Therapeutic Angiogenesis and Myocardial Regeneration

Ischemic heart disease is the leading cause of morbidity and mortality in the Western world. The term “ischemic heart disease” covers a broad spectrum of manifestations ranging from effort-induced angina without myocardial damage, through stages of chronic myocardial ischemia with associated reversible impairment in ventricular function, to states of irreversible myocardial injury and necrosis resulting in congestive heart failure (CHF). Ischemic heart disease, therefore, is the leading cause of CHF, a disease process that affects approx 1% of adults in the United States, with 550,00 new cases diagnosed annually and an incidence of 10 cases per 1000 population after age 65 (1). With the aging of the population, the incidence of this problem is increasing, as evidenced by the number of discharges for CHF, which rose from 377,00 in 1979 to 999,000 in 2000 (165% increase) (1). In addition, >50,000 deaths per year in the United States are directly attributable to CHF (1). Likewise, the costs of caring for these patients is enormous, with $3.6 billion ($5471 per discharge) paid to Medicare beneficiaries for CHF-related treatment based on the most recently available data from 1998 (1). Currently, median survival after diagnosis of CHF is 1.7 yr for men and 3.2 yr for women (1), indicating a general inadequacy of presently available treatment options for the majority of these patients. Consequently, novel therapies are needed to improve the outlook for this patient population.