Optimal Dietary Strategies for Prevention of Atherosclerotic Cardiovascular Disease in Diabetes: Evidence and Recommendations Abstract Purpose of Review This review presents the current available evidence of the effects of several dietary patterns on atherosclerotic cardiovascular disease (ASCVD) risk in patients with type 2 diabetes (T2D). Recent Findings Evidence demonstrates improvements in cardiovascular risk factors with some dietary patterns in the general population. However, evidence is limited for glycemic control and cardiovascular benefit in patients with T2D for Dietary Approaches to Stop Hypertension and plant-based dietary patterns. Evidence suggests that carbohydrate-restricted dietary patterns improve glycemic control and decrease the use of anti-hyperglycemic medications. The Mediterranean dietary pattern has the most evidence for glycemic control and decreased ASCVD risk in patients with T2D. There is no evidence on ASCVD outcomes in patients with T2D for any other dietary pattern. Summary The Mediterranean dietary pattern has the most evidence for cardiovascular benefit in patients with T2D. Future research should examine the effect of dietary patterns on ASCVD outcomes.

Cell Cycle–Mediated Cardiac Regeneration in the Mouse Heart Abstract Purpose of Review Many forms of heart disease result in the essentially irreversible loss of cardiomyocytes. The ability to promote cardiomyocyte renewal may be a promising approach to reverse injury in diseased hearts. The purpose of this review is to describe the impact of cardiomyocyte cell cycle activation on cardiac function and structure in several different models of myocardial disease. Recent Findings Transgenic mice expressing cyclin D2 (D2 mice) exhibit sustained cardiomyocyte renewal in the adult heart. Earlier studies demonstrated that D2 mice exhibited progressive myocardial regeneration in experimental models of myocardial infarction, and that cardiac function was normalized to values seen in sham-operated litter mates by 180 days post-injury. D2 mice also exhibited markedly improved atrial structure in a genetic model of atrial fibrosis. More recent studies revealed that D2 mice were remarkably resistant to heart failure induced by chronic elevated afterload as compared with their wild type (WT siblings), with a 6-fold increase in median survival as well as retention of relatively normal cardiac function. Finally, D2 mice exhibited a progressive recovery in cardiac function to normal levels and a concomitant reduction in adverse myocardial remodeling in an anthracycline cardiotoxicity model. Summary The studies reviewed here make a strong case for the potential utility of inducing cardiomyocyte renewal as a means to treat injured hearts. Several challenges which must be met to develop a viable therapeutic intervention based on these observations are discussed.

Mechanisms and Evidence for Heart Failure Benefits from SGLT2 Inhibitors Abstract Purpose of Review To review the clinical trial data and underlying mechanistic principles in support of the robust cardiovascular (CV) benefits, in particular, heart failure (HF) outcomes association with sodium-glucose co-transporter-2 (SGLT2) inhibitors. Recent Findings Several large CV outcome trials in patients with type 2 diabetes mellitus (T2DM) and with either established atherosclerotic CV disease (ASCVD) or at high risk for ASCVD reveal that SGLT2 inhibitors cause reductions in CV and HF endpoints. The reduction in ASCVD appears to be confined to those with established ASCVD on the order of ≈ 14%, as does the mortality benefit—all-cause and CV-related. However, hospitalization for HF are reduced by ≈ 33% and occur regardless of baseline patient characteristics. The unprecedented HF outcomes are theorized to occur via several possible mechanisms and include optimization of conventional ASCVD risk factors, improvement in hemodynamics, prevention of cardiac and renal remodeling, inhibition of hormone dysregulation, use of more efficient metabolic substrates, ion channel inhibition, anti-inflammatory effects, and anti-oxidant effects. Summary Recent evidence has unveiled the irrefutable data that SGLT2 inhibitors reduce CV events in patients with T2DM, with a profound effect on reductions in hospitalization for HF. Though several mechanisms conveying this benefit are suggested, most are based in limited data requiring further validation. Nonetheless, the arrival of SGLT2 inhibitors has ushered in a new era of CV risk reductions therapies.

Programming Pacemakers to Reduce and Terminate Atrial Fibrillation Abstract Purpose of Review The goal of this paper is to review present knowledge regarding preventive and antitachycardia pacing algorithms, aimed to reduce atrial fibrillation (AF) burden in patients when pacing is indicated. Recent Findings Reactive antitachycardia pacing (ATP), the new generation of ATP, is significantly associated with a reduced risk of AF. In patients with indication for pacing and history of AF, pacemakers endowed with atrial preventive pacing and atrial ATP combined with managed ventricular pacing proved superior to standard dual-chamber pacing. Managed ventricular pacing is an algorithm that minimizes unnecessary right ventricular pacing. Progression to persistent AF is prevented by ventricular pacing minimization in patients with normal PR interval. Summary The synergistic effect of pacemakers that combine atrial preventive pacing with reactive ATP and with algorithms that minimize ventricular pacing can reduce AF incidence and decrease the combined endpoint of permanent AF, hospital admissions, and mortality.

