Heart最新文献

Cardiovascular disease (CVD) remains one of the leading causes of mortality in England, with its burden disproportionately concentrated in the North. Studies in the last few decades have highlighted that factors such as low education, high levels of unemployment, poor housing and reduced access to healthy food are strongly associated with the higher incidence of lifestyle risks-smoking, obesity and physical inactivity. These in turn increase rates of hypertension, dyslipidaemia and diabetes in the population. Beyond lifestyle factors, psychosocial mechanisms such as chronic stress and associated increase in allostatic load, due to long-standing deprivation, contribute to the biological risk of CVD. Early life disadvantage, ethnic and gender inequalities, and delayed management of intermediate risk factors further exacerbate the regional divide in England. Furthermore, the long-term impacts of COVID-19 and healthcare-associated national policies, including austerity-related funding deductions, have intensified pre-existing disparities. Evidence demonstrates that current preventative strategies, such as the National Health Service Health Check, have had limited success in reaching underserved communities, highlighting the need for targeted therapies. The National Institute of Health and Care Research Inequalities Challenge is a remarkable opportunity for the United Kingdom's (UK) leading research organisations to help tackle these inequalities associated with CVD and make a significant difference. Without such efforts, the excess CVD burden is likely to persist, perpetuating entrenched health inequalities. This review examines the different social determinants of health underlying these disparities, with a particular focus on socioeconomic deprivation, lifestyle risk factors, environmental and structural issues.

Anticoagulation is a critical component in the treatment of cardiovascular diseases. Large randomised controlled trials have demonstrated that direct oral anticoagulants (DOACs) are effective and safe for stroke prevention in patients with atrial fibrillation (AF) and treatment or prevention of venous thromboembolism. Nevertheless, for specific cardiac indications and patient characteristics, vitamin K antagonists (VKAs) rather than DOACs are either preferred, or the benefit of DOACs in comparison to VKAs remains uncertain. These include, among others, mechanical heart valves, AF associated with moderate-to-severe mitral stenosis, left ventricular or atrial thrombus, and older patients with frailty. As VKAs will continue to play a vital role in the management of patients with cardiovascular diseases in the foreseeable future, this review discusses cardiac indications and patient characteristics that necessitate the use of VKAs and general management principles of VKA therapy.

Atrial fibrillation (AF) is the most common arrhythmia and is a leading cause of stroke and heart failure yet often remains undiagnosed. Screening has been proposed to identify asymptomatic AF and initiate preventive treatment, but evidence for reduction in hard clinical endpoints such as stroke and heart failure remains inconclusive. In this state-of-the-art review, we critically examine major AF screening trials across opportunistic, systematic and consumer-driven strategies, focusing on design features, population selection, monitoring strategies and outcomes. Variability in trial design, particularly in randomisation timing, participation rates and intensity of monitoring, significantly affects both AF detection and clinical outcomes. Systematic screening shows promise, but many trials were underpowered for hard outcomes. Opportunistic screening is easy to implement, but typically yields modest benefits, likely due to single timepoint assessments. Consumer-led, wearable-based screening shows high positive predictive value, but further evaluation in high-risk populations is needed. The success of AF screening hinges on reaching at-risk individuals and selecting effective monitoring strategies. Precision-based approaches and artificial intelligence-guided targeting may ensure that screening yields clinical and economical benefit.

Cancer therapy-related cardiovascular toxicity is an increasingly recognised challenge in modern oncology, as life-saving treatments can lead to significant cardiac complications. This review explores the current landscape of medical strategies aimed at preventing cardiotoxicity across a broad range of cancer therapies. High-risk patients are identified based on clinical and treatment-related risk factors, necessitating proactive risk stratification. Neurohormonal blockade strategies have shown promising although not universally consistent effects against therapy-induced cardiovascular toxicity. As well, lipid-lowering agents may offer additional cardiovascular protection through both lipid modulation and anti-inflammatory properties. Moreover, emerging evidence supports the potential of sodium glucose cotransporter 2 inhibitors and glucagon-like peptide-1 receptor agonists in mitigating cardiotoxic effects, calling for dedicated clinical trials. In the meantime, the 2022 European Society of Cardiology guidelines provided a structured approach to integrating pharmacological and non-pharmacological protective strategies in cardio-oncology. Challenges remain in standardising care due to heterogeneous data and limited large-scale trials. Multidisciplinary collaboration, ongoing translational research and personalised medicine are crucial to optimising cardiovascular outcomes in patients with cancer.