Editorial articles

Most cardiologists view themselves as strong, hardened clinicians with a broad knowledge-base, alongside (sometimes very) specialist expertise. As clinicians we are seen to embody the quintessential type A stereotype, impervious to most emotional traumas, managing and coping with frequent, both sudden and slow, demises and challenging, complex and often time-pressured, scenarios.

I am no stranger to the demands of a profession that requires precision, composure, and resilience. Yet, behind the façade of clinical and academic competence, lies a reality that many of us, including myself, are reluctant to confront: the personal and professional toll that psychiatric illness can take on physicians.

Cardiovascular disease (CVD) is one of the leading causes of death and disability in the UK. The implications for the NHS are profound, as increasing hospital admissions strain resources and escalate wait times. Currently, people with one or more long-term conditions use 50% of all general practitioner (GP) appointments, 64% of all outpatient appointments, and 70% of hospital beds.¹ With CVD now the cause of one in four premature deaths² in the UK, transforming the way CVD is prevented and care is provided, is becoming increasingly crucial.

With National Health Service England (NHSE) recently publishing their 2025/26 priorities and operational planning guidance,³ there is a need for systems to address inequalities and shift towards prevention. To address this challenge in the West Midlands, a transformative approach to CVD prevention and management was taken that included early diagnosis, effective management and comprehensive education. The work was led by Health Innovation West Midlands (HIWM) and colleagues from primary and secondary care across all six integrated care systems (ICSs).

Chronic obstructive pulmonary disease (COPD) and cardiovascular disease (CVD) represent major global health burdens, collectively affecting hundreds of millions worldwide.¹ COPD is projected to become the third leading cause of death globally by 2030, while CVD remains the primary cause of mortality worldwide.² Historically viewed as distinct entities, a paradigm shift is underway as mounting evidence reveals a complex, bi-directional relationship between these conditions.^3,4 This growing recognition extends beyond shared risk factors like smoking, encompassing common pathophysiological mechanisms, such as systemic inflammation and oxidative stress.⁵ The interplay between COPD and CVD presents unique challenges and opportunities, necessitating a re-evaluation of traditional management approaches and calling for more integrated, multi-disciplinary care strategies.

Hypertension is the most important single modifiable risk factor for cardiovascular disease prevention. An estimated 1.28 billion adults aged 30–79 years have hypertension worldwide.¹ Around 16 million adults in the UK suffer with hypertension, which is roughly a third of the adult population.² The benefits of lowering blood pressure (BP) are firmly established down to 140/90 mmHg. More recently, several randomised-controlled trials (RCTs) have assessed the benefits of lowering targets further to <120 mmHg systolic. ACCORD, SPRINT, RESPECT, ESPRIT and BPROAD RCTs compared a systolic blood pressure (SBP) target of <120 mmHg versus <140 mmHg.^3–7 The ACCORD trial recruited patients with diabetes, and RESPECT recruited patients with stroke.^3,4 Both of these RCTs demonstrated no significant difference in their pre-specified primary outcomes of major cardiovascular events in ACCORD, and recurrence of stroke in RESPECT. The ACCORD trial found more serious adverse events with intensive BP targeting, and the RESPECT trial ended early due to slow recruitment and funding.^3,4 Both had a relatively small number of participants, which may have contributed to the negative result seen in these studies.

James Mackenzie was born on 12 April 1853 in Scone, Perthshire, Scotland, and educated at the village primary school and then Perth Academy. At age 15 he left school, apparently at his own request, to become an assistant at a local chemist’s shop, then a chemist’s apprentice in Perth, qualifying as a chemist (pharmacist) at the age of 20 and working as a chemist in Glasgow. He began to study medicine at the University of Edinburgh at the age of 21.

He was tall and broad-shouldered demonstrating physical and mental strength. He mastered French and German, in both of which he was able to read medical literature. He read and published extensively. He even published novels. His non-medical interests included chess and sporting activities. His marriage, at the age of 34, was a happy one, lasting until his death from coronary artery disease on 25 January 1925. He had two daughters, one of whom died at the age of 16, which grieved him for life.

You are a cardiology trainee (or you want to be one) and you’re contemplating your future career development. You’ve just noticed that cardiology is on the competitive side, and you want to maximise your chances of getting ahead. You light on the idea that you might do some research, get some publications, and that this might stand you in good stead for the future. Well …

From the outside, it might seem that research is quite glamorous – flying to conferences in exotic places, wining and dining with the great and the good, delivering lectures to rapt audiences in large halls … sadly, the reality is quite different, particularly at an early stage in research.

The sixteenth-century French surgeon Ambroise Paré remarked, “aneurysms which happen in the internal parts are incurable”,^1,2 underscoring the historical challenges of managing aortic disease. Frank Nicholls’ autopsy report of King George II of England (1760) was the first to describe aortic arch dissection.³ It was not until 1944 that Crafoord and Nylin reported the first end-to-end aortic anastomosis for coarctation resection,⁴ and shortly after, Gross set the stage for rapid aortic repair advancements by replacing a coarctation segment with an arterial homograft.⁵

In 1952, Cooley and DeBakey utilised homografts for thoraco-abdominal aortic aneurysm repair,⁶ and by 1954 they introduced aortic dissection surgery. In 1957, homografts had been used to replace ascending aorta⁷ and arch.⁸

During the 1970s, Crawford pioneered thoraco-abdominal aneurysm repair, employing an anatomic endovascular graft-inclusion technique. His innovations improved early survival rates, achieving a remarkable 92%.⁹ Rather than fully resecting the aneurysm, the retained aneurysmal wall was wrapped around the replacement graft. In contemporary practice, open aortic repair remains the standard of care for the majority of patients.

For more than 30 years, Cardiac Risk in the Young (CRY) has been at the forefront of efforts to prevent sudden cardiac deaths in young people. Established in 1995, CRY has transformed the landscape of cardiac screening, research, and bereavement support in the UK and beyond. Through pioneering research, large-scale screening initiatives, and raising awareness, CRY has saved lives, supported affected families, and driven critical policy changes. This article explores CRY’s impact over the past three decades and its continuing efforts to prevent young sudden cardiac death (YSCD).

Acute coronary syndrome (ACS) events in people receiving long-term haemodialysis (HD) are common, present atypically and are associated with poor outcomes.^1–3 Diagnosis is challenging, and treatment even more so. The complexity of this population drives their exclusion from clinical trials, resulting in a scarcity of evidence supporting any ‘optimal’ treatment strategy.⁴ Guidelines are, as a result, vague and, to a degree, contradictory.^5–7 These are some of the reasons that the combination of cardiac and renal disease strike fear into even the most seasoned clinicians. Is it this fear that underlies the observed conservatism in treatment of those with advanced chronic kidney disease (CKD), and are we, therefore, contributing inadvertently to the adverse outcomes we are simultaneously striving to avoid? I commend Muhammad Haider and colleagues for tackling this challenging area, and attempting to summarise our knowledge in their review: “Diagnosis and management of ACS in patients with ESRD on haemodialysis: a comprehensive review”.⁸

The arrival of sodium-glucose cotransporter type 2 (SGLT2) inhibitors has ushered in a new era in the management of cardiometabolic diseases. These innovative agents, initially developed for glycaemic control in type 2 diabetes, have unexpectedly demonstrated significant cardiovascular benefits, revolutionising cardiologists’ approach to the prevention and treatment of heart failure and cardiovascular events.¹