The Division of Cardiovascular Medicine is involved in broad areas of clinical and basic science research. The first general area is the study of new pharmacological therapies for acute coronary syndromes and interventional cardiology. These studies involve the evaluation of new anti-platelet therapy (GPIIb/IIIa inhibitors), growth factors (VEGF and FGF), and radiation therapy. The latter two are the most novel approaches to treating patients with coronary artery disease. Growth factors have been shown to enhance the development of collateral blood flow and two ongoing multicenter trials are evaluating the use of fibroblast growth factor and vascular endothelial growth factor in the development of new collaterals in patients who are not candidates for revascularization. In the ARTISTIC and ARREST Trials, intravascular radiation therapy, given in a low dose, is being evaluated to prevent the development of restenosis, a serious problem affecting patients who have undergone angioplasty.

Basic research into the mechanism of restenosis is also currently ongoing, with the evaluation of the role of extracellular matrix and collagen and the role of the nuclear receptor P-par gamma. In addition, the mechanism of the beneficial effects of radiation in the prevention of restenosis is being evaluated in a porcine model of restenosis.

Numerous studies are ongoing in the atherosclerosis research unit, formerly the Atherosclerosis Research Institute. Current studies involve the evaluation of estrogen replacement in post-menopausal women and the role of Vitamin E and anti-oxidants.

The effects of various new pharmacological treatments for high blood pressure and congestive heart failure are also currently be studied. In particular, the risks and benefits of various agents, including calcium channel blockers, are being carefully studied.

Studies by Dr. Kloner's group at the Good Samaritan Heart Institute include clinical and translational basic science. Currently, several projects are looking at Viagra and its effect on coronary blood flow and high blood pressure, gene therapy and the effect of genes injected into the heart for vascular endothelial growth, and the use of a hormone called the fibroblastic growth factor to enhance the growth and differentiation of immature heart cells that are then implanted into diseased hearts.

Finally, the development of newer diagnostic imaging modalities is being undertaken. A novel, high resolution echocardiographic device has been developed that can image structures as small as cell components. When fully developed, it may allow for more precise understanding of cellular events that occur in cardiac and vascular disease.

Howard Hodis, M.D.

The Benefit of Estrogen-Progestin Lipid-Lowering Hormone Atherosclerosis Regression Trial

Role of Vitamin E in the Prevention of Atherosclerosis

Role of Antioxidants in Atherosclerosis: A single center, randomized trial sponsored by the NHLBI is evaluating the benefits of estrogen-progestin and lipid lowering therapy in women, who have evidence of mild to moderate atherosclerosis. Three year follow-up is planned and the trial has met enrollment criteria and is currently in the follow-up phase. Also, the benefit of Vitamin E in the prevention of atherosclerosis using noninvasive assessment, namely the measurement of intimal medial thickness by d-mode ultrasound. The role of antioxidants in athersclerosis are also being investigated.

Uri Elkayam, M.D.

The Effect of Amlodipine on Survival in Patients with CHF

The Effect of Natrecor BNP Given as a Continuous Infusion in the Treatment of Decompensated CHF

The Roles of Amlodipine and BNP in the Treatment of Severe Congestive Heart Failure are Being Studied in these Multicenter Drug Studies.

Robert A. Kloner, M.D., Ph.D.

Database Study of Patients with High Blood Pressure Using Multiple Antihypertensive Medicine and Then Received Viagra.

Cell implantation therapy using a hormone called fibroblastic growth factor to enhance the growth and differentiation of immature heart cells.

Testing substances that inhjibit white cells from sticking to blood vessels as a way of possibly decreasing damage during a heart attack.

Cellular and biochemical mechanisms of a powerful heart attack size reducer - preconditioning using various heart models.