Triglycerides and risk of atherosclerotic cardiovascular disease: An update

Regulation of triglyceride-rich lipoprotein (TGRL) metabolism. Serum triglyceride concentration identifies the presence of potentially atherogenic TGRLs. Human genetics strongly support remnants of TGRLs as a causal cardiovascular risk factor. Remnants of TGRLs play a role in residual risk on statin therapy. Apo: apolipoprotein; ANGPTL: angiopoietin-like protein; LPL: lipoprotein lipase; RLP: remnant lipoprotein.

     

Framingham Heart Study: JACC Focus Seminar, 1/8

The Framingham Heart Study is the longest-running cardiovascular epidemiological study, starting in 1948. This paper gives an overview of the various cohorts, collected data, and most important research findings to date. In brief, the Framingham Heart Study, funded by the National Institutes of Health and managed by Boston University, spans 3 generations of well phenotyped White persons and 2 cohorts comprised of racial and ethnic minority groups. These cohorts are densely phenotyped, with extensive longitudinal follow-up, and they continue to provide us with important information on human cardiovascular and noncardiovascular physiology over the lifespan, as well as to identify major risk factors for cardiovascular disease. This paper also summarizes some of the more recent progress in molecular epidemiology and discusses the future of the study.     

Evaluation for Heart Transplantation and LVAD Implantation: JACC Council Perspectives

Timely referrals for transplantation and left ventricular assist device implantation play a key role in favorable outcomes in patients with advanced heart failure. Nonetheless, evaluation usually occurs at advanced heart failure centers and is obscured from referring physicians. The purposes of this review are to explain the decision-making process for candidacy for advanced therapies and to describe the potential impact of the new organ allocation algorithm on center decision making. The document first addresses the signs of advanced heart failure, specifically focusing on the importance of the syndrome of low cardiac output as a key feature of advanced heart failure, and then summarizes the evaluation as a 3-step process addressing the following questions: 1) Is transplantation or durable assist device placement indicated? 2) Are there contraindications to either intervention? 3) How can one choose between transplantation and left ventricular assist device implantation if advanced therapies are indicated and not contraindicated?