Extract
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Although cardiac problems commonly are the centre of interest and attention, cardiovascular problems outside the heart are equally important.1 Pulmonary embolisms are the third most important cause of cardiovascular death, particularly in high risk patients with right ventricular dysfunction and elevated cardiac biomarkers.2 Peripheral artery disease accounts for an important part of morbidity and hospitalizations in cardiovascular patients, and the mortality associated with it—in contrast to coronary disease—is not falling.3 Thus, this Focus Issue starts with the Year in Cardiology 2019 series, the ‘The year in cardiology: aorta and peripheral circulation’, by Christian Heiss and colleagues on behalf of the ESC Working Group on Aorta and Peripheral Vascular Diseases.4 With the growing recognition of peripheral vascular disease, it has become necessary to consolidate imprecisions in terminology. For atherosclerotic disease of the lower extremity arteries, the specific term LEAD (for lower extremity arterial disease) should be used, while peripheral vascular disease is now considered to be the umbrella term encompassing all arterial diseases other than the aorta and coronaries. Of note, incident LEAD and, in particular, its severe form critical limb ischaemia is associated with elevated levels of cardiac troponin and N-terminal pro brain natriuretic peptide or NT proBNP.5 Interestingly, in routine clinical practice, COMPASS-eligible patients suited for low dose rivaroxaban represent a substantial fraction of stable peripheral artery disease patients. Indeed, such patients experienced a higher rate of the primary outcome compared with COMPASS participants in the aspirin-alone treatment arm.6
