International Circulation: I’d like to talk today about heart failure specifically.  We have seen several lead breaking heart failure trials presented here at AHA 2009 and one of those trials was the HEAAL study. Can you give us your brief opinion on the HEAAL study as well as any comments about how we can evaluate it? Additionally， what do you think the contribution is to the progress regarding how we can treat heart failure?
 

    《国际循环》：我今天想特别探讨一下心衰。AHA 2009上已经报道了一些心衰领先临床试验，其中之一是HEAAL研究。您能谈谈对HEAAL研究的简要看法么？我们应该如何对其进行评论？此外，您认为这对心衰治疗有何促进作用？
 

    Prof. Nissen：We don’t use Losartan very often for heart failure primarily because we have very good data for another group of drugs.  In my opinion， the data for the ACE inhibitors is very good and that they should be the first line agent for heart failure.  Perhaps 3%~5% of patients in this country will get cough from the ACE inhibitors and in those patients we have been using Candesartan because the very large， very successful trial， CHARM， showed benefit.  The high versus low dose Losartan trial really tells us a lot more about the fact that the traditional doses of Losartan that have been used were probably too low. The drug was launched with the wrong dose and now， 15 years later， have found the right dose of Losartan but I don’t think it is going to have a terribly large impact on our practice.

    Nissen教授：最初我们还不常用氯沙坦治疗心衰，因为有另一类药物的较好数据。ACE抑制剂可以作为治疗心衰的一线用药。也许美国有3%~5%的患者会发生ACE抑制剂导致的咳嗽，对这类患者我们使用坎地沙坦。一项大型、非常成功的试验CHARM试验显示坎地沙坦较好受益。大、小剂量氯沙坦试验表明，氯沙坦的传统剂量太小。药物研发时的剂量错误导致在15年后，也就是现在，才使我们发现了氯沙坦的正确剂量。但是我并不认为这将对临床实践产生可怕的影响。