Abstract
Cardiac rehabilitation in transcatheter aortic valve implanted patients
As a result of the ageing population in western countries, together with a progressive worsening in the cardiovascular risk profile at a population scale, it is anticipated that more patients with aortic valve disease will be in need of transcatheter aortic valve implantation (TAVI) in the near future, and of postoperative interventions to optimise functional/exercise capacity. 1 A recent report has documented the benefit of cardiac rehabilitation in TAVI patients in terms of exercise capacity and quality of life, at least in the short term. 2 In this issue, for the first time it is demonstrated that the benefit of cardiac rehabilitation was maintained in the long term of two-year follow up. 3 Larger studies are needed to confirm the benefit not only on exercise capacity but also on prognosis.
Safety of early discharge after primary coronary angioplasty
Starting patient education and setting a comprehensive preventive plan, including cardiac rehabilitation, lifestyle changes and secondary prevention therapies as soon as possible after ST-segment elevation myocardial infarction (STEMI) is of critical importance. 4 Here, a meta-analysis which included five randomised controlled trials on early discharge in patients with STEMI treated with primary coronary angioplasty (1575 patients in total) confirmed that shortening the length of stay was safe, with no detrimental effect on mortality and readmission rates. 5
Ambient air pollution and cardiovascular diseases
A rigorous review is here presented, focused on the main mechanisms linking particulate matter (PM) to cardiovascular disease (CVD), particularly to the biological processes related to the local and systemic inflammatory response in acute and chronic exposure. 6 The existing experimental, preclinical and epidemiological studies have contributed to a better understanding of the different pathological mechanisms,7,8 but the real trigger action of PM in the acute onset of CVDs remains unclear.
Metabolic syndrome in acute coronary syndrome
The metabolic syndrome (MetS) is characterised by the co-occurrence of multiple metabolic disorders that are risk factors for both type 2 diabetes and atherosclerotic CVD, but the pathophysiology of the MetS remains far from clear. However, the benefit of physical activity is well documented. 9 Here, a large randomised controlled study is showing that in patients who have recently suffered an acute coronary syndrome, the presence of MetS is associated with the risk of adverse cardiovascular events, but this risk appears to be primarily driven by the presence of diabetes mellitus. In contrast, a diagnosis of MetS on its own did not provide incremental information for risk stratification in this population once diabetes history was considered.
Lipid lowering therapy and cardiovascular outcomes
Correlation between lipid lowering therapy and reduction in cardiovascular event is not clear: small study effects in meta-analyses or inadequate duration of follow-up of the studies have been advocated. To overcome this limitation, a Bayesian network meta-analysis was conducted comparing statins, ezetimibe with or without statins, PCSK9 inhibitors and placebo in adult patients with hypercholesterolaemia. 10 However, the findings from this analysis should be interpreted with caution as high values may provide only supportive, and not conclusive, evidence for treatment options.
Physical activity and atrial fibrillation
Contradictory findings exist regarding the effect of physical activity and occurrence of atrial fibrillation. 11 The meta-regression analysis, here presented, shows that 1) physical activity volume and the risk of atrial fibrillation present a J-shaped relation, 2) physical activity at volumes up to 20 MET-h/week is associated with reduced atrial fibrillation risk, 3) volumes exceeding this threshold show no benefit. 12
2016 USPSTF Recommendations for Primary Cardiovascular Prevention
International organisations have published major guidelines or statements on statins for primary prevention of CVDs. 13 In this issue the use of the US Preventive Services Task Force (USPSTF) recommendations for the initiation of statin treatment was validated in a large Israeli population, also comparing the performance of these guidelines with the American College of Cardiology/American Heart Association (ACC/AHA) recommendations. 14 Using a retrospective analysis of electronic health record data routinely collected, calibration, discrimination and net reclassifications were very similar for both recommendations, but the application of the USPSTF recommendations could reduce overtreatment with statins by 26% in patients newly eligible for statin treatment compared with the ACC/AHA guidelines.
B-type natriuretic peptide and clinical risk scores in heart failure
Natriuretic peptides are established predictors of outcome in several clinical conditions, including heart failure, and their assessment is now widespread.15,16 Nevertheless, they are not included in major risk scores. It is here shown that N-terminal pro B-type natriuretic peptide (NT-proBNP) levels improved risk stratification power of the 3C-HF and the Seattle heart failure scores. NT-proBNP showed better reclassification capability for all cause mortality than the 3C-HF score. 17
Footnotes
Declaration of conflicting interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author(s) received no financial support for the research, authorship, and/or publication of this article.