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Volume 7, No 2 - Spring 2006

Volume 7, No 2 - Spring 2006

Table of Contents

Inhibiting the Renin-Angiotensin System to Prevent Cardiovascular Diseases: Do We Need a More Comprehensive Strategy? Treatment Update
The renin-angiotensin system (RAS) plays a pivotal role in the progression of some forms of hypertension and cardiovascular disease. The development of angiotensinconverting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) has provided physicians with effective and well-tolerated inhibitors of the RAS. However, it remains open to question whether ACE inhibitors and ARBs have fully delivered the reductions in cardiovascular risk that we might have expected. There is little doubt that in conditions such as chronic and acute heart failure or diabetic nephropathy these drugs have provided significant protection. But, in patients with high-risk hypertension, for instance, the anticipated benefits of RAS blockade have been less obvious. This article provides a critical assessment of the results of clinical trials of ACE inhibitors and ARBs across a variety of clinical conditions and assesses the potential need for new methods for blocking the renin system, including the use of renin inhibitors. [Rev Cardiovasc Med. 2006;7(2):45-54]
Peripheral Arterial Disease: An Overview of Endovascular Therapies and Contemporary Treatment Strategies Treatment Review
Even in the absence of symptoms, peripheral arterial disease carries with it a significant risk of morbidity and mortality; thus, screening with the use of the ankle-brachial index is important in identifying patients at risk. Endovascular therapy in the lower extremities is continually evolving for treatment of patients with claudication symptoms or limb-threatening ischemia. Alternative treatments such as cryotherapy and the use of laser-assisted angioplasty hold much promise but need further investigation. In the case of renal artery stenosis and resulting hypertension, supportive clinical evidence is limited for renal revascularization despite the rationale for reducing cardiovascular risk. The current standard of care for significant carotid artery stenosis can include carotid stenting and carotid endarterectomy, but medical therapy may have a role also. [Rev Cardiovasc Med. 2006;7(2):55-68]
Congestion in Acute Heart Failure Syndromes: Importance of Early Recognition and Treatment Diagnostic Review
The vast majority of acute heart failure syndrome (AHFS) hospitalizations are related to clinical congestion, rather than to a low cardiac output state. Patients develop hemodynamic congestion (high left ventricular filling pressure) several days to weeks before the onset of clinical symptoms and signs. Congestion is an important predictor of both mortality and morbidity in patients with AHFS. As a result, congestion is an essential evaluative and therapeutic target in AHFS patients. It is plausible that early identification of hemodynamic congestion, before the clinical manifestations are present, could reduce the need for hospital admission and readmission. [Rev Cardiovasc Med. 2006;7(2):69-74]
Platelet Activation and Progression to Complications CME Certified Article - Treatment Update
<p>Platelets localize, amplify, and sustain the coagulant response at an injury site and release procoagulant platelet-derived microparticles. Abnormalities in platelet size and function may be present in acute coronary syndromes and following percutaneous coronary intervention (PCI). Platelet functional assessment prior to PCI is a predictor for the subsequent occurrence of adverse clinical events. Trials of glycoprotein IIb-IIIa inhibitors as adjunctive pharmacotherapy for PCI show that the magnitude of platelet inhibition achieved by therapy correlates with the degree of clinical benefit observed. In general, optimal periprocedural outcomes require high levels of platelet inhibition. Combined administration of antiplatelet therapies may produce additive or synergistic inhibition of platelet-mediated thrombosis. [Rev Cardiovasc Med. 2006;7(2):75-81]</p>
Best of the ACC Scientific Sessions 2006 Meeting Review
Highlights from the American College of Cardiology Scientific Sessions March 11-14, 2006 Atlanta, GA
Obesity Reviewing the Literature
Stroke Reviewing the Literature