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Background: In head-to-head studies, ST2 is often the most powerful biomarker predictor of risk; for example, ST2 was recently shown to be superior to galectin-3 in patients with chronic HF. ST2 can change significantly over time and serial measurement of ST2 adds independent and additive information to the baseline value and traditional risk factors in chronic HF if a rise and/or fall around the cut-off of 35 ng/mL is seen. ST2 levels may interact with specific HF therapies. Beta-blockers, angiotensin II receptor antagonists and mineralocorticoid receptor antagonists may influence ST2 values, opening the door for the possibility of guided HF therapy using serial measurement. Large, prospective trials are needed to evaluate this further. Methods: 30 In-patients and out-patients with chronic heart failure treated in Lilavati Hospital and Research Centre, Mumbai were observed over period of six months. Their Serum ST2 value and outcomes at the end of six months were studied. The study population included males and females, from different age groups and various etiological factors for heart failure. Standard statistical analysis methods were used to draw the conclusion. Observations: It was observed that amongst 30 patients, 11 patient died during 6 month study period and all of these patients had ST2 level more than 35 ng/ml, while 19 patient survived, of which 9 had ST2 level ≤ 35ng/ml and 10 had ST2 level more than 35 ng/ml.(p=0.011) ST2 level is associated significantly with the survival of patient. Conclusion: All patient who died during 6 month study period had ST2 level more than 35 and significant association was found between ST2 and Survival we can interpret that higher ST2 level associated with higher mortality in heart failure patients. [ABSTRACT FROM AUTHOR]

Blockade of the renin-angiotensin system (RAS) plays an important role in the prevention and correction of cardiovascular diseases. Agents that block the RAS such as angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) are major in this league. There have been numerous clinical trials looking at the use of ACEIs and ARBs in hypertension, heart failure (HF), and other special population who remain at high risk for cardiovascular and cardiometabolic abnormalities. Overall, ACEIs are the first line agents, recommended for high cardiovascular risk patients and are supported suitably by worldwide therapeutic guidelines including class IA recommendation from American College of Cardiology (ACC)/American Heart Association. These recommendations are based on, large body of clinical results which overall supports ACEIs in reducing mortality, MI, stroke, and new-onset congestive heart failure, and their unique cardioprotective benefits in patients with diabetes, independent of coexistent atherosclerosis and concomitant nephropathy. Although, theoretically, ARBs offer improved blockade of the RAS system than ACEIs, their relative effectiveness in the treatment of HF and other comorbid cardiovascular conditions remains controversial as evident from clinical trial and meta-analysis results which shows that ARBs are not as effective in reducing mortality, rate of hospitalisation, prevention of nephropathic progression, etc. The results from the latest ONTARGET 'non-inferiority' trial has further elucidated the fact that ARBs are no better than ACEIs at reducing fatal and non-fatal cardiovascular events including MI and CV death. Although theoretically, combination of ACEIs and ARBs is an attractive therapeutic option as none of them block RAS completely, but it may also open the gate for supplementary collection of adverse events as has been evidenced in recent trials. Although, there are no data at present to precisely suggest the efficacy differences between all available ACEIs, there are trials which support that ramipril, a long acting ACEI with good tissue penetration, potent long-lasting inhibition of ACE may not be applicable to other available ACEIs. Ramipril also specifically reduces major adverse coronary and cerebrovascular events in post MI patients when compared to other ACEIs or placebo. When clinicians are faced with the choice of using either an ACEI or an ARB in high-risk patients, they should be mindful of the unique differences between each class of medication, particularly with respect to MI and CV death, and also the range of indications, cost and individual convenience.