal fetal medicine, anesthesia, and nursing.

J Am Coll Cardiol: 04 Feb 2019; 73:457-476
Halpern DG, Weinberg CR, Pinnelas R, Mehta-Lee S, Economy KE, Valente AM
J Am Coll Cardiol: 04 Feb 2019; 73:457-476 | PMID: 30704579
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Artificial Intelligence in Cardiovascular Imaging: JACC State-of-the-Art Review.

Dey D, Slomka PJ, Leeson P, Comaniciu D, ... Sengupta PP, Marwick TH
Data science is likely to lead to major changes in cardiovascular imaging. Problems with timing, efficiency, and missed diagnoses occur at all stages of the imaging chain. The application of artificial intelligence (AI) is dependent on robust data; the application of appropriate computational approaches and tools; and validation of its clinical application to image segmentation, automated measurements, and eventually, automated diagnosis. AI may reduce cost and improve value at the stages of image acquisition, interpretation, and decision-making. Moreover, the precision now possible with cardiovascular imaging, combined with \"big data\" from the electronic health record and pathology, is likely to better characterize disease and personalize therapy. This review summarizes recent promising applications of AI in cardiology and cardiac imaging, which potentially add value to patient care.

J Am Coll Cardiol: 25 Mar 2019; 73:1317-1335
Dey D, Slomka PJ, Leeson P, Comaniciu D, ... Sengupta PP, Marwick TH
J Am Coll Cardiol: 25 Mar 2019; 73:1317-1335 | PMID: 30898208
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Cholesteryl Ester Transfer Protein Inhibition for Preventing Cardiovascular Events: JACC Review Topic of the Week.

Armitage J, Holmes MV, Preiss D
Cholesteryl ester transfer protein (CETP) facilitates exchange of triglycerides and cholesteryl ester between high-density lipoprotein (HDL) and apolipoprotein B100-containing lipoproteins. Evidence from genetic studies that variants in the CETP gene were associated with higher blood HDL cholesterol, lower low-density lipoprotein cholesterol, and lower risk of coronary heart disease suggested that pharmacological inhibition of CETP may be beneficial. To date, 4 CETP inhibitors have entered phase 3 cardiovascular outcome trials. Torcetrapib was withdrawn due to unanticipated off-target effects that increased risk of death, and major trials of dalcetrapib and evacetrapib were terminated early for futility. In the 30,000-patient REVEAL (Randomized Evaluation of the Effects of Anacetrapib through Lipid Modification) trial, anacetrapib doubled HDL cholesterol, reduced non-HDL cholesterol by 17 mg/dl (0.44 mmol/l), and reduced major vascular events by 9% over 4 years, but anaceptrapib was found to accumulate in adipose tissue, and regulatory approval is not being sought. Therefore, despite considerable initial promise, CETP inhibition provides insufficient cardiovascular benefit for routine use.

J Am Coll Cardiol: 04 Feb 2019; 73:477-487
Armitage J, Holmes MV, Preiss D
J Am Coll Cardiol: 04 Feb 2019; 73:477-487 | PMID: 30704580
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:

This program is still in alpha version.