Current Opinion in Cardiology最新文献

{"title":"Cardiometabolic vulnerability in cardio-oncology: mechanistic links, clinical implications, and emerging preventive strategies.","authors":"Jean Kim, Maishara Muquith, Le Huang, Alvin Chandra","doi":"10.1097/HCO.0000000000001285","DOIUrl":"10.1097/HCO.0000000000001285","url":null,"abstract":"<p><strong>Purpose of review: </strong>Cardiovascular disease is a leading cause of morbidity and mortality among patients with cancer, yet individual risk is highly heterogeneous. This review examines cardiometabolic vulnerability as a unifying framework linking baseline cardiometabolic risk factors with cancer therapy-related cardiovascular injury and discusses emerging pharmacologic and lifestyle interventions for cardiovascular risk mitigation.</p><p><strong>Recent findings: </strong>Epidemiologic and mechanistic studies demonstrate that obesity, insulin resistance, dyslipidemia, and hypertension, often exacerbated by cancer therapies, amplify systemic inflammation, neurohormonal activation, endothelial dysfunction, and metabolic inflexibility. These disturbances interact with specific anticancer treatments, including anthracyclines, HER2-targeted agents, VEGF pathway inhibitors, endocrine therapies, and immune checkpoint inhibitors, increasing susceptibility to diverse cardiovascular toxicities. Emerging evidence supports multimodal preventive strategies integrating pharmacologic interventions targeting neurohormonal, metabolic, and inflammatory pathways with lifestyle modifications, though optimal approaches require further validation in cancer populations.</p><p><strong>Summary: </strong>Cardiometabolic vulnerability provides a framework to understand heterogeneous cardiovascular risk in cancer patients. Integrating cardiometabolic profiling with therapy-specific risk assessment may improve prevention strategies in cardio-oncology. Continued research is needed to refine risk stratification and inform personalized approaches for this growing population.</p>","PeriodicalId":55197,"journal":{"name":"Current Opinion in Cardiology","volume":" ","pages":"165-176"},"PeriodicalIF":1.9,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147500804","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Novel approaches to cardiac rehabilitation among patients with cardiovascular disease: current and future states.","authors":"Gabrielle Schwab, Rebecca Vigen","doi":"10.1097/HCO.0000000000001287","DOIUrl":"10.1097/HCO.0000000000001287","url":null,"abstract":"<p><strong>Purpose of review: </strong>Novel approaches to cardiac rehabilitation delivery, the integration of emerging exercise modalities, and the extension of cardiac rehabilitation principles to additional disease states have the potential to improve care for patients with established and evolving indications. This review summarizes recent advances in hybrid and home-based cardiac rehabilitation, digital and behavioral technologies, innovative exercise strategies, and the application of cardiac rehabilitation to broader patient populations.</p><p><strong>Recent findings: </strong>Technology-enabled cardiac rehabilitation models - including hybrid delivery, remote monitoring, wearables, gamification, and behavioral-economic nudges - demonstrate promise in improving participation, adherence, and engagement. Concurrently, newer exercise modalities offer more personalized and physiologically targeted programs. Evidence supports expanding cardiac rehabilitation to additional clinical populations, including individuals with heart failure with preserved ejection fraction and cardio-oncology, and demonstrates meaningful benefits in older and frail adults, with improvements in exercise capacity, symptoms, and quality of life.</p><p><strong>Summary: </strong>Advances in digital health, behavioral science, and exercise physiology are increasingly reshaping cardiac rehabilitation, moving beyond traditional, center-based models toward more flexible, patient-centered, and data-enabled approaches to cardiovascular care. Further research is needed to refine implementation, evaluate long-term outcomes, and ensure equitable access. Integrating novel exercise modalities with technology-enabled and behavioral approaches may help modernize cardiac rehabilitation and extend its therapeutic reach.</p>","PeriodicalId":55197,"journal":{"name":"Current Opinion in Cardiology","volume":"41 3","pages":"177-184"},"PeriodicalIF":1.9,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147582143","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Weight loss as the optimal cardiometabolic management strategy for preventing and treating heart failure.","authors":"Thomaz Alexandre Costa, Amanda R Vest, Josephine Harrington","doi":"10.1097/HCO.0000000000001284","DOIUrl":"10.1097/HCO.0000000000001284","url":null,"abstract":"<p><strong>Purpose of review: </strong>To synthesize current evidence supporting intentional weight reduction as a cardiometabolic strategy for treating and preventing heart failure (HF) across the ejection-fraction spectrum, examine the influence of baseline obesity on treatment effects of established HF therapies, and highlight key knowledge gaps and future research directions.