Search

Patients with type 2 diabetes mellitus are at a higher risk of developing heart failure compared with the healthy population. In recent landmark clinical trials, sodium-glucose co-transporter 2 (SGLT2) inhibitor therapies improve blood glucose control and also reduce cardiovascular events and heart failure hospitalisations in patients with type 2 diabetes. Intriguingly, such clinical benefits have also been seen in patients with heart failure in the absence of type 2 diabetes although the underlying mechanisms are not clearly understood. Potential pathways include improved glycaemic control, diuresis, weight reduction and reduction in blood pressure, but none fully explain the observed improvements in clinical outcomes. More recently, novel mechanisms have been proposed to explain these benefits that include improved cardiomyocyte calcium handling, enhanced myocardial energetics, induced autophagy and reduced epicardial fat. We provide an up-to-date review of cardiac-specific SGLT2 inhibitor–mediated mechanisms and highlight studies currently underway investigating some of the proposed mechanisms of action in cardiovascular health and disease.

Myocardial infarction with non-obstructive coronary arteries (MINOCA) was first described over 80 years ago. The term has been widely and inconsistently used in clinical practice, influencing various aspects of disease classification, investigation and management. MINOCA encompasses a heterogenous group of conditions that include both atherosclerotic and non-atherosclerotic disease resulting in myocardial damage that is not due to obstructive coronary artery disease. In many ways, it is a term that describes a moment in the diagnostic pathway of the patient and is arguably not a diagnosis. Central to the definition is also the distinction between myocardial infarction and injury. The universal definition of myocardial infarction distinguishes acute myocardial infarction, including those with MINOCA, from other causes of myocardial injury by the presence of clinical evidence of ischaemia. However, these ischaemic features are often non-specific causing diagnostic confusion, and can create difficulties for patient management and follow-up. The purpose of this review is to summarise our current understanding of MINOCA and highlight important issues relating to the diagnosis, investigation and management of patients with MINOCA.

COVID-19 is the first major pandemic the modern world has faced since the Spanish influenza pandemic of 1918 and has had a profound impact on all aspects of society.1 Governments worldwide have established emergency plans to help tackle and reduce the rapid spread of the infection, with social isolation being implemented by most to varying degrees. Healthcare systems are facing unprecedented challenges and real-time restructuring and, as expected, this has resulted in an excess mortality worldwide.1 The first fatality with COVID-19 in the UK was reported on 2 March 2020, with subsequent nationwide lockdown on 23 March 2020. Public health concerns have focused on the increases in mortality directly attributable to COVID-19 and the indirect consequences of the pandemic on the healthcare system’s ability to manage non-COVID-19 related life-threatening illnesses due to diversion of established healthcare resources and capacity. This is a complex situation and there is also some overlap in direct and indirect causes of mortality. For example, as with other viral and respiratory illnesses, there is the potential for COVID-19 to trigger other fatal events that may not have otherwise happened. For example, it is well described that there is a 44% increase in myocardial infarction in the weeks after respiratory tract infections.2 There is also the concern that patients themselves may be reluctant to seek attention because of concerns regarding contracting COVID-19 in the hospital or burdening an overstretched healthcare system that is trying to cope with seriously ill patients with COVID-19. In the current issue of Heart , Wu and colleagues have assessed the impact of COVID-19 on both the population incidence and location of acute cardiovascular mortality that sheds light on some of these …