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This year in cardiovascular research has had some solid contributions to the field, and I am pleased to share with you the NEJM Journal Watch Cardiology Editorial Board's picks for the top stories of the year.
Prevention was a popular theme among the picks, taking half of the slots. The HOPE-3 trial evaluated lipid control and blood pressure control in high-risk patients. Rosuvastatin lowered risk, but intensive blood-pressure reductions with candesartan/hydrochlorothiazide did not. Interestingly, Allan Brett, the NEJM Journal Watch General Medicine Editor-in-Chief, and I had some disagreement about the study's implications, and you can read our differing perspectives in the summary. Two studies addressed lifestyle, a refreshing change in a field that likes to focus on drugs and procedures. In one study, greater muscle strength and high exercise capacity at around age 18 were associated with long-term benefits in risk of vascular events and arrhythmias — suggesting the possibility that early fitness matters over a lifetime. In a remarkable study of genetic and lifestyle data from three prospective cohorts, researchers concluded that healthy lifestyles can apparently reduce genetic risk; those with high genetic risks and healthy lifestyles had about half the risk of those without those lifestyles. In a study of dietary salt in 133,118 individuals from 49 countries, both higher and lower sodium intake was associated with higher risk of adverse outcomes (and higher intake was a risk factor only in those with hypertension), all of which has complicated the ongoing debate about sodium consumption. And a study of semaglutide, a glucagon-like peptide 1 analogue for diabetes, suggested that it can prevent cardiovascular disease, a surprising and important finding that needs confirmation.
Two studies focused on cardiomyopathy. One, examining the use of an implantable cardioverter–defibrillator for patients with severe symptomatic nonischemic cardiomyopathy, found no overall mortality benefit despite an improvement in sudden death rates. The other study, a 10-year follow-up of the STICH trial, compared bypass surgery with medical therapy for patients with ischemic cardiomyopathy. The bypass group had significantly lower all-cause mortality, even though, unfortunately, mortality was high in both groups.
From the interventional cardiologists, we had a trial comparing drug-eluting stents (DES) with bare metal stents among patients with stable angina and an acute coronary syndrome. At 6 years, there was no difference in all-cause mortality and nonfatal myocardial infarction, but those with DES were about half as likely to have target-lesion revascularization. Another study tested anticoagulation strategies for patients with atrial fibrillation and a new stent; here, thrombotic events were about the same in patients receiving low-dose rivaroxaban plus a single P2Y12 inhibitor, very–low-dose rivaroxaban plus aspirin and a P2Y12 inhibitor, or adjusted-dose warfarin plus low-dose aspirin and a P2Y12 inhibitor, but bleeding was more common with warfarin. Finally, the year would not be complete without a transcatheter aortic-valve replacement (TAVR) study. In this one, TAVR was tested against surgery in an intermediate-risk group. At 2 years, the risk for death or disabling stroke was one in five but was not statistically different between the groups, opening the procedure to a wider range of patients who may prefer it to surgery.
We'd like to hear which articles you thought were most important this past year. Please let us know by commenting below. Thanks very much for your continued readership of NEJM Journal Watch Cardiology, and our best wishes for 2017.
Our Cardiology Top Stories for 2016 are:
HOPE-3: A Primary Cardiovascular Prevention Trial in People at Intermediate Risk
Physical Fitness in Late Adolescence Linked to Future Cardiovascular Outcomes
A Healthy Lifestyle Can Mitigate High Genetic Risk for Coronary Artery Disease
The Benefits and Detriments of Salt: It's Complicated
Semaglutide Passes Cardiovascular Safety Test in Patients with Type 2 Diabetes
Should Patients with Nonischemic Heart Failure Receive an ICD?
For Ischemic Cardiomyopathy, Bypass Surgery May Be Better After All
Is This the Beginning of the End for Bare-Metal Stents?
Which Anticoagulation Strategy for Patients with Atrial Fibrillation and a New Stent?