Is There Currently a Place for Combined Mitral and Aortic Transcatheter Interventions? Abstract Purpose of Review The goal was to evaluate published data on the incidence, diagnosis, and management of symptomatic combined mitral and aortic valvular disease. Furthermore, to identify the role of treatment using contemporary transcatheter techniques. Recent Findings Up to a quarter of symptomatic adult valvular disease is caused by multiple left-sided valvular lesions. The etiologic spectrum of this combined disease has shifted from rheumatic to degenerative. Both presentation and diagnosis of lesions are modified compared with isolated disease. Based upon narrative review, there are only limited observational experiences, insufficient to provide robust guidance. These data, however, indicate the feasibility of interventions such as transcatheter aortic valve replacement and edge-to-edge mitral valve repair to treat such disease and mitigate the risks of open surgery. Summary Combined aortic and mitral valve disease is commonly encountered. There is a role for transcatheter interventions based on limited data; however, more research is needed.

A Cardio-Oncology Data Commons: Lessons from Pediatric Oncology Abstract Purpose of Review To describe the role of big data in cardio-oncology. Recent Findings There is a trend towards developing cloud-based, integrated registries to improve data collection, access, and analysis. Summary Using a template from pediatric oncology, a cardio-oncology data commons is a novel opportunity to integrate data elements into a cloud-based platform. A cloud-based registry provides advantages of multi-institutional collaboration, rapid data access, a virtual visualization, and analytic tools to reduce infrastructure redundancy. The data commons would include integrated clinical data, blood samples, and genomic data to streamline discovery and analysis for researchers. A cardio-oncology data commons would be a large step forward in bringing cardio-oncology to the forefront of big data.

Is There a Safety Concern for Drug-Coated Balloons in Peripheral Arterial Disease? Abstract Purpose of Review Drug-coated balloons (DEB) and drug-eluting stents (DES) emerged as a tool to aid in lowering the rates of neointimal hyperplasia and target lesion restenosis following endovascular peripheral arterial disease (PAD) interventions. Recent Findings Although the initial trials comparing these devices with non-drug balloons and stents showed favorable results, more recent data raised concerns regarding the mid to long-term safety of these devices. Summary In this review, we will discuss the evolution of endovascular therapy for PAD, with highlights regarding the recent debates on the long-term safety of the drug-coated devices for treatment of PAD.

Who Should Receive a Wearable Defibrillator Vest at Hospital Discharge? Abstract Purpose of Review To discuss the role of wearable cardioverter defibrillator (WCD) vests in preventing sudden cardiac death (SCD) in at-risk populations. Recent Findings The impact of randomized-controlled trials with implantable cardioverter-defibrillators (ICD) therapy is well established in randomized clinical trials in ischemic cardiomyopathy. Although the benefits are not as clear in non-ischemic cardiomyopathy, meta-analyses show significant mortality benefits from immediate electrical cardioversion strategies. The role of WCDs in at-risk populations in whom ICD therapy is temporarily not indicated is not as well-established. Smaller cohort trials have shown efficacy in patients with newly-diagnosed cardiomyopathy, requiring temporary ICD explantation, and others with less common indications for WCD therapy. Summary The Vest Prevention of Early Sudden Death Trial was a landmark randomized control study seeking to examine the benefits of WCD therapy in at-risk population, and although the primary endpoint of reducing arrhythmic death was not reached, the structure of the trial and significant differences in total mortality make a compelling case for continued use of WCD therapies in our healthcare systems.

Pulmonary Artery Denervation: Update on Clinical Studies Abstract Purpose of Review Sympathetic overactivity plays an important role in the progression of pulmonary arterial hypertension (PAH). The purpose of this review is to illustrate localization of pulmonary arterial sympathetic nerves, the key steps of pulmonary artery denervation (PADN) procedure, and to highlight clinical outcomes. Recent Findings Sympathetic nerves mostly occurred in the posterior region of the bifurcation and pulmonary trunk. Emerging preclinical data provided the potential of PADN for PAH. PADN, produced at bifurcation area, improved a profound reduction of pulmonary arterial pressure and ameliorated clinical outcomes with an exclusive ablation catheter. The application of PADN in the patients of PAH or combined pre-capillary and post-capillary PH (CpcPH) improved the hemodynamic parameters and increased 6MWD. Summary Sympathetic overactivity aggravates PAH. PADN is a promising interventional treatment for PAH and CpcPH. Additional clinical trials are warranted to confirm the efficacy of PADN.

Enhancing Social Support Among People with Cardiovascular Disease: a Systematic Scoping Review Abstract Purpose of Review The presence of social support is a major determinant of positive health outcomes among people with cardiovascular disease (CVD); however, little is known about the most effective strategies for enhancing social support among this population. The aim of this scoping review was to describe the effectiveness of interventions seeking to enhance social support among people living with CVD and synthesize the evidence. Recent Findings A systematic search for articles that (a) reported on interventions which may enhance social support and (b) included a measure of social support revealed 21 studies. Interventions to enhance social support were diverse and included cognitive behavioural therapy, mindfulness, peer support, and multi-faceted cardiac rehabilitation programmes. Most studies were of fair to good quality according to the PEDro criteria. With the exception of caregiver-oriented interventions, few studies reported significant changes in social support measures. Summary Early evidence suggests that caregiver-oriented strategies may offer a promising avenue for enhancing social support; however, more research of higher quality is required to determine the optimal strategies to enhance support among those living with CVD.