</p><p><strong>Recent findings: </strong>Visceral adipose tissue, central obesity, and dysfunctional adipose mass are linked to the development and progression of HF with preserved ejection fraction (HFpEF). Recent trials show that incretin-based therapies (semaglutide, tirzepatide) improve exercise capacity, symptoms, and quality of life in HFpEF, and potentially reduce HF events. Patients with higher degrees of obesity may derive greater benefit from incretin-based therapies and other guideline-directed therapies, including mineralocorticoid receptor antagonists (MRA), sodium-glucose transport 2 (SGLT2) inhibitors, and angiotensin receptor-neprilysin inhibitor (ARNI). While observational studies suggest intentional weight loss may lower HF risk, randomized trials of antiobesity medications have yet to further clarify this potential benefit.</p><p><strong>Summary: </strong>Weight loss is currently recommended as an optimal strategy for individuals with obesity and HFpEF, given consistent benefits for exercise capacity, functional status, and quality of life, with a potential for reducing clinical events. Intentional weight loss impact in HFrEF and its role in primary HF prevention remains uncertain. Large, well designed cardiovascular outcome trials of intentional weight-loss interventions in populations with obesity and HF, or obesity and elevated HF risk, are needed to establish clinical efficacy and better define individuals who benefit from those interventions across the spectrum of ejection fraction.</p>","PeriodicalId":55197,"journal":{"name":"Current Opinion in Cardiology","volume":" ","pages":"147-156"},"PeriodicalIF":1.9,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147391836","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"2025 ESC/EACTS valvular heart disease guidelines: key updates and surgical implications for cardiac surgeons.","authors":"Shubh K Patel, Adham Elsherbini, Syed M Ali Hassan, Raj Verma, Christopher White, Michael W A Chu","doi":"10.1097/HCO.0000000000001289","DOIUrl":"10.1097/HCO.0000000000001289","url":null,"abstract":"<p><strong>Purpose of review: </strong>The 2025 ESC/EACTS Guidelines for valvular heart disease introduce substantial changes in timing and modality of intervention, making a focused appraisal of their surgical implications highly relevant for contemporary cardiac practice.</p><p><strong>Recent findings: </strong>The guidelines formalize imaging-based staging of cardiac damage, lower thresholds for intervention in aortic stenosis and primary mitral regurgitation, and refine age- and risk-stratified allocation of surgery vs. transcatheter therapies across aortic, mitral, and tricuspid disease. They expand indications for transcatheter aortic valve implantation, mitral and tricuspid transcatheter edge-to-edge repair, and transcatheter valve replacement in carefully selected high-risk patients, while strengthening the role of durable surgical valve repair, complex aortic and multivalve procedures, and lifetime valve management strategies. Organizationally, they define and emphasize the importance of Heart Valve Centres and volume-outcome relationships.</p><p><strong>Summary: </strong>These guideline recommendations reflect upon contemporary evidence to support thoughtful decision making, encourage earlier intervention, and reinforce the central role of cardiac surgery and cardiology partnerships in achieving best patient outcomes through Heart Valve Centres. Cardiac surgeons should continue advance excellence in valve repair and reconstructive surgery and embrace the complementary role of transcatheter valve therapies.</p>","PeriodicalId":55197,"journal":{"name":"Current Opinion in Cardiology","volume":" ","pages":"200-216"},"PeriodicalIF":1.9,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147500831","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sutureless aortic valves: timing, technique, and evidence.","authors":"Shubh K Patel, Syed M Ali Hassan, Nitish K Dhingra, Raj Verma, Gideon Cohen","doi":"10.1097/HCO.0000000000001277","DOIUrl":"10.1097/HCO.0000000000001277","url":null,"abstract":"<p><strong>Purpose of review: </strong>This review synthesizes contemporary evidence for sutureless aortic valve replacement (SuAVR). It focuses on indications, imaging-guided sizing, operative technique, outcomes, and complications to clarify where SuAVR meaningfully complements or substitutes conventional surgical aortic valve replacement and transcatheter aortic valve implantation.</p><p><strong>Recent findings: </strong>Modern studies show SuAVR consistently shortens cardiopulmonary bypass and cross-clamp times by 25-50%, produces low discharge gradients and larger effective orifice areas, and is particularly advantageous in elderly patients, small annuli, redo operations, and concomitant procedures. Routine multidetector-row computed tomography perimeter sizing and meticulous annular decalcification have reduced clinically relevant paravalvular leak to low single digits, whereas higher implantation and conservative ballooning have lowered permanent pacemaker implantation rates toward single digits. Mid-term durability is encouraging, with 95-97% freedom from structural valve deterioration and 94-97% freedom from reintervention at 5  years. Conduction-system injury, transient thrombocytopenia, and residual pacemaker risk remain the principal trade-offs.