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Core Curriculum

• Impact of vascular biology in treatment of cardiovascular disease Section I: RAS manipulation

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 major focus of this section of the lecture program is in the following areas:

  • Emerging basic science advances in the role of the renin-angiotensin system (RAS) in vascular biology and implications for clinical practice
  • Latest clinical trials that are continuing to demonstrate significant improvement in clinical outcomes through treatment directed to the vascular wall
  • Recent clinical trials that demonstrate significant reductions in coronary artery disease, stroke, hypertensive nephropathy, and diabetes through RAS manipulation



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Section I: RAS manipulation

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Section I: RAS manipulation Optimizing the use of evidence-based CHD therapies would save lives

Section I: RAS manipulation

Download S002.ppt (8 slides - 1.2MB)

Section I: RAS manipulation Vicious Cycle of Ang II production Proinflammatory effects of Ang II Endothelial dysfunction and increased oxidative stress predict CV events ACE activity is increased in coronary artery specimens from patients with ACS Ang II induces superoxide production in human vascular tissue Inhibition of NAD(P)H oxidase by ACEI blunts superoxide (O2-) production ACE inhibition: Continuum of beneficial effects

Section I: RAS manipulation

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Section I: RAS manipulation HOPE: Effect of ACEI plus concomitant cardiovascular therapy on MI HOPE: Reduction of risk for LVH in high-risk patient subgroups HOPE: Impact of LVH reversal or prevention on primary outcome HOPE: Estimated vs observed risk reductions HOPE: Clinical benefits compare favorably with major statin trials in CAD patients Cost-effectiveness of proven CV and non-CV interventions for risk reduction AHA/ACC secondary CHD prevention guidelines: Lifestyle modifications AHA/ACC secondary CHD prevention guidelines: Drug treatment AHA/ACC secondary CHD prevention guidelines: Goals for BP, lipids, glucose

Section I: RAS manipulation

Download S004.ppt (9 slides - 1.5MB)

Section I: RAS manipulation Influence of hypertension on carotid atherosclerosis PROGRESS: Effect of ACEI-based BP reduction on stroke PROGRESS: Similar reductions in events regardless of BP status PROGRESS: Differing effects of combination and single-drug regimens Stroke risk reduction in HOPE and PROGRESS Stroke risk reduction in clinical trials with ACE inhibitors AHA primary stroke prevention guidelines: Lifestyle modifications AHA primary stroke prevention guidelines

Section I: RAS manipulation

Download S005.ppt (16 slides - 2.7MB)

Section I: RAS manipulation AASK: Study design AASK: Changes in GFR according to baseline UP/Cr (3-year data) AASK: Risk reduction in GFR decline, ESRD, or death with ACEI, AASK: Clinical implications REIN post hoc analysis: Kidney survival by GFR tertile with ACEI REIN post hoc analysis: Renoprotective effect of ACEI is independent REIN post hoc analysis: Clinical implications Multidrug approach to patients with chronic nephropathy Targets of multidrug approach in chronic nephropathy or nephrotic-range proteinuria patients Renal disease progression after diagnosis of type 1 and type 2 diabetes Microalbuminuria progression rate predicts CHD mortality in diabetic patients Effect of ARBs in patients with type 2 diabetes and nephropathy Trials of RAS inhibition in patients with type 2 diabetes and microalbuminuria IRMA-2: Primary outcome MICRO-HOPE: Effect of ACE inhibition on renal and CV outcomes

Section I: RAS manipulation

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Section I: RAS manipulation HOPE: Reduction in new-onset diabetes Potential mechanisms for reduction in new-onset diabetes with ACEI CV risk reduction with ACEIs in type 2 diabetes: ABCD, CAPPP, and FACET Evidence-based effects of antihypertensive agents in diabetic patients ADA: BP goals and treatment indictations for hypertensive diabetic patients ADA: Pharmacologic treatment of high BP in patients with diabetes— Majority of high-risk diabetic patients are not receiving optimal therapy

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, Monarch 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, Monarch Pharmaceuticals, Pfizer Inc, and Wyeth Pharmaceuticals.

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

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