Summer's Almost Gone, There's Much to Still Look Forward To

Debabrata Mukherjee,

Editor in Chief

We are finally ready to move on from the scorching summer days to beautiful fall splendor in many parts of our country. Many of us are also looking forward to the football season, and some of us are hoping that our home teams will do better this year. On a more serious note, this issue of Cardiology Review provides discussion and viewpoints on many important articles, which I am sure you will find quite useful.

Drs Niki Katsiki and Dimitri P. Mikhailidis review US trends in the last 20 years of diabetes-related complications and report that diabetes-related morbidity and mortality has been substantially reduced during the last 2 decades. However, there is a need for further improvements in prevention, early diagnosis, and effective treatment of diabetes mellitus and diabetic complications, especially in light of the rapidly increasing prevalence of obesity and diabetes mellitus worldwide.

Drs Steven Stevens and Kalyanam Shivkumar discuss leadless self-contained pacemakers in humans and opine that the LEADLESS trial demonstrated an innovative and sweeping advance in cardiac pacing technology. The fate of this innovation as a true contender in the pacing world will depend on whether it can compile reasonable safety record, one which will need to exceed our expectations of traditional pacing with a lead and pulse generator.

Dr Thomas Whayne looks at alternative medicines and supplements for the primary prevention of cardiovascular disease and cancer, and warns that clinical guidelines developed by the US Preventive Services Task Force cast much doubt on alternative medications and dietary supplements consisting of vitamins and/or minerals. Nevertheless, the clinical reality is that the use of various dietary supplements by patients will probably continue. He suggests that each patient will have to be assessed individually and made a partner in any decision on supplementation, based on the available evidence.

Dr Saurav Chatterjee reviews optimal duration of dual antiplatelet therapy after drug-eluting stent implantation. Although the risks of late stent thrombosis with drug-eluting stents, especially after cessation of dual antiplatelet therapy, are well known, the optimal duration of dual antiplatelet therapy following percutaneous coronary intervention with drug-eluting stents remains unclear. Emerging data suggest that optimal duration of dual antiplatelet therapy after newer-generation drug-eluting stents may be significantly shorter, which is being tested in prospective studies.

Dr Glenn Levine discusses the impact of coronary collateral circulation on outcomes in patients with acute coronary syndromes, and states that it is intuitive that the presence of coronary collateral circulation should be cardioprotective and beneficial. The presence of collateral vessels subtending the area of jeopardized myocardium should provide at least some blood flow, which may prevent irreversible myonecrosis, or at least delay or mitigate myonecrosis until a time when an occlusion may become at least partially patent again, either by administered anticoagulant or thrombolytic therapy, through mechanical intervention, or spontaneously. This should lead to avoidance of MI or a smaller degree of myonecrosis, greater preservation of left ventricular function, and improved prognosis. However, he points out, despite these potential benefits, it is unclear how this information can be used to improve outcome and prognosis in patients with acute coronary syndromes.

Dr Alison Bailey discusses live counseling versus website-based lifestyle/medication intervention to reduce heart disease risk, and thinks that that there are innovative strategies to improve cardiovascular health variables beyond personally delivered counseling. She further affirms that we must continue to explore new options for motivating individuals to make sustainable change, and technology will surely play a role.

In our Clinical Forum section, Drs Hitinder Gurm, Mehdi Shishehbor, and Khaled M. Ziada have a lively discussion on the future role of renal denervation. It remains to be seen whether the SYMPLICITY HTN-3 hypertension trial was a death knell for this technology or if renal denervation can overcome the negative results with better-designed trials. I am sure you will enjoy the debate.

Also, our rundown of major studies presented at American Diabetes Association’s 74th Scientific Sessions should keep you updated on the latest happenings in this field. Managing editor Jackie Syrop discusses several of the most exciting, including combination diabetes drug therapy, the role of lifestyle and metformin in delaying diabetes onset, the concept of a “bionic pancreas,” and the cost-effectiveness of statins.

I hope that you will find these commentaries to be valuable and enjoyable. I encourage you to share your insights, thoughts, and personal experiences on the topics touched upon in this issue. On a broader level, I would love to hear feedback on how we can make this journal even better. My goal continues to be to make you look forward to every issue of Cardiology Review.

Debabrata Mukherjee

Editor-in-Chief