Bone Marrow Takes Center Stage in Cardiovascular Disease
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Atherosclerosis is a lipid-driven inflammatory disease that underpins myocardial infarction and stroke,1 and it is the leading cause of death worldwide.2 It is not unusual to think of cardiovascular disease as a product of lifestyle,3 and indeed, as countries become wealthier and their populations become more sedentary, cardiovascular disease incidence increases. Over the years, epidemiological and experimental research has identified many factors that influence an individual’s cardiovascular risk. Although some of these are inevitable consequences of genetics and the passage of time—sex and age, for example, because men are at higher risk and everyone’s risk increases with age—many others are inextricably linked to lifestyle. Consuming fatty foods, lack of exercise, smoking, excessive psychosocial stress, and poor sleep contribute to measurable risk factors, such as high low-density lipoprotein, obesity, hypertension, and diabetes mellitus, all of which increase the risk of myocardial infarction and stroke. These connections sometimes lead to the popular misunderstanding that cardiovascular disease can be prevented by making healthy lifestyle choices. Unfortunately, the causes of myocardial infarction and stroke are not exclusively behavioral. An article by Wang et al4 in this issue of Circulation Research is an excellent illustration of how inheritance crucially shapes our responsiveness to environmental stimuli.
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We have all heard it: the diet-conscious runner who collapses from a heart attack at 40 years and the obese life-long drinker and smoker who dies at 90 years. Although anecdotal, do these examples nevertheless tell us something meaningful about cardiovascular disease? Over the past 15 years, genome-wide association studies have revealed that certain mutations can either increase the risk of or protect against myocardial infarction.5,6 In other words, …