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Volume 6, No 3 - Summer 2005

Volume 6, No 3 - Summer 2005

Table of Contents

The Past, Present, and Future of Statin Therapy Treatment Review
Statins are a remarkably safe and efficacious class of medications that have proved to be invaluable in the fight against heart disease. Statins have been prescribed to millions of patients for nearly 20 years; thus there have been hundreds of millions of patient-years of use, with relatively few adverse effects and incalculable benefits. Results from large-scale clinical trials have shown that statins are associated with dramatic decreases in cardiovascular risk. It seems certain that statins will remain a valuable and essential part of the lipid-lowering landscape, but combinations of statins with other lipid-lowering agents are increasingly important. Even with the most potent statins, the desired low-density lipoprotein cholesterol goal might not be attained with statin monotherapy. Furthermore, because of the increasing prevalence of diabetes and the metabolic syndrome, along with their attendant multiple lipid abnormalities, combinations of statins with medications targeted toward multiple lipoprotein particles will emerge. [Rev Cardiovasc Med. 2005;6(3):129-139]
Expanding Cardiac Resynchronization for Systolic Heart Failure to Patients With Mechanical Dyssynchrony and Atrial Fibrillation Treatment Update
Despite progress in the management of heart failure (HF) using pharmacotherapy, the mortality and morbidity associated with this condition remain unacceptably high. Cardiac resynchronization therapy (CRT), a left-sided pacing therapy for drugrefractory and highly symptomatic HF patients with ventricular conduction delay, has been shown to improve left ventricular (LV) systolic function, myocardial oxygen consumption, and New York Heart Association functional class and to inhibit or reverse LV chamber dilation and remodeling. Atrial fibrillation is common in patients with HF and is associated with significant worsening of HF and myocardial function. Only recently have trials been designed to specifically study CRT in patients with HF and chronic atrial fibrillation. These studies have shown that CRT with biventricular or univentricular LV pacing in patients with atrial fibrillation corrects mechanical dyssynchrony and results in significant and sustained improvement in functional capacity, LV ejection fraction, quality of life, and QRS duration. [Rev Cardiovasc Med. 2005;6(3):140-151]
Chronic Angina: New Medical Options for Treatment Treatment Update
As the US population ages, the pool of patients with coronary artery disease and stable angina is projected to grow. Conventional approaches with mechanical and pharmacological therapies have made inroads toward curbing this trend, reducing the risk of future myocardial infarction and cardiac death. However, the potential benefits of currently available antianginal medications are limited by reduced work capacity, orthostasis, and important drug-drug interactions. A new approach is represented by the piperazine derivatives trimetazidine (TMZ) and ranolazine (RNZ). TMZ acts to partially inhibit fatty acid oxidation, thus shifting myocardial energy metabolism to a lower oxygen-consuming state. A total of 16 randomized trials have been completed with TMZ. In the US market, 6 trials have been completed with RNZ. RNZ has been separately classified as a late sodium channel inhibitor, which reverses action potential prolongation, suppresses early after-depolarizations, and terminates resultant ventricular tachycardia. Though it has some of the same fatty acid oxidation properties as TMZ, this is not considered its primary mechanism of action. This paper reviews medical approaches to chronic stable angina and highlights RNZ as an important advance for patients and clinicians in the US market. [Rev Cardiovasc Med. 2005;6(3):152-161]
Exploring a New Definition of Hypertension Meeting Review
A Report from the American Society of Hypertension Annual Meeting May 14–18, 2005 San Francisco, CA