The discoveries of Dimera that shape the direction of this unique research and development company are based on growing insights into balancing genomic regulatory contributions, rather than aiming to only symptomatically treat, cardiovascular disease. The primary discoveries discussed on this website focus on blood vessel reactivity, in particular the abnormal increase in coronary artery contraction (vasoconstriction) that occurs in heart disease, and which severely limits ability to exercise and as a result, the quality of life. Dimera strategies derive from recognition that failure of coronary artery reactivity modulation contributes (along with atherosclerosis) to coronary artery disease.
Steroid hormonal modulation of blood vessel reactivity is particularly relevant for women. The outcome of both the combined estrogen and progestin (Prempro) and estrogen only (Premarin) arms of the Women's Health Initiative have brought focus on the question of how to treat and prevent cardiovascular disease in women. The fact is that the number of deaths of women per year has consistently been greater than that in men for the last 15 years, and has not decreased as it has in men. Perhaps the most important lesson to learn from the graph below is that failure to acknowledge symptoms and causes of coronary disease that appear to be due to exaggerated reactivity, which is a different presentation occuring more predominantly in women, especially black women.
Chest pain originating from the heart (angina pectoris) in women is typically not related to exercise, is often classified as "atypical" angina, and importantly has signs and symptoms different from those usually found in men. Until the last decade, nearly all research data (and thus consequent diagnostic and treatment conclusions) were based on cardiovascular disease forms that occur frequently in males. Women have been denied access to the most advanced medical management if they do not show the typical (exercise-induced) angina pectoris, usually correlated with obstructions, as in men. The standard of medical care for women must progress. There is now the new and real opportunity to make past history of the notion of the inevitability that a woman must spend the last half of her life (from menopause on) with deteriorating cardiovascular function.
With the serious facts about the leading cause of death stated, here is the reason for optimism. Important new concepts are being pioneered. Coronary artery reactivity modulation is a previously unrecognized, but important, consequence of steroid hormone homeostatic actions on coronary, cerebral, renal, urogenital, and other important blood vessels. Coronary hyperreactivity due to falling levels of progesterone, beginning early in perimenopause, has profound quality of life significance, advancing with age in postmenopausal women. Declining levels of progesterone (usually beginning between the 35th-40th birthday) are furthermore hypothesized by Dimera to be important both in women and men. In males, progesterone (secreted by steroidal glands) is also present at levels that modulate gene expression in blood vessels.
Coronary hyperreactivity, a major contributing factor in coronary dysfunction, as a functional (not a fixed structural) abnormality, will not be detected by standard Treadmill Exercise Tests or even by coronary angiography in the catheterization laboratory, and thus may go undiagnosed (which is likely in women). Dimera has developed and advocates the concept of using other measures, such as cold pressor test challenges, for diagnosis and correction of the underlying cause of the abnormality (that we term hyperreactivity) at the genome level (gene expression).
Dimera research presented on the References Cited page of this website (and based on 40 years of NIH funded cardiovascular research focused on the blood vessel wall) has extensively demonstrated (in primates) that cardiovascular disease in both women and men may arise due to such functional (non-structural) causes (e.g., atherosclerotic plaques and blood clots). Alternatively stated, reactivity can be as important as fixed plaque or clot types of coronary obstructions. Critically important increases in duration and extent of both coronary and peripheral vasoconstriction to normal stimuli unequivocally add to the structural causes of blood vessel disease (Hermsmeyer 2004). Hyperreactivity that is closely correlated with advanced molecular biological understanding of gene expression of the thromboxane-prostanoid (TP) receptor has been demonstrated and verified (based on our 8 major publications shown on the References Cited page). Overexpression of the TP receptor appears to be due to a deficit of a low continuous backgroud level of progesterone, and thus the problem can be rectified at the source (meaning few or no side-effects) by replacement of the deficit.
Recent recognition of the critical importance of life-long regulation of heart, brain, kidney, bone, and immune functions by steroid hormones is a major medical advance. Increasingly, Family Physicians, Endocrinologists, Gynecologists, Women's Health Specialists, and other front line practitioners have embraced the concept of non-oral, continuous release steroid hormones which are clearly both more effective and also minimize adverse side-effects. For example, the take-home message for better use of steroid medicines from the October 2007 North American Menopause Society meeting in New York is, start low (in dosage), go slow (in starting or stopping treatment), and use transdermal (not oral) forms of the steroid medicines. Presently, steroid hormone therapies are prescribed most extensively by primary care physicians who represent your most immediate access to effective care. Dimera expects that fact to continue and assume increased importance.
Loss of the cardiovascular health which is necessary for continued youthful physical activity (tennis, marathons, racketball, skiing, swimming, hiking, soccer, basketball, baseball, mountain climbing, etc, with attention to the need for progesterone-balanced TP expression in the blood vessel wall thus may not be inevitable. With continued restraint of TP expression at the gene level, the duration of peak cardiovascular health is hypothesized by Dimera (with growing scientific evidence based on solid cardiovascular research advances) to be significantly extended. Dimera predicts major meaningful, quality-of-life, high value advances in medical care on planet Earth. Be optimistic!
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