Professor Jay N. Cohn, Director of the Rasmussen Centre for Cardiovascular Disease Prevention at the University of Minnesota Medical School, Minnesota, USA, talks to Cardio-Debate about the ‘Unresolved Issues in the Search for Better Heart Failure Strategies’.

The main issue with drugs used in heart failure management, explains Professor Cohn, is that they were designed to slow progression and improve survival. “We’ve dealt with drugs that block the renin and angiotensin system, the vasopressin system, the aldosterone system, and more recently focussing on stimulating nitric oxide as another mechanism, that contributes to progression of the disease.”

The problem is that these drugs do multiple things,” he adds. “They don’t work at one site, and some of the things they do, we don’t understand. We certainly don’t understand why they influence the course of heart failure.”

“We keep adding drugs to the regimen, and we now have patients taking up to seven different drugs because each has ben shown to be effective in a large population. But we really don’t understand how the individual patient responds to these drugs,” he says. “That would really require us to have more insight into the mechanisms that vary from individual to individual.”