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Core Curriculum

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

The VBWG Core Curriculum 2003 slide lecture compendium Impact of vascular biology in treatment of cardiovascular disease, provides updates on new science and mechanisms of disease, plus implications of recent clinical trials.

Areas of focus:

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:

  • The neurohormonal model of vascular dysfunction in heart failure and implications for treatment
  • Reassessing management of heart failure based on recent clinical trials
  • Confronting misconceptions about ß-blockers and expanding opportunities for CV protection with neurohormonal blockade.




A. Heart failure: A challenge to the healthcare delivery system

Download 03HFS001.ppt (3 slides - 0.5MB)

A.  Heart failure: A challenge to the healthcare delivery system The comparative cost of heart failure High lifetime risk of heart failure

B. Vascular dysfunction of the failing heart:

Download 03HFS002.ppt (14 slides - 2.5MB)

B.  Vascular dysfunction of the failing heart: Role of RAAS and SNS in HF progression Combination ACEI and b-blockade enhances RAAS inhibition b-Blockade blunts stress-related increase in coronary atherosclerosis b-Blocker Cholesterol-lowering Asymptomatic Plaque Study (BCAPS):  Study design BCAPS: Change in carotid artery bulb IMT during 3-year follow-up ELVA:  Study design ELVA:  b-Blockade decreases atherosclerotic progression Results from Heart Protection Study: First major vascular event (coronary Hypothesis: b-Blockade improves myocardial function and reverses remodeling Myocardial gene expression in dilated cardiomyopathy in response to Hypothetical mechanism of b-blocker induced improvement in Potential consequences of inflammation in heart failure Potential associations of early b-blockade

C. Reassessing clinical management of heart failure:

Download 03HFS003.ppt (14 slides - 2.6MB)

C.  Reassessing clinical management of heart failure: MERIT-HF:  Reduction in total mortality and hospitalizations in women MERIT-HF: Efficacy of b-blockade in elderly patients with heart failure COPERNICUS: Effect of b-blockade in patients with severe HF by MERIT-HF:  Effects of b-blockade on mortality in post-MI and MERIT-HF:  Effect of b-blockade on total mortality or HF hospitalization b-Blocker titration in major HF trials MERIT HF: Discontinuation from study medicine during follow-up MERIT-HF: Consistent heart rate reduction with lower vs higher MERIT-HF: Flexible dosing achieves consistent results b-Blockade modifies circadian pattern of ventricular tachyarrhythmias Sudden death: Risk reduction with b-blockade MADIT II: Survival with prophylactic ICD in MI patients with EF ≤30% Predictive power of BNP for HF hospitalization or death

D. Neurohormonal blockade across the continuum

Download 03HFS004.ppt (19 slides - 3.7MB)

D.  Neurohormonal blockade across the continuum b-Blockade for cardioprotection SOLVD: Effect of b-blockade on mortality in patients with asymptomatic ACC/AHA heart failure guidelines:  Treating asymptomatic patients ACC/AHA heart failure guidelines: Treating symptomatic patients Contemporary therapy for heart failure Effect of b-blockade on mortality among high-risk post-MI patient subgroups: Observational study Potential role of b-blockade in survival after percutaneous coronary intervention b-Blockade after percutaneous coronary intervention: Benefits observed in Common misconceptions about b-blockade b-Blockade and potential symptoms of depression, fatigue, and sexual dysfunction Expanded options for patients with renal hypertension: AASK study design AASK: Effect of drug intervention on proteinuria AASK: Risk reduction in GFR decline, ESRD, or death—Outcomes with AASK: BP achieved vs drugs required Trends in cardiac medications of proven benefit in outpatients Secondary prevention medications are underprescribed in women with CAD Morbidity and mortality benefits of b-blockade in HF: Number Health and economic impact of increased use of b-blockers after first MI
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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 or AstraZeneca, Aventis Pharmaceuticals Inc, King Pharmaceuticals, Pfizer Inc, Wyeth Pharmaceuticals, or the publisher. The reader is advised to consult the full prescribing information of each product prior to use.

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 Inc, King Pharmaceuticals, Pfizer Inc, and Wyeth Pharmaceuticals.

©2003 Medical Education Consultants, Inc. (MEDCON). All rights reserved.

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