VASCULAR BASIS FOR THE TREATMENT OF ISCHEMIA

心肌缺血活动性被用来评估风险和管理 患有冠状动脉疾病的患者。的存在和严重程度 缺血引发了关于如何治疗这种疾病的根本重要问题 解决问题，减少不良后果的发生。试点研究是 正在评估标准抗心绞痛治疗的有效性 (药物和血运重建)。然而，在冠心病患者中 动脉粥样硬化，危险因素，如血浆低密度脂蛋白和氧化低密度脂蛋白 已知会损害内皮功能，导致血管扩张丧失， 异常的血管收缩、促凝血剂表面和粘连 炎性细胞。临床研究表明，这些功能障碍 是梗阻患者心肌缺血的重要原因 冠状动脉疾病。因此，我们计划检验这一假设 A积极治疗血浆低密度脂蛋白和氧化低密度脂蛋白；(A)结果 在改善脑缺血患者的脑缺血活动方面有重要作用 冠状动脉疾病，以及(B)特征相反的细胞/血管壁 动脉粥样硬化患者的动脉功能障碍。我们 计划前瞻性随机、双盲、安慰剂对照、平行 冠心病患者的设计试验，活动性心肌 缺血和血浆低密度脂蛋白升高。动态心电监测与超声 对肱动脉内皮依赖性血管运动的检查将 两者均可用于测量缺血和动脉功能障碍的活动性。 在基线和治疗12个月后(1)标准饮食(对照组) 组)，(Ii)标准饮食加洛伐他汀(降低低密度脂蛋白策略)，以及 (3)标准饮食、洛伐他汀和普罗布考(降低低密度脂蛋白和氧化低密度脂蛋白 战略)。提出了初步研究和初步数据，以支持 这项提议。该项目的目标是测试新的 旨在治疗血管功能障碍的治疗方法 冠状动脉粥样硬化，试图控制缺血，即 与不良后果风险增加有关。如果这个替代方案 目前标准抗心绞痛药物的大量使用和血运重建 如果证明是有效的，它可能会对 旨在控制影响患者的不良事件的策略 冠状动脉疾病。

The activity of myocardial ischemia is used to assess risk and manage patients with coronary artery disease. The presence and severity of ischemia raises fundamentally important questions about how to treat this problem and reduce the occurrence of adverse outcomes. Pilot studies are in progress evaluating the effectiveness of standard anti-anginal therapies (drugs and revascularization). however, in patients with coronary atherosclerosis, risk factors such as plasma LDL and oxidized LDL are now known to impair endothelial function leading to loss of vasodilation, abnormal vasoconstriction, a procoagulant surface, and adhesion of inflammatory cells. Clinical research has shown that these dysfunctions are important causes of myocardial ischemia in patients with obstructive coronary artery disease. Therefore, we plan to test the hypothesis that athe aggressive treatment of plasma LDL and oxidized LDL will; (a) result in important improvements in the activity of ischemia in patients with coronary artery disease, and (b) reverse characteristic cell/vessel wall dysfunctions in the arteries of these patients with atherosclerosis. We plan a prospective randomized, double-blind, placebo-controlled, parallel design trial in patients with coronary artery disease, active myocardial ischemia and raised plasma LDL. Ambulatory ECG monitoring and ultrasonic examination of endothelium-dependent vasomotion of the brachial artery will both be used to measure athe activity of ischemia and arterial dysfunction at base-line and after 12 months of therapy with (1) standard diet (Control Group), (ii) standard diet plus lovastatin (LDL lowering strategy), and (iii) standard diet, lovastatin and probucol (LDL and oxidized LDL lowering strategy). Pilot studies and preliminary data are presented in support of this proposal. The goals of this project are to test the value of new therapies aimed at treating the vascular dysfunctions that characterize coronary atherosclerosis in an attempt to control the ischemia that is associated with increased risk of adverse outcomes. If this alternative to the present massive use of standard anti-anginal drugs an revascularization proves effective, it would likely have important implications for strategies aimed at control of adverse events affecting patients with coronary artery disease.