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• Improving Outcomes in Heart Failure: New Insights From Vascular Biology



Improving Outcomes in Heart Failure: New Insights From Vascular Biology

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Improving Outcomes in Heart Failure: New Insights From Vascular Biology Heart Failure:
A Public Health Concern 20% Lifetime risk for HF after age 40 Hypertension is the No. 1 risk factor for HF Diabetes: A frequent comorbidity with HF Diabetes is the No. 1 risk factor for HF in women with coronary disease Increasing risk for HF in women with CHD: Impact of diabetes, renal insufficiency, obesity Heart Failure Pathophysiology Important pathophysiologic mechanisms in HF (1) Important pathophysiologic mechanisms in HF (2) Important pathophysiologic mechanisms in HF (3) Neurohormonal model of HF Diabetes pathogenesis accelerates HF RAAS in CV continuum: Pivotal role of AT1 receptors in the failing heart Primary targets of treatment in HF Angiotensin receptor blockade in the CVD continuum Clinical Trial Update Survival studies of -blockade in HF MERIT-HF: Metoprolol succinate CR/XL lowers risk of hospitalization with/without diabetes MERIT-HF: Benefit of -blockade with/without diabetes Pooled HF trials: Effect of -blockade on survival in diabetic patients GEMINI: Design GEMINI: Change in HbA1c and insulin sensitivity RESOLVD substudy: Effect of metoprolol succinate CR/XL on glucose and insulinRESOLVD substudy: No effect on glucose and insulin with metoprolol succinate CR/XL Implications for -blockade in diabetes and HF MERIT-HF: Mortality benefit of -blockade in the elderly Meta-analysis: -Blockade improves survival in elderly HF patients SENIORS: Design SENIORS: Primary and secondary outcomes SENIORS: Clinical relevance Benefit of -blockade on mortality in urban patients with HF Not all -blockers are the same Metoprolol tartrate vs metoprolol succinate CR/XL: Significant pharmacokinetic differences Effect of metoprolol succinate CR/XL vs atenolol on exercise heart rate/SBP over 24 h   Recommended ACEI doses do not completely halt Ang II formation in HF CHARM Program: 3 Component trials comparing candesartan with placebo CHARM Program: Reduction in mortality and morbidity CHARM-Overall: CV death and non-CV death—Secondary endpoints CHARM-Overall: Reduction in mortality and nonfatal MI with candesartan CHARM—Low LVEF trials: Risk reductions at 1 and 2 years with candesartan CHARM Program: Outcomes overview CHARM-Overall: Reduction in new-onset diabetes VALIANT: Design VALIANT: Treatments show similar effect on outcome VALIANT: Poorer 1-year outcomes in patients with new-onset or previous diabetes Clinical implications of CHARM and VALIANT Benefit of ARB + ACE inhibitor in HF ARBs in LV dysfunction: Before/after CHARM and VALIANT Difference in target dosing among ARB trials Impact of RAAS modulation on mortality in HF patients with renal insufficiency Summary ACC/AHA stages of systolic HF and treatment options
This program was prepared and produced by Medical Education Consultants, LLCSM, Westport, Connecticut, 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, or the publisher.
The reader is advised to consult the full prescribing information for each product prior to use.

© 2005 Medical Education Consultants, LLCSM (MEDCON). All rights reserved.

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