Division of Cardiovascular Diseases Strategic Plan

Goals in Cardiovascular Clinical Problems or Disease States

2.2d. Improve the management of acute and chronic coronary syndromes

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Overview

Improved management of clinically manifest coronary artery disease (CAD) is the focus of this goal. This goal seeks to develop and test new approaches to the identification of individuals at high risk for major adverse CV events, and conduct clinical trials of promising drugs, mechanical, and other interventional approaches. Manipulating the physical, cellular, humoral, and chemical environment of coronary arteries and cardiomyocytes can be used as potential strategies for treating acute and chronic coronary syndromes and their sequelae. Interdisciplinary collaboration in basic, translational, and clinical research and development of therapeutic and/or preventive approaches for acute coronary syndromes is anticipated. These approaches may become useful for acute cerebrovascular events, as well.

Strategies to Accomplish this Goal May Entail:

Basic Research:

  • Study fundamental mechanisms of ischemia/reperfusion injury.
  • Identify genetic and environmental pathways that confer susceptibility and protection from ischemic injury.
  • Study cardiac preconditioning to limit infarct size.
  • Study the role of endogenous signaling molecules as important mediators of ischemic injury and cytoprotection.
  • Identify molecular, biochemical and cellular mechanisms involved in the progression of existing coronary lesions and in plaque stability and rupture.
  • Define the molecular determinants of repair and regeneration of the arterial wall.

Translational Research:

  • Develop and validate animal models that predict or replicate human coronary heart disease and use them to validate basic mechanisms and test new therapies.
  • Implement phase I and II studies of a stent or medication designed to suppress plaque activation.
  • Determine the sensitivity and specificity of in vitro platelet function assays for predicting clinical events.
  • Develop new imaging techniques that identify vulnerable plaques/patients.

Clinical Research:

  • Assess which patients with chronic coronary disease benefit from revascularization.
  • Explore physiologic mechanisms by which diet, exercise and physical conditioning affect response to treatments for clinical CV disease .
  • Develop and validate a new paradigm for individually tailored thrombolytic/ antithrombotic therapy.
  • Test approaches to reducing reperfusion injury.

Contributing Sources:

September 2008

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