European Heart Journal

The aim of the European Heart Journal (EHJ) is to attract innovative, methodologically sound, and clinically relevant research manuscripts able to change clinical practice and/or substantially advance knowledge on cardiovascular diseases. As the reference journal in cardiovascular medicine, the EHJ is committed to publishing only the best cardiovascular science adhering to the highest ethical principles. EHJ uses highly rigorous peer-review, critical statistical review and the highest quality editorial process, to ensure the novelty, accuracy, quality, and relevance of all accepted manuscripts with the aim of inspiring the clinical practice of EHJ readers and reducing the global burden of cardiovascular diseases. This review article summarizes the quality standards pursued by the EHJ to fulfill its mission.

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The heart of the ageing endurance athlete: the role of chronic coronary stress

Gemma Parry-Williams, Sabiha Gati, Sanjay Sharma

doi : 10.1093/eurheartj/ehab095

European Heart Journal, Volume 42, Issue 28, 21 July 2021, Pages 2737–2744

Moderate physical exercise is associated with an irrefutable reduction in cardiac morbidity and mortality. The current guidelines recommend at least 150 min of moderate exercise or 75 min of vigorous exercise per week. Endurance athletes perform exercise at a level that is 10- to 20-fold greater than these recommendations. These athletes reveal several structural and functional cardiac adaptations including increased cardiac size, enhanced ventricular filling, and augmentation of stroke volume even at the highest heart rates. The long-term effects of endurance exercise on the heart are unknown. Endurance exercise is associated with a transient increase in serum concentrations of biomarkers of cardiac damage and ventricular dysfunction which improves within 72 h. Over the past decade, there have been emerging studies reporting attenuated mortality benefit amongst individuals who perform the highest volume of exercise. Studies in lifelong male athletes aged above 40 years old show a higher prevalence of high coronary artery calcium scores (>300 Agatston units), a higher coronary plaque burden, and myocardial fibrosis compatible with subclinical myocardial infarction compared with relatively sedentary healthy controls, raising speculation that lifelong intense exercise imposes chronic coronary stress on the heart. This review article will provide a critical analysis of the existing data.

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Colchicine and the heart

Massimo Imazio, Mark Nidorf

doi : 10.1093/eurheartj/ehab221

European Heart Journal, Volume 42, Issue 28, 21 July 2021, Pages 2745–2760

Colchicine is a unique, sophisticated anti-inflammatory agent that has been used for decades for the prevention of acute inflammatory flares in gout and familial Mediterranean fever. In recent years, clinical trials have demonstrated its potential in a range of cardiovascular (CV) conditions. Colchicine is avidly taken up by leucocytes, and its ability to bind to tubulin and interfere with microtubular function affects the expression of cytokines and interleukins, and the ability of neutrophils to marginate, ingress, aggregate, express superoxide, release neutrophil extracellular traps, and interact with platelets. In patients with acute and recurrent pericarditis, clinical trials in >1600 patients have consistently shown that colchicine halves the risk of recurrence [relative risk (RR) 0.50, 95% confidence interval (CI) 0.42–0.60]. In patients with acute and chronic coronary syndromes, multicentre randomized controlled trials in >11 000 patients followed for up to 5?years demonstrated that colchicine may reduce the risk of CV death, myocardial infarction, ischaemic stroke and ischaemia-driven revascularization by >30% (RR 0.63, 95% CI 0.49–0.81). The use of colchicine at doses of 0.5–1.0?mg daily in CV trials has proved safe. Early gastrointestinal intolerance limits its use in ?10% of patients; however, ?90% of patients tolerate it well over the long term. Despite isolated case reports, clinically relevant drug interactions with moderate to strong CYP3A4 inhibitors/competitors or P-glycoprotein inhibitors/competitors are rare if this dosage of colchicine is used in the absence of advanced renal or liver disease. The aim of this review is to summarize the contemporary data supporting the efficacy and safety of colchicine in patients with CV disease.

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Coronary artery disease: ‘gout’ in the artery?

Timo E Strandberg, Petri T Kovanen

doi : 10.1093/eurheartj/ehab276

European Heart Journal, Volume 42, Issue 28, 21 July 2021, Pages 2761–2764

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Efficacy and safety of low-dose colchicine in patients with coronary disease: a systematic review and meta-analysis of randomized trials

Aernoud T L Fiolet, Tjerk S J Opstal, Arend Mosterd, John W Eikelboom, Sanjit S Jolly, Anthony C Keech, Peter Kelly, David C Tong, Jamie Layland, Stefan M Nidorf, Peter L Thompson, Charley Budgeon, Jan G P Tijssen, Jan H Cornel the Colchicine Cardiovascular Trialists Collaboration

doi : 10.1093/eurheartj/ehab115

European Heart Journal, Volume 42, Issue 28, 21 July 2021, Pages 2765–2775

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Time to commence or time out for colchicine in secondary prevention of cardiovascular disease?

Aruna D Pradhan

doi : 10.1093/eurheartj/ehab210

European Heart Journal, Volume 42, Issue 28, 21 July 2021, Pages 2776–2779

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Myocardial hypoxic stress mediates functional cardiac extracellular vesicle release

Achille Anselmo, Derk Frank, Laura Papa, Chiara Viviani Anselmi, Elisa Di Pasquale, Marta Mazzola, Cristina Panico, Francesca Clemente, Cristiana Soldani, Christina Pagiatakis, Rabea Hinkel, Ruth Thalmann, Reiner Kozlik-Feldmann, Michele Miragoli, Pierluigi Carullo, Marco Vacchiano, Antonio Chaves-Sanjuan, Nadia Santo, Maria Angela Losi, Matteo Carlo Ferrari, Annibale Alessandro Puca, Vincent Christiansen, Hatim Seoudy, Sandra Freitag-Wolf, Norbert Frey, Astrid Dempfle, Mark Mercola, Giovanni Esposito, Carlo Briguori, Christian Kupatt, Gianluigi Condorelli

doi : 10.1093/eurheartj/ehab247

European Heart Journal, Volume 42, Issue 28, 21 July 2021, Pages 2780–2792

Increased shedding of extracellular vesicles (EVs)—small, lipid bilayer-delimited particles with a role in paracrine signalling—has been associated with human pathologies, e.g. atherosclerosis, but whether this is true for cardiac diseases is unknown.

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