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Core Curriculum

• Impact of vascular biology on cardiovascular disease, risk prevention, and treatment Section III: Heart failure: The new vascular biology imperative to blunt progression

The VBWG Core Curriculum 2004: Impact of vascular biology on cardiovascular disease, risk prevention, and treatment. Volume VI. This edition of the core curriculum is special, because it marks the 10th anniversary of the Vascular Biology Working Group. It covers basic science and clinical advances in vascular biology in a spectrum of disorders. The material is presented in five sections:

This slide/lecture program describes the epidemiology and pathophysiology of heart failure (HF) and highlights treatment strategies to prevent the development and progression of the syndrome. The contents provide insights and updates in key areas.

  • Defining the public health burden of HF in an aging population
  • Update on mechanisms of HF pathophysiology
  • Recent clinical trials with advances in sympathetic and renin-angiotensin-aldosterone-system blockade in managing HF to reduce disease progression
  • Latest guidelines and strategies for avoiding the onset of HF in high-risk patients and blunting disease progression




    Heart failure: An increasing public health burden

    Download 04CoreHFS001.ppt (7 slides - 1.3MB)

    Heart failure: An increasing public health burden HF in diabetes: A frequent complication Hospital discharges for HF by age: 1990 vs 2000 20% Lifetime risk for HF after age 40 Hypertension is the No. 1 risk factor for HF Cumulative incidence of HF by hypertension stage US trends in HF: Older, sicker patients, lower survival rates

    Important pathophysiologic mechanisms in HF (1)

    Download 04CoreHFS002.ppt (13 slides - 3.5MB)

    Important pathophysiologic mechanisms in HF (1) Important pathophysiologic mechanisms in HF (2) Important pathophysiologic mechanisms in HF (3) Neurohormonal model of HF -Blockade normalizes Ang II-provoked release of norepinephrine in HF Molecular model of HF Regulation of key molecules in cardiac EC coupling bystress-activated pathways Myocardial force generation increases in response to -blockade  in HF after exposure to isoproterenol The RAAS in HF Escape of Ang II despite ACE inhibition RESOLVD: Ang II concentrations similar at baseline and study end AT1-receptor blockade improves vasorelaxation in HF by upregulation of eNOS via AT2 receptors Primary targets of treatment in HF

    CHARM Program: 3 Component trials comparing candesartan with placebo

    Download 04CoreHFS003.ppt (46 slides - 9.1MB)

    CHARM Program: 3 Component trials comparing candesartan with placebo CHARM Program: Baseline characteristics CHARM Program: Baseline medications CHARM-Overall: CV death and non-CV death CHARM Program: Reduction in mortality and morbidity CHARM Program: Reduction in CHF hospitalization CHARM-Preserved: Hospital admissions for CHF CHARM-Overall: Effects of candesartan on CV death or HF hospitalization—Subgroup analysis CHARM-Overall: Effects of candesartan on CV death or HF hospitalization—Subgroup analysis (cont’d) CHARM-Added: Effect of combined ACE inhibitor/-blocker/AT1-receptor blocker CHARM-Overall: Drug discontinuations for adverse events CHARM: Clinical implications CHARM-Overall: Reduction in new-onset diabetes CHARM: Impact of treatment HF with preserved LV systolic function in the elderly: Impact on survival CHARM-Preserved: CV death or CHF hospitalization CHARM-Preserved: Primary and secondary outcomes CHARM-Preserved: Clinical implications VALIANT: Design VALIANT: Concomitant medications VALIANT: Treatments show similar effect on outcome VALIANT: Clinical implications VALIANT: Effect of treatment on mortality—Subgroup analysis RESOLVD: Comparative impact of ACE inhibitor, ARB, and -blocker alone or combined on LVEF Differences in dosing among ARB trials Survival studies of -blockade in HF -Blockers improve survival in diabetic patients with HF:  A meta-analysis MERIT-HF: -Blockade improves survival in CHF MERIT-HF: -Blockade improves survival in post-MI patients  with HF MERIT-HF: Subgroup analysis in post-MI patients with HF (LVEF <25%) SOLVD: Heart rate predicts progression of asymptomatic LV dysfunction MERIT-HF: Effect of -blockade on heart rate MERIT-HF: -Blockade decreases mortality and hospitalization independent of resting heart rate CHRISTMAS: Design CHRISTMAS: Trial profile CHRISTMAS: Change in LVEF according to number of segments affected by myocardial hibernation COMET: Trial profile COMET: All-cause mortality COMET: Heart rate at each visit COMET: Blood pressure -Blocker HF trials: Mortality results Mortality rates in perspective CIBIS-II, MERIT-HF, COMET Immediate-release vs sustained release metoprolol: Significant pharmacokinetic differences COMET: Clinical implications Comparison of -blocker effects in major HF trials Not all -blockers are the same

    ACC/AHA guidelines for HF therapy: Key features

    Download 04CoreHFS004.ppt (3 slides - 0.7MB)

    ACC/AHA guidelines for HF therapy: Key features Classification of HF: ACC/AHA stage vs NYHA class ACC/AHA stages of systolic HF and treatment options
    Published by Medical Education Consultants, LLC (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, King Pharmaceuticals Inc, Pfizer Inc, and 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, LLC, Westport, Connecticut, on behalf of the University of Florida College of Medicine through an unrestricted educational grant provided by AstraZeneca, King Pharmaceuticals Inc, Pfizer Inc, and Wyeth Pharmaceuticals.

    ©2004 Medical Education Consultants, LLC (MEDCON). All rights reserved.

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