EAN: 9783642633324

MOLECULAR APPROACHES TO HEART FAILURE THERAPY K...

G. HASENFUSS  E. MARBAN Heart failure embodies the central irony of modern medicine. As we have
become increasingly adept at treating the major proximate causes of death in Western society 
we have effectively converted acute illness into chronic malady. The last twenty years have
witnessed a revolution in the treatment of acute coronary syndromes  myocardial infarction in
particular. Patients who reach the hospital now have every expectation of leaving alive  but
not necessarily well. Our ability to blunt the edge of ischemic insults has en gendered new
problems: a new cohort of patients whose hearts function well enough to enable short-term
survival  but at the cost of decreased ex ercise tolerance  dyspnea and increased long-term
mortality. The irony is compounded by our increasingly sophisticated pharmacopeia for the treat
ment of heart failure  which  by slowing the progression of ventricular dys function  has
created a chronic illness. The fact of its chronicity makes heart failure no less deadly. In
symptomatic patients  mortality exceeds 5-10% per year even with the best contemporary therapy.
Not all heart failure is ischemic  of course  but the final common phenotype is eerily
concordant regardless of the proximate cause. No wonder  then  that heart failure is the
leading cause of hospitalization in America and in Western Europe and that the prevalence of
the disease continues to rise. Drugs have indeed revolutionized heart failure therapy  ACE
inhibitors and beta-adrenergic blockers having the most outstanding records to date.

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