Ischemic muscle in the heart or the leg causes pain and progressive loss of function, both of which can be averted by adequate revascularization. Primary revascularization strategies such as thrombolysis and percutaneous coronary intervention (PCI) that aim to salvage ischemic tissue are therefore the hallmark of modern therapy. In addition, medical management of the patient with obstructive coronary disease includes highly effective drugs that reduce oxygen requirement of the myocardium. The current success of that strategy is exemplified by a tremendous reduction in cardiovascular mortality and an appreciable contribution to the rise in life expectancy in industrialized societies. To further improve the outcome of primary revascularization, a number of alternative strategies have been developed that either salvage compromised muscle by providing extra blood supply or condition the ischemic tissue to adapt to periods of a high oxygen demand-supply ratio in anticipation of gradual reperfusion. The latter can be initiated before ischemia, i.e. preconditioning. Recently, conditioning after the ischemic insult during early reperfusion, dubbed postconditioning, has gained considerable attention. Both processes have in common that they are regulated by intracellular pathways, which can be stimulated by various endogenous substances. Some of these, like growth factors, find their

Correspondence to: Mark J Post, MD, PhD, Department of Physiology, Universiteitssingel 50, 6229 ER Maastricht, The Netherlands, Tel: +31 43 3881200, Fax: +31 43 3884166, E-mail: [email protected]

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