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Obesity is a global epidemic, which, directly and indirectly, contributes to almost all cardiovascular diseases, including atherosclerotic cardiovascular disease, heart failure and atrial fibrillation. Reduction of weight is associated with substantial improvements in cardiometabolic risk factors, including blood pressure and glycaemic control, with over 10% weight loss required to see improvement in rates of major adverse cardiovascular events. Glucagon-like peptide-1 (GLP-1) receptor agonists have changed the landscape of type 2 diabetes and obesity management, showing significant benefit in glycaemic control and weight loss. Their potential for cardiovascular benefits means that they will likely have a central role in the management of patients with obesity-related cardiovascular diseases. This review summarises currently available GLP-1-based pharmacotherapies and highlights recent trials demonstrating cardiovascular benefits, and also provides practical guidance for patient selection, available agents, their initiation and patient monitoring. This will serve as an aid for cardiovascular clinicians, who will inevitably encounter patients suitable for, or already using, these drugs in their daily practice.

A 61-year-old man with Brugada syndrome (BrS) (SCN5A mutation) presented with chest pain to a district general hospital (DGH). There was no history of syncope or ventricular arrhythmias. A subcutaneous implantable cardioverter-defibrillator (S-ICD) was in situ for primary prevention following extraction of a previous transvenous ICD due to infection.

Investigations suggested a non-ST-elevation myocardial infarction. While awaiting coronary angiography, he developed a ventricular tachycardia (VT) storm with recurrent cardiac arrests over 30 minutes due to polymorphic VT, receiving seven S-ICD shocks.

Defibrillation, isoprenaline and quinidine were employed to manage the polymorphic VT storm, permitting transfer to a tertiary centre for further investigations. Coronary angiography demonstrated an occluded marginal artery, which was managed medically. Isoprenaline was weaned following quinidine initiation, the S-ICD reactivated, and he was discharged. A year later, there have been no further ventricular arrhythmias while on quinidine.

This case report demonstrates the effectiveness of isoprenaline, which is easily accessible and readily available in DGHs, in stabilising an acute Brugada storm. Quinidine allowed successful weaning from isoprenaline, but lack of availability limits its use. Finally, this case report highlights both the benefits and risks of primary prevention ICDs in BrS.

We present a patient with medication-refractory inappropriate sinus tachycardia (IST) who was hospital-bound and successfully treated with hybrid thoracoscopic ablation.

‘Publish or perish’. This well-known phrase, likely first mentioned over a century ago, was even once the title of a one-day course run in central London, which I attended. Thankfully, this mantra has faded from prominence in recent years, but what does it mean, why did it become so (in)famous and what have the consequences been? Oxford physician, clinical pharmacologist and writer Dr Jeffrey Aronson proposed a definition for the ‘publish or perish’ paradigm last year, suggesting the following:

“An aphorism that describes the pressure on an academic to have innovative scholarly material published in reputable journals or other forms of scholarly output, sufficiently often, in order to avoid demotion, dismissal, failure to progress in one’s scholarly career, or diminishing the status or reputation of one’s scholarly community or discipline.”¹

Lipid management is a key component of secondary prevention after acute coronary syndrome (ACS), but guideline adherence is variable. Adjunctive lipid-lowering therapies (LLTs) beyond statins are available, yet eligibility in the real-world setting is not well-described. We aimed to improve local post-ACS lipid management, and evaluate eligibility for LLTs.

Consecutive admissions of patients with ACS to a district general hospital from April to June 2022 were assessed for: inpatient lipid-profile assessment, inpatient LLT management, and outpatient repeat lipid profiles. A structured intervention, including updating blood testing panels, education, and reference resources, was implemented. We re-audited admissions in April–June 2024, where eligibility for adjunctive LLTs was assessed.

There were 97 (cycle 1) and 102 (cycle 2) patients identified. While performance was suboptimal in cycle 1, we observed improvements in cycle 2 (baseline full lipid profile testing from 10% to 75%; appropriate LLT management 65% to 78%; post-discharge repeat testing 37% to 63%). At one year post-ACS, 35% of patients remained subtherapeutic, but medication changes were rare.

In conclusion, through use of a structured intervention, we were able to improve post-ACS lipid management. Many patients fail to achieve therapeutic lipid lowering. Strategies to address this are urgently required.

A man in his eighties presented with a two-week history of left-arm swelling and bruising. Twelve years earlier, he had undergone dual-chamber pacemaker implantation for bradycardia and syncope. His past medical history included hypertension, paroxysmal atrial fibrillation (pAF), and coronary artery bypass grafting (CABG) 15 years prior.

Upon further investigation with ultrasound Doppler, and computerised tomography (CT) of his chest, a thrombus was confirmed in the left subclavian vein, associated with a pacing lead. He was initiated on a three-week course of low molecular weight heparin (LMWH). Although his symptoms initially improved, traces of the thrombus remained on his follow-up CT after commencing treatment, and he was continued on lifelong direct oral anticoagulant (DOAC).

Pathogenesis, incidence, investigations and management of pacemaker-induced thrombosis are discussed. This case illustrates a rare, delayed presentation of pacemaker-induced thrombosis in the context of a symptomatic presentation and highlights the potential need for prolonged anticoagulation.

In the UK, the majority (90%) of hypertension is managed in primary care. Yet, for the 10% who require secondary-care input, there is no specialist register for doctors who manage hypertension. There is a mismatch across the nations with regards to access to secondary care for management of complex hypertension cases. Heterogeneity exists in terms of local specialist services, referral pathways, and specialties overseeing care.

We polled across primary care in the UK to assess accessibility to a local specialist hypertension clinic, the clinical reasons for referral and the specialty referred to. Cardiology was by far and away the leading specialty for referrals. Yet the vast majority of cardiology trainees in the UK are receiving minimal, if any, specialist training in hypertension. A cardiology registrar is likely to spend substantially more days on-call for general medicine than the amount of specialist clinics they can attend in hypertension.

We are facing a major deficit in the specialist management of hypertension if the trainees of today are not ready to provide the required expertise and oversight for the complex cases of tomorrow.

The burden of hypertension in the UK is profound.¹ It is the leading modifiable risk factor for cardiovascular disease, chronic kidney disease and vascular dementia, affecting approximately 30% of adults, with an estimated 4.2 million remaining undiagnosed – an alarming figure that underscores longstanding gaps between evidence and implementation in routine care.^2–5 Against this backdrop, the British and Irish Hypertension Society (BIHS), in partnership with the British Heart Foundation Clinical Research Collaborative (BHF‑CRC), has developed the first national, consensus‑driven effort to define future research priorities in hypertension.⁶ This represents a landmark initiative: a structured attempt to align research, policy, and clinical services with the realities of modern hypertension care.

Over eight million UK citizens are at unnecessary risk of the avoidable consequences of hypertension because of inadequate blood pressure (BP) control.¹ Improving this is a key objective of the Department of Health and Social Care, and is one of the five major priorities in the NHSE Core20PLUS5 approach to reducing healthcare inequalities.² The national emphasis on hypertension case finding and management requires a significant increase in the availability of specialist advice and management, which can improve control and outcomes.