依姆多济南__培训课件.pptVIP

* Cellular and Molecular BiologyTM 2005;51, 307-320.ORGANI NITRATES IN CARDIOVASCULAR DISEASE Drugs used in the treatment of CAD fall in two different catagories (Table 1). Some of these drugs exert antianginal effects, while others delay the progression of CAD (121). Antianginal drugs such as nitrates, β-blockers and calcium channel antagonists favourably shift the ratio of myocardial oxygen demand and supply. They relieve chest pain and reduce the duration and frequency of acute ischemic events. In addition, β-blockers have been shown to improve survival in acute myocardial infarction, while the various types of calcium channel antagonists have a neutral effect on mortality (50,55). The dihydropyridine amlodipine reduced intima-media thickness in CAD patients and this was associated with a significant reduction of the 3-year event rate but did not affect mortality (101). In contrast, clinical data on the effects of nitrates on the prognosis of patients with stable angina pectoris are still lacking (96,122) and although a meta-analysis indicates a small but significant decrease in CAD-mortality among nitrate treated patients (57), some clinical data raised the suspicion that nitrates may rather increase mortality in CAD (89). Non-antianginal drugs are used to improve the outcome of CAD patients (Table 2). During the last 15 years many clinical trials have repeatedly shown the value of these drugs. In Germany, the results of the HOPE trial have led to broaden the indications of ramipril, which is now also offered to reduce the risk of myocardial infarction, stroke or cardiovascular death. * Circulation. 2002;106:2510.Mini-Review. Nitrate Tolerance -- A Unifying Hypothesis .Tommaso Gori, MD; John D. Parker, MD From the Division of Cardiology, Department of Medicine, Mount Sinai and University Health Network Hospitals, University of Toronto, Toronto, Canada. Therapy with organic nitrates is associated with a complex series of responses that seem to mediate the phe