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Core Curriculum

• Impact of vascular biology in treatment of cardiovascular disease Section III: Neurohormonal strategies in heart failure

The VBWG Core Curriculum 2002 slide lecture program, Impact of vascular biology in treatment of cardiovascular disease, covers basic science and clinical advances in vascular biology in a spectrum of disorders. The material is presented in four sections:

The material in this section of the slide lecture program discusses new approaches to the treatment of heart failure with a focus on the following areas:

  • Insights into the biology of the failing heart and the implications for treatment
  • The cardiovascular impact of neurohormonal treatment strategies
  • Expanding the use of b-blockade in diverse populations
  • ACC/AHA guidelines outlining strategies for early prevention and slowing progression



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Section III: Neurohormonal strategies in heart failure

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Section III: Neurohormonal strategies in heart failure Growing HF epidemic: Threefold increase over past decade Sudden death: A major health problem Medication use in HF by office-based physicians

Section III: Neurohormonal strategies in heart failure

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Section III: Neurohormonal strategies in heart failure Interplay between cardiac function and neurohormonal system in HF Pathophysiology of myocardial remodeling: Transition from compensated hypertrophy to HF Biologic effects of neurohormones coactivated in HF Induction of fetal gene pattern in hypertrophy and HF Diagnostic and prognostic significance of neuroendocrine factors in HF ß-Blockade decreases TNF-α and natriuretic peptides in HF patients treated with ACEI Biological responses mediated by adrenergic receptors in the human heart Metoprolol upregulates cardiac β1-receptor density in the failing heart ß-Blockade reduces cardiomyocyte apoptosis in dogs with HF Strategies to prevent/reverse HF progression

Section III: Neurohormonal strategies in heart failure

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Section III: Neurohormonal strategies in heart failure Deleterious effects of sympathetic activation β-Blockade in atherosclerosis BCAPS: Study design BCAPS: Change in carotid artery bulb IMT during 3-year follow-up BCAPS: Ultrasound results at 36 months ELVA: Study design      BCAPS and ELVA: Implications for ß-blockers as antiatherosclerotic agents Long-term ß-blockade reduces oxidative stress in patients with HF MERIT-HF substudy: Effect of ß-blockade on LV remodeling ß-Blockade restores LV geometry in patients with HF Role of ß-blockade in prevention of sudden death Sudden death: Risk reduction with ß-blockade Combination ACEI and ß-blockade enhances RAS inhibition in patients with HF Survival benefit of ACEI + ß-blockade in HF

Section III: Neurohormonal strategies in heart failure

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Section III: Neurohormonal strategies in heart failure CIBIS II: Survival results COPERNICUS: Survival results MERIT-HF: Primary outcomes MERIT-HF: Clinical outcomes with ß-blockade Effect of ß-blockade on survival in severe HF: Pooled trial results MERIT-HF: Effect of ß-blockade in patients with severe HF Dosage: CIBIS-II, MERIT-HF, COPERNICUS MERIT-HF: Patient response during titration MERIT-HF: Deaths and hospitalizations during titration phase MERIT-HF: Tolerability of ß-blockade is similar to placebo MERIT-HF: Achieved ß-blocker dose vs outcomes Val-HeFT: ARB vs usual therapy in HF—Study overview Val-HeFT: Morbidity and mortality in subgroups

Section III: Neurohormonal strategies in heart failure

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Section III: Neurohormonal strategies in heart failure ß-Blocker HF studies: Effect of race US Carvedilol Trials: Survival without hospitalization among black vs nonblack patients Response to ß-blockade in HF: Effect vs race MERIT-HF: Effect of ß-blockade on hospitalizations in female patients ß-Blocker HF studies: Effect of treatment on mortality by gender MERIT-HF: Risk reductions with ß-blockade in the elderly MERIT-HF: Risk reductions in diabetic patients COPERNICUS: Effects of carvedilol in diabetic vs nondiabetic patients with severe HF Myths about ß-blockers in HF

Section III: Neurohormonal strategies in heart failure

Download S006.ppt (4 slides - 0.7MB)

Section III: Neurohormonal strategies in heart failure ACC/AHA guidelines for HF therapy: Stages A and B ACC/AHA guidelines for HF therapy: Stages C and D ß-Blockade in HF

Published by Medical Education Consultants, Inc. (MEDCON), on behalf of the University of Florida College of Medicine.

The editorial content of this program does not necessarily reflect the views or recommendations of the University of Florida College of Medicine, AstraZeneca, Aventis Pharmaceuticals, Monarch Pharmaceuticals, Pfizer Inc, or Wyeth Pharmaceuticals.

This program was prepared and produced by Medical Education Consultants, Inc., Westport, Connecticut, on behalf of the University of Florida College of Medicine through an unrestricted educational grant provided by AstraZeneca, Aventis Pharmaceuticals, Monarch Pharmaceuticals, Pfizer Inc, and Wyeth Pharmaceuticals.

©2002 Medical Education Consultants, Inc. (MEDCON). All rights reserved.

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