Cardiology Today Editorial Board selects top 10 stories of 2014

Allan S. Jaffe, MD

There is sound experimental and observational bias for being enthused about renal denervation. However, we have all observed apparent innovations which, when put to the test, failed. There are a huge number of reasons to continue to study this approach and perhaps there are technical issues or patient-selection issues that will in the long run explain the data. However, for now, its use should be reserved for highly selected cases.

Barry Greenberg, MD

PARADIGM-HF was an extremely well-done study that assessed a novel approach to treatment chronic HF with reduced ejection fraction. The results showed that LCZ696 (Novartis), a combined angiotensin receptor blocker and neprilysin inhibitor, reduced the likelihood for the combined endpoint of HF hospitalization or CV mortality by 20% compared with enalapril. There was also a highly significant reduction in CV mortality with LCZ696 with a very acceptable safety profile. This study provides compelling evidence that this dual-acting neurohormonal-modulating agent more favorably influences outcome than does a standard guideline-approved therapy that targets renin-angiotensin alone. These results are likely to alter the therapeutic approach to managing patients with HF and reduced ejection fraction.

L. Samuel Wann, MD

Presented with a potentially unstable patient with an acute MI, it seems intuitive that only immediately threatening coronary lesions — the infarct-related artery — should be treated acutely. Several studies now show that this approach may be too conservative, that there is long-term outcome benefit from treating significant stenoses of non–infarct-related as well as infarct-related arteries during the initial presentation to the cath lab.

Michael Weber, MD

The JNC 8 recommendation for BP treatment targets in older patients was controversial and, to many experts in the field of hypertension, represented a narrow and potentially troubling overinterpretation of the limited evidence available. Patients aged 60 to 80 years are a major part of the hypertension population and often are at high CV risk. To relax a well-established and safe target of 140/90 mm Hg in favor of 150/90 mm Hg simply because evidence differentiating between the two targets is unavailable or inconclusive is difficult to justify, and potentially dangerous. If the JNC 8 recommendation is wrong, vulnerable patients in this age group could pay the price of premature mortality, coronary events and particularly strokes.

Seth S. Martin, MD

My view is that collegial discussion about the ACC/AHA cholesterol guidelines has been critical to moving forward their successful implementation. I personally have learned a lot from my colleagues while striving to optimally interpret the thoughtful recommendations of the guideline authors and apply the recommendations to individual patients in clinical practice. Hopefully constructive discourse will continue to bring attention to these important guidelines, including key elements like the clinician-patient risk discussion, and improve the care of our patients.