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Role of Coronary Vasoconstriction in Ischemic Heart Disease and Search for Novel Therapeutic Targets

机译:冠状动脉血管收缩在缺血性心脏病中的作用及寻找新的治疗靶点

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Atherothrombosis has long been recognized as an important mechanism of cardiac events in ischemic heart disease, and large multicenter clinical studies have shown the benefit of antiplatelet agents, statins, /?-blockers and angiotensin converting enzyme inhibitors in preventing these events. However, more recent studies have been less successful at showing incremental gains in targeting these mechanisms, suggesting that the limits of this strategy have been exploited. Coronary vasoconstriction is another important mechanism in ischemic heart disease but has received little attention and yet is a potential therapeutic target, In the current review, the reasons why coronary vasconstriction has received insufficient consideration are explored. In particular, we need to change our approach from lumping heterogeneous clinical entities together to focusing on clinically-discrete homogeneous groups with a common mechanism and thus therapeutic target. The role of coronary vasoconstriction is examined in the various ischemic syndromes (variant angina, chronic stable angina, acute coronary syndromes and syndrome X) and the underlying mechanisms discussed. Finally, in order to advance studies in this field, an innovative research strategy is proposed, including: (1) selection of paradigmatic cases for the various ischemic syndromes; (2) candidate therapeutic targets; and (3) approaches in assessing the clinical efficacy of these potential therapies.
机译:长期以来,动脉粥样硬化被认为​​是缺血性心脏病中心脏事件的重要机制,大型多中心临床研究表明,抗血小板药,他汀类药物,β-受体阻滞剂和血管紧张素转化酶抑制剂可预防这些事件。但是,最近的研究未能成功地显示出针对这些机制的增量收益,这表明该策略的局限性已被利用。冠状动脉血管收缩是缺血性心脏病的另一重要机制,但很少受到关注,但仍是潜在的治疗靶点。在本综述中,探讨了冠状动脉血管收缩未得到充分考虑的原因。特别是,我们需要将我们的方法从将异类临床实体混在一起转变为关注具有共同机制并因此具有治疗靶点的临床离散同质基团。在各种缺血性综合征(变异性心绞痛,慢性稳定型心绞痛,急性冠状动脉综合征和X综合征)中检查了冠状动脉血管收缩的作用,并讨论了其潜在机制。最后,为了推进这一领域的研究,提出了一种创新的研究策略,包括:(1)选择各种缺血综合征的典型病例; (2)候选治疗靶点; (3)评估这些潜在疗法的临床疗效的方法。

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