Pierpont, Gordon L., M.D., Ph.D.

CARDIOLOGY / INTERNAL MEDICINE

The autonomic nervous system is critically involved in the Pathophysiology of many cardiovascular diseases, and numerous medications have either direct or indirect autonomic effects. Ongoing studies are seeking expanded ways to evaluate autonomic function in health and disease by examining heart rate recovery from exercise. This involves custom analysis of exercise heart rate recovery that is designed to provide independent assessment of both sympathetic and parasympathetic function, as well as the nature of the interaction between the two. Exercise recovery is analyzed and compared among normal subjects and those with heart failure, diabetes, hypertension, and known parasympathetic disturbances such as neurally mediated syncope. The results are compared to other measures of autonomic function, such as heart rate variability, valsalva maneuver and cold face test. In addition, this investigator remains active as a participant in several large national and international cooperative therapeutic trials. This includes the HOPE-TOO trial, a follow-up to the HOPE trial. The international multicenter HOPE trial recently demonstrated the benefit of angiotensin converting enzyme inhibitors in prolonging life in patients with known vascular disease, or who are at high risk for vascular disease. HOPE-TOO is evaluating the effects of vitamin E, vitamins B-6, B-12, and folate in a similar group of patients. The vitamin E arm of the trial was just completed and showed no beneficial or detrimental effects. The CARP trial (Coronary Artery Revascularization Prophylaxis trial) is a VA cooperative study designed to determine if routine prophylactic revascularization is beneficial in patients with coronary artery disease about to undergo vascular surgery. COORS (Current Opinion On Revascularization Study) is a substudy of CARP designed to assess current opinions among cardiologists in various regions of the US and Canada regarding the efficacy of prophylactic revascularization in patients with coronary disease about to undergo vascular surgery.