Coronary vessel formation in development and disease: mechanisms and insights for therapy

The formation of new blood vessels after myocardial infarction (MI) is essential for the survival of existing and regenerated cardiac tissue. However, the extent of endogenous revascularization after MI is insufficient, and MI can often result in ventricular remodelling, progression to heart failure and premature death. The neutral results of numerous clinical trials that have evaluated the efficacy of angiogenic therapy to revascularize the infarcted heart reflect our poor understanding of the processes required to form a functional coronary vasculature. In this Review, we describe the latest advances in our understanding of the processes involved in coronary vessel formation, with mechanistic insights taken from developmental studies. Coronary vessels originate from multiple cellular sources during development and form through a number of distinct and carefully orchestrated processes. The ectopic reactivation of developmental programmes has been proposed as a new paradigm for regenerative medicine, therefore, a complete understanding of these processes is crucial. Furthermore, knowledge of how these processes differ between the embryonic and adult heart, and how they might be more closely recapitulated after injury are critical for our understanding of regenerative biology, and might facilitate the identification of tractable molecular targets to therapeutically promote neovascularization and regeneration of the infarcted heart

Emerging lipoprotein-related therapeutics for patients with diabetes

Dyslipidemia is a major risk factor for atherosclerosis in both diabetic and nondiabetic subjects, which is a common cause of morbidity and premature mortality. Based on and supported by favorable outcomes of clinical trials, drugs targeting lipoprotein metabolism are widely used, particularly in developed countries. Drugs to improve lipid levels, in particular to lower low-density lipoprotein (LDL) cholesterol (LDL-C), are commonly used for the primary and secondary prevention of cardiovascular disease. Of the LDL-C-lowering drugs, HMG-CoA reductase inhibitors (“statins”) are particularly effective at reducing cardiovascular disease, both in people with and without diabetes mellitus [1, 2], with more intensive LDL-C lowering being more effective than less intensive LDL-C lowering [3–12]. Statins are effective cardioprotective agents in both type 1 and type 2 diabetes patients [2]