</p><p><strong>Summary: </strong>With Heart-Team selection and standardized computed tomography-first workflows and implant technique, SuAVR is a valuable surgical option that expands minimally invasive and complex surgical candidacy. Definitive adoption requires randomized long-term comparisons and standardized pacemaker-avoidance protocols.</p>","PeriodicalId":55197,"journal":{"name":"Current Opinion in Cardiology","volume":" ","pages":"185-199"},"PeriodicalIF":1.9,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146215056","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Targeting genomic instability to attenuate age-dependent cardiovascular disease.","authors":"Ali J Marian","doi":"10.1097/HCO.0000000000001280","DOIUrl":"https://doi.org/10.1097/HCO.0000000000001280","url":null,"abstract":"","PeriodicalId":55197,"journal":{"name":"Current Opinion in Cardiology","volume":"41 3","pages":"105-108"},"PeriodicalIF":2.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147582139","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Genetic factors contributing to atherosclerosis.","authors":"Michael A Raddatz, Hooman Allayee, Aldons J Lusis","doi":"10.1097/HCO.0000000000001286","DOIUrl":"10.1097/HCO.0000000000001286","url":null,"abstract":"<p><strong>Purpose of review: </strong>Atherosclerosis is a highly complex and heterogeneous disease characterized by inflammation and lipid accumulation in the arterial wall. Genetic studies to identify loci and genes predisposing to the disease have now been carried out in large human cohorts and the underlying pathways have been studied in animal models, primarily mice. This review summarizes recent findings relating to genetic contributions to the disease and implications for diagnosis and treatment.</p><p><strong>Recent findings: </strong>Recent discoveries of genes contributing to all aspects of atherosclerosis and related diseases, including inflammation, lipid levels and oxidation, clonal hematopoiesis, hypertension, cardiac function, and aortic stenosis, are discussed. Altogether, several hundred contributing genes have been identified, and these are enabling a better understanding of the important pathways involved. These findings have also led to the development of improved diagnostic methods, including overall risk evaluation, and the identification of new therapeutic targets.</p><p><strong>Summary: </strong>Genetics is proving to be a powerful approach to dissecting atherosclerosis. Genetic studies promise to revolutionize the diagnosis and treatment of the disease.</p>","PeriodicalId":55197,"journal":{"name":"Current Opinion in Cardiology","volume":" ","pages":"120-128"},"PeriodicalIF":1.9,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13110901/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147516844","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Current opinion in cardiology, epigenetics of heart failure.","authors":"Assam El-Osta","doi":"10.1097/HCO.0000000000001279","DOIUrl":"10.1097/HCO.0000000000001279","url":null,"abstract":"<p><strong>Purpose of review: </strong>Heart failure is not simply a pump that has grown tired; it is a tissue that adapts and then, too often, becomes locked into its adaptations. This review examines how epigenetic regulation - chromatin accessibility, histone modifications, DNA methylation and hydroxymethylation, and the reader complexes that interpret these marks - converts transient stress into durable transcriptional programs. We focus on the mechanisms by which the failing heart acquires regulatory \"memory,\" and on the chromatin control nodes that are emerging as actionable targets for therapy and for biomarker development.</p><p><strong>Recent findings: </strong>Three lines of evidence are reshaping the field. First, the failing-heart transcriptome is increasingly governed by a tractable set of chromatin control points: acetylation balance [histone deacetylases (HDACs) versus histone acetyltransferases (HATs) such as p300/CREB-binding protein (CBP)] and acetyl-lysine readers [bromodomain and extraterminal (BET) proteins, including bromodomain-containing protein 4 (BRD4)] that amplify hypertrophic, inflammatory, and profibrotic programs. Second, the adult human myocardium is not epigenetically inert: reproducible disease-associated methylation signatures and regulatory shifts are detectable across cardiomyopathy and ischemic heart failure, with early signals that some features may move with physiologic recovery. Third, acute stress phenotypes are being reframed as chromatin-state problems: Takotsubo syndrome compresses stress-to-dysfunction into days, and emerging mechanistic work supports an acetylation/deacetylation axis as a tractable regulatory lever in Takotsubo-like injury.