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(Circulation. 2007;116:1344-1345.)
© 2007 American Heart Association, Inc.

Editorial

Bypassing Big Pharma

James M. Downey, PhD; Michael V. Cohen, MD

From the University of South Alabama, Departments of Physiology (J.M.D., M.V.C.) and Medicine (M.V.C.), Mobile, Ala.

Correspondence to James M. Downey, MSB 3074, University of South Alabama, Mobile, AL 36688. E-mail jdowney@usouthal.edu

Key Words: Editorials • coronary disease • ischemia • reperfusion

An extract of the first 250 words of the full text is provided, because this article has no abstract.

There have been many resounding victories in the war against coronary artery disease. Among those are antiarrhythmic drugs, pacemakers, coronary bypass surgery, coronary angioplasty, reperfusion therapy, and statins. But the one goal that has continuously eluded us has been the clinical availability of an effective cardioprotective agent. Although reperfusion therapy has partially achieved the goal of limiting infarct size in the setting of acute myocardial infarction, the logistics usually prevent restoration of perfusion until after a significant amount of myocardium has been lost to infarction. In 1974, when Braunwald¹ proposed that priority should be given to the identification of interventions that would make the myocardium resistant to infarction, nobody knew what an arduous task that would be. In the beginning, "big pharma" was a strong partner in this quest, and many drugs were evaluated. The first wave of drugs like ß-blockers and calcium antagonists were examined because it was believed that they would reduce oxygen consumption and that an improvement in the supply-demand relationship in the heart would suppress infarction. Unfortunately, the determinants of oxygen consumption in the ischemic heart are very different from those in the well-perfused heart, and not surprisingly, these drugs were ineffective. Then, the focus shifted to antioxidants and antiinflammatory agents. Their preclinical performance was inconsistent, and the clinical trials that they spawned were all decidedly negative. Most recently, a great deal of money was spent on the development of the sodium–hydrogen exchange blocker cariporide, which again failed in clinical trials. Adenosine and insulin suffered similar . . . [Full Text of this Article]

This article has been cited by other articles:

				W. R. Tracey Letter by Tracey Regarding Article, "Bypassing Big Pharma" Circulation, March 18, 2008; 117(11): e194 - e194. [Full Text] [PDF]

				J. M. Downey and M. V. Cohen Response to Letter Regarding Article, "Bypassing Big Pharma" Circulation, March 18, 2008; 117(11): e195 - e195. [Full Text] [PDF]