ADAPTATION TO MYOCARDIAL STRESS IN DISEASE STATES - IS PRECONDITIONING A HEALTHY HEART PHENOMENON

Effective therapeutic strategies for protecting the ischaemic myocardi um are much sought after. Ischaemic heart disease in humans is a compl ex disorder, often associated with other systemic diseases such as dys lipidaemia, hypertension and diabetes that exert multiple biochemical effects on the heart, independently of ischaemia. Ischaemic preconditi oning of myocardium is a well-described adaptive response in which bri ef exposure to ischaemia markedly enhances the ability of the heart to withstand a subsequent ischaemic insult. The underlying molecular mec hanisms of this phenomenon have been extensively investigated in the h ope of identifying new rational approaches to therapeutic protection o f the ischaemic myocardium. However, most studies have been undertaken in animal models in which ischaemia is imposed in the absence of othe r disease processes. In this article, Peter Ferdinandy, Zoltan Szilvas sy and Gary Baxter review the ways in which systemic diseases might mo dify the preconditioning response and they emphasize the importance of further preclinical studies that specifically examine preconditioning in relation to complicating disease states.