Association of anxiety and depression with all-cause mortality in individuals with coronary heart disease.

• Examination of the relationship between affective disorders and autonomic cardiovascular control.
  
  * Examination of the mechanisms underlying the increased cardiac mortality associated with anxiety disorders.
  
  * Examination of the role of behavioral factors (diet, exercise) as modulators of glycemic control and in the pathogenesis of cardiovascular autonomic neuropathy.

My current research focus is on biological, behavioral and sociocultural factors involved in the etiology and management of hypertension, coronary artery disease, and congestive heart failure. The role of stress and the sympathetic nervous system in disease onset and progression is of central interest. Current research issues being studied include: (i) Ethnicity and gender as factors related to the pathogenesis of hypertension; (ii) Mechanisms by which menopause increases the risk of cardiovascular disease in women; (iii) Mechanisms by which stress may provoke episodes of myocardial ischemia in patients with coronary artery disease; (iv) Stress biomarkers that are associated with adverse clinical outcomes in cardiac patients; (v) The development of coping skills interventions to improve prognosis and quality of life in patients with congestive heart failure; (vi) Circadian blood pressure profiles for risk stratification in patients with hypertension; (vii) Biological and behavioral factors contributing to elevated nighttime blood pressure and blunted nighttime blood pressure dipping.

Comprehensive assessments of cardiovascular regulatory systems define the daily activity in the biobehavioral research laboratory. Assessments include: (i) hemodynamic (blood pressure, cardiac output, systemic vascular resistance) and neurohumoral responses (plasma epinephrine and norepinephrine) during psychological and physical stress testing; (ii) alpha and beta adrenergic receptor function, the baroreceptor reflex, and cardiac vagal control; (iii) endothelial function, and vascular structure and compliance; (iv) left ventricular structure and function by echocardiography; (v) 24-hour ambulatory blood pressure and cardiac output monitoring; (vi) Noninvasive assessments of arterial stiffness and central aortic pressure; (vii) Psychometric assessments of personality and lifestyle characteristics related to cardiovascular disease.

A secondary research interest is in the use and development of noninvasive techniques for evaluating the cardiovascular system. Developments include an ambulatory impedance cardiography system, permitting assessment of 24-hour hemodynamics during normal daily activities, and biomarkers of cardiovascular risk obtained using ultrasound imaging.

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Currently, my research focuses upon the theoretical aspects of homeopathy and its clinical utilization, as well as the broader field of alternative (complementary) medicine. this is a field which has traditionally been overlooked as a legitimate scientific discipline. Other areas of activity are as in the past, i.e., clinical treatment, epidemiology, risk factors, pathogenesis of posttraumatic stress, social phobia, other anxiety status, and depression. These are illustrated by recent publications on treatment, epidemiology, health service utilization and quality of life in social phobia and PTSD, drug treatment of panic disorder. Magnetic resonance studies of social phobia have been completed and further studies are planned.

My current research interests are focused in the area of diagnostic and interventional cardiac catheterization. In the arena of diagnostic cardiac catheterization, I am currently evaluating the role of Prostaglandin E1 in the prevention of contrast induced renal dysfunction. In the arena of interventional cardiac catheterization, I have been actively involved in both the development and subsequent determination of potential niches for new interventional technologies in the management of coronary artery disease. These interventional technologies include balloon angioplasty, the perfusion balloon catheter, transluminal extraction catheter, and several intracoronary stents.