</p><p><strong>Summary: </strong>Epigenetics provides a mechanistic account of why cardiac injury can outlast its trigger and a rational route to intervention by targeting reader complexes, writer-eraser balance, and remodeler-mediated enhancer control. The translational mandate is precision: define causal regulatory nodes by cell type and disease phase and develop biomarkers that distinguish hemodynamic improvement from molecular reset.</p>","PeriodicalId":55197,"journal":{"name":"Current Opinion in Cardiology","volume":" ","pages":"129-137"},"PeriodicalIF":1.9,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146215111","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exercise training for the prevention and treatment of cardiometabolic disease.","authors":"Steve Kong, Stephen Foulkes, Anthony E Peters","doi":"10.1097/HCO.0000000000001288","DOIUrl":"10.1097/HCO.0000000000001288","url":null,"abstract":"<p><strong>Purpose of review: </strong>The aim of this study is to provide an updated overview on exercise training as an optimal strategy for preventing and treating cardiometabolic complications.</p><p><strong>Recent findings: </strong>Physical inactivity is recognized as one of the most significant, modifiable risk factors for cardiovascular disease (CVD), the leading cause of mortality worldwide. Despite well established guidelines, nearly one-third of adults fail to meet recommended activity levels. Physical inactivity is associated with increased risk of CVD and cardiometabolic complications including coronary artery disease, heart failure, hypertension, stroke, obesity, type 2 diabetes, and dyslipidemia. Home exercise prescriptions and supervised exercise training programs including aerobic ± resistance training have been shown to modify risk and treat cardiometabolic disease. This includes positive effects on glycemic control, obesity, stroke, hypertension, heart failure, and primary and secondary prevention of atherosclerotic CVD. The cardioprotective effects of exercise training programs appear to be multifactorial, mediated through specific structural and functional cardiovascular adaptations, and systemic effects including improved lipid metabolism, enhanced mitochondrial efficiency, and attenuation of systemic inflammation.</p><p><strong>Summary: </strong>In this review, we summarize recent evidence for various exercise training programs in preventing and managing cardiometabolic disease and explore the physiologic mechanisms underlying their cardiovascular benefits.</p>","PeriodicalId":55197,"journal":{"name":"Current Opinion in Cardiology","volume":" ","pages":"157-164"},"PeriodicalIF":1.9,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147500783","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advancing gene and base editing for cardiovascular disease: overcoming barriers in delivery, precision and safety.","authors":"Tae Kyeong Kim, J Travis Hinson","doi":"10.1097/HCO.0000000000001278","DOIUrl":"10.1097/HCO.0000000000001278","url":null,"abstract":"<p><strong>Purpose of review: </strong>Cardiovascular disease (CVD) remains a leading cause of morbidity and mortality despite major advances in pharmacological, devices, and surgical care. Gene editing technologies have introduced a transformative approach to correct pathogenic variants and modulate disease pathways. This review highlights recent progress in editing technologies that are currently or may soon be applied to address cardiovascular disorders, summarizes recent preclinical and clinical studies that demonstrate improved precision and efficacy, and examines technical and translational challenges that must be overcome for broader clinical application.</p><p><strong>Recent findings: </strong>We summarize preclinical advances, including refined target selection, improved delivery strategies, and enhanced therapeutic efficiency. We highlight emerging technologies that aim to overcome longstanding constraints such as limited vector cargo capacity, protospacer-adjacent motif (PAM) incompatibility, chromatin accessibility, suboptimal editing efficiency, and off-target activity. We also summarize the increasing clinical experience with in-vivo editing - particularly using lipid nanoparticle (LNP) and adeno-associated virus (AAV)-based platforms - that has also revealed important safety considerations, including vector immunogenicity, systemic inflammation, and organ-specific toxicities.</p><p><strong>Summary: </strong>Despite rapid progress, successful clinical translation of gene and base editing for CVD continues to hinge on two central challenges: efficient and precise delivery and mitigation of immunogenicity and toxicity from both delivery vectors and gene-editing enzymes. Although next-generation editors and targeted delivery systems have expanded the scope of feasible cardiovascular applications, overcoming these biological barriers remains the critical step toward achieving well tolerated, durable, one-time genomic therapies. Continued innovation in vector engineering, tissue-selective delivery, and immunologic risk mitigation will be essential for advancing editing technologies into cardiovascular care.</p>","PeriodicalId":55197,"journal":{"name":"Current Opinion in Cardiology","volume":" ","pages":"138-146"},"PeriodicalIF":1.9,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146151315","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}