1
|
Mars K, Humphries S, Leissner P, Jonsson M, Karlström P, Lauermann J, Alfredsson J, Kellerth T, Ravn-Fischer A, Erlinge D, Lindahl B, Yndigegn T, Jernberg T, Held C, Olsson EMG, Hofmann R. Effects of beta-blockers on quality of life and well-being in patients with myocardial infarction and preserved left ventricular function-a prespecified substudy from REDUCE-AMI. EUROPEAN HEART JOURNAL. CARDIOVASCULAR PHARMACOTHERAPY 2024:pvae062. [PMID: 39217445 DOI: 10.1093/ehjcvp/pvae062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2024] [Revised: 08/12/2024] [Accepted: 08/20/2024] [Indexed: 09/04/2024]
Abstract
AIMS In the Randomized Evaluation of Decreased Usage of Beta-Blockers after Acute Myocardial Infarction (REDUCE-AMI) study, long-term beta-blocker use in patients after acute myocardial infarction (AMI) with preserved left ventricular ejection fraction demonstrated no effect on death or cardiovascular outcomes. The aim of this prespecified substudy was to investigate effects of beta-blockers on self-reported quality of life and well-being. METHODS AND RESULTS From this parallel-group, open-label, registry-based randomized clinical trial, EQ-5D, and World Health Organization well-being index-5 (WHO-5) questionnaires were obtained at 6-10 weeks and 11-13 months after AMI in 4080 and 806 patients, respectively. We report results from intention-to-treat and on-treatment analyses for the overall population and relevant subgroups using Wilcoxon rank sum test and adjusted ordinal regression analyses. Of the 4080 individuals reporting EQ-5D (median age 64 years, 22% female), 2023 were randomized to beta-blockers. The main outcome, median EQ-5D index score, was 0.94 [interquartile range (IQR) 0.88, 0.97] in the beta-blocker group, and 0.94 (IQR 0.88, 0.97) in the no-beta-blocker group 6-10 weeks after AMI, OR 1.00 [95% CI 0.89-1.13; P > 0.9]. After 11-13 months, results remained unchanged. Findings were robust in on-treatment analyses and across relevant subgroups. Secondary outcomes, EQ-VAS and WHO-5 index score, confirmed these results. CONCLUSION Among patients after AMI with preserved left ventricular ejection fraction, self-reported quality of life and well-being was not significantly different in individuals randomized to routine long-term beta-blocker therapy as compared to individuals with no beta-blocker use. These results appear consistent regardless of adherence to randomized treatment and across subgroups which emphasizes the need for a careful individual risk-benefit evaluation prior to initiation of beta-blocker treatment.
Collapse
Affiliation(s)
- Katarina Mars
- Department of Clinical Science and Education, Division of Cardiology, Karolinska Institutet, Södersjukhuset, Stockholm, Sjukhusbacken 10, 188 83, Sweden
| | - Sophia Humphries
- Department of Women's and Children's Health, Uppsala University, Uppsala 751 85, Sweden
| | - Philip Leissner
- Department of Women's and Children's Health, Uppsala University, Uppsala 751 85, Sweden
| | - Martin Jonsson
- Department of Clinical Science and Education, Division of Cardiology, Karolinska Institutet, Södersjukhuset, Stockholm, Sjukhusbacken 10, 188 83, Sweden
| | - Patric Karlström
- Department of Internal Medicine, Ryhov County Hospital, Jönköping 551 85 Sweden
| | - Jörg Lauermann
- Department of Internal Medicine, Ryhov County Hospital, Jönköping 551 85 Sweden
| | - Joakim Alfredsson
- Department of Cardiology and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping 581 83, Sweden
| | - Thomas Kellerth
- Division of Cardiology and Emergency medicine, Centralsjukhuset Karlstad, Karlstad 651 82, Sweden
| | - Annica Ravn-Fischer
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg 405 30, Sweden
- Institute of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska Academy University of Gothenburg, Gothenburg 405 30, Sweden
| | - David Erlinge
- Department of Cardiology, Clinical Sciences, Lund University, Skane University Hospital, Lund 222 42, Sweden
| | - Bertil Lindahl
- Department of Medical Sciences, Cardiology, Uppsala University, Uppsala 751 85, Sweden
- Uppsala Clinical Research Center, Uppsala University, Uppsala 751 85, Sweden
| | - Troels Yndigegn
- Department of Cardiology, Clinical Sciences, Lund University, Skane University Hospital, Lund 222 42, Sweden
| | - Tomas Jernberg
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm 171 77, Sweden
| | - Claes Held
- Department of Medical Sciences, Cardiology, Uppsala University, Uppsala 751 85, Sweden
- Uppsala Clinical Research Center, Uppsala University, Uppsala 751 85, Sweden
| | - Erik M G Olsson
- Department of Women's and Children's Health, Uppsala University, Uppsala 751 85, Sweden
| | - Robin Hofmann
- Department of Clinical Science and Education, Division of Cardiology, Karolinska Institutet, Södersjukhuset, Stockholm, Sjukhusbacken 10, 188 83, Sweden
| |
Collapse
|
2
|
Marti HP, Pavía López AA, Schwartzmann P. Safety and tolerability of β-blockers: importance of cardioselectivity. Curr Med Res Opin 2024; 40:55-62. [PMID: 38597063 DOI: 10.1080/03007995.2024.2317433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 02/02/2024] [Indexed: 04/11/2024]
Abstract
Cardioselective β-blockade is generally well tolerated in practice and contraindications to this therapy are uncommon. β-blockers are a diverse therapeutic class, and their individual tolerability profiles are influenced strongly by their pharmacodynamic effects across different adrenergic receptