University of Rochester Medical Center, Rochester, N.Y.

I'm Dr. Arthur Moss, professor of medicine and cardiology and director of the Heart Research Follow-Up program.

I'm also the principal investigator of a large clinical trial that's ongoing, trying to see if we can prevent the development and inhibit the development of heart failure in at-risk patient with heart disease. And also trying to improve survival through the use of the implantable defibrillator, a device that has now been on the market for 20 years or so.

The idea of this is that there are patients who have had previous heart attacks or have an inflammatory condition of the heart something called myocarditis, where they end up with a lot of scar in the heart and these patients are at risk for very dangerous heart rhythm disorders.

And what we've been able to show in the past, is that with an implantable defibrillator in these patients, it can reduce the risk of death by about 30 percent, and this is in the very high risk group.

We are currently working on a study to prevent the development of heart failure with what we refer to, and has been referred to, as resynchronization therapy. A way of pacing a portion of the heart to make it contract more efficiently and more uniformly, and our current study is a large study involving 1820 patients who are randomized either to the resynchronization therapy or not.

And the findings from this study should be available sometime within the next year. So this is, as a physician we frequently treat patients who have established heart disease, at the same time we have a responsibility to try and practice preventive cardiology for the primary prevention of heart attacks and heart disease.

And it is in this realm where the epidemiology of trying to prohibit weight gain so that one avoids the development of diabetes, the treatment aggressively of high blood pressure so that this prevents the stress and strain on vessel walls, and the controlling of cholesterol levels that are now quite easy to do, and finally the prohibition and elimination of smoking.

And in this primary prevention, this has had a very significant effect in reducing the frequency and incidence of coronary disease, or more commonly, heart attacks.

So there is that preventive aspect. There is the need for aggressive treatment when the patient does have a heart attack by opening up the blood vessel -- that's called angioplasty -- that is they open up the blood vessel and may require a stent.

And then the third aspect is in patients with established chronic disease. Can we, in fact, prevent the occurrence of heart failure and heart rhythm disorders? And that's where I've spent a good portion of our time and research.

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