Comment

Metabolic diseases are important risk factors for the development of heart failure, and energetic deficit and oxidative stress are important in its pathophysiology. A Focus issue in Nature Reviews Cardiology appraises the metabolic alterations in heart failure, with an emphasis on substrate and intermediate metabolism, vascular dysfunction, inflammation and mechano-energetic uncoupling, integrating these different pathomechanistic angles into one cohesive view.

Aortic dissection has long been considered a rare, unpreventable and inevitably fatal disease. However, recent advances now prove otherwise. The patient-led Think Aorta campaign is challenging old thinking, improving diagnosis and advocating for better care, such as family screening. Patient advocacy and recent international guidelines classifying the aorta as an organ are catalysts for further improvements in patient care.

Effective engagement with cardiovascular societies enhances professional development, academic growth and leadership opportunities. We describe practical strategies for cardiovascular professionals to connect with their peers, seek mentorship, advance professionally and contribute as active members of the cardiovascular society, to develop an impactful career and advance the field of cardiac medicine.

Conference presentation skills are a crucial, yet often overlooked, element in the dissemination of cardiovascular research. In an era of information overload and digital communication, the ability to clearly and engagingly present scientific data is essential, to ensure that the findings are understood, shared and implemented into clinical practice.

Digital communication increasingly shapes early-career cardiology. Social media offers powerful tools for education, networking and career growth, but also poses challenges such as misinformation and lack of professionalism. In this Comment article, we outline practical strategies for effectively navigating social media in the early stages of a cardiology career.

New research shows how the social determinants of cardiovascular health vary locally within cities. Artificial intelligence makes it possible to quantify the relative importance of these social determinants at a hyper-local level, which can inform interventions. To realize these opportunities, new partnership models are needed that pay special attention to data quality and governance.

This call to action aims to increase awareness of inclusive language in medicine to enhance the experiences of patients and staff and improve health outcomes. Recognizing that terms change, we urge all health-care professionals to advocate for their colleagues and patients. This responsibility to educate the community should not fall exclusively onto marginalized communities.

Large language models represent a transformative leap in artificial intelligence and natural language processing, offering exciting potential across cardiology, from clinical care to education and research. However, several crucial challenges limit the practical implementation of large language models in cardiology. Interdisciplinary research is imperative to overcome these barriers.

English has long been the dominant language in scientific communication. Although having a universal language for scientific communication is beneficial, this standard imposes a considerable barrier for researchers who do not speak English fluently. However, the current generation of scientists is overcoming this barrier through the use of artificial intelligence-based language tools.

Debate exists regarding the best terminology for common presentations of heart diseases caused by epicardial and/or microvascular coronary artery disease with or without myocardial ischaemia. In this Comment, we discuss the pros and cons of a new proposal to replace the vessel-based nomenclature of acute and chronic coronary syndromes with the myocardial-oriented nomenclature of acute and non-acute myocardial ischaemic syndromes.

The burden of atrial fibrillation (AF) is increasing worldwide; however, most existing data on AF epidemiology are from Western regions. According to our analyses, the estimated absolute prevalence of AF in the Asia–Pacific region in 2023 was approximately 80 million, which is much higher than has been calculated for other global regions.

The immune response is not unlike a game of chess, with white and black pieces playing opposing roles and orchestrating an opening, a middle and an endgame of innate immunity, adaptive immunity and resolution, respectively. After decades of research, the study of atheroimmunology has brought the first therapeutics to the clinic. Can we resynchronize the immune system in atherosclerosis and save the king?

The under-representation of women in cardiovascular clinical trials persists across participant, clinician and research roles. This gap perpetuates health inequity and hampers the generation, translation and implementation of optimal evidence-based care. Urgent action is needed to address barriers, promote diversity, and ensure inclusive trial design and health-care delivery and dissemination, for more equitable cardiovascular health.

Novel cardiovascular therapeutics have the potential to improve health outcomes, but financial toxicity from high out-of-pocket costs can limit the reach of these medications and worsen existing health disparities. Understanding the phenomenon of financial toxicity in treating cardiovascular disease is crucial to achieving health equity.

In this Comment, we critically examine the association between the increasing consumption of ultra-processed foods and their negative effect on cardiovascular health. We explore the historical evolution of food processing, the Nova food classification and the epidemiological evidence, and highlight the need for urgent public health interventions.

Representation of Black patients in cardiovascular clinical trials remains dismally low, reflective of systemic and structural barriers, which can lead to missed opportunities to meet community-identified needs, understand responses to medical therapies and improve cardiovascular care. Innovative, multilevel strategies focused on Black communities are warranted to increase enrolment of this population into clinical research.

Mosaic loss of chromosome Y (mLOY) refers to the condition in male individuals in which a detectable fraction of cells lose the Y chromosome. Prevalent in haematopoietic cells, this common somatic mutation is associated with decreased longevity and an increased risk of age-related diseases, including cardiovascular disease. Haematopoietic mLOY provides further insight into the sex-specific disparities that exist in disease susceptibility.

Racial and ethnic disparities in cardiovascular health in the USA result in a persistent mortality gap between white and Black individuals, increase health-care costs and compromise an egalitarian society. Solutions to racial inequities require risk factor control and the implementation of evidence-based medicine and anti-racism policies. Overcoming these disparities is not only a practical necessity, but also a moral imperative.

For patients with heart failure and reduced left ventricular ejection fraction, intravenous iron is likely to deliver clinical and prognostic benefits for those with anaemia and transferrin saturation <20%, especially if serum ferritin exceeds 100 μg/l. A serum ferritin of <100 μg/l does not appear to be useful as a marker of iron deficiency.

Despite the high consumption of fermented foods and beverages worldwide, their role in a healthy diet is still up for debate. Some fermented beverages have been demonstrated to protect against cardiovascular disease, but many aspects of the effects of fermented foods on cardiovascular health are uncertain. Better-designed studies are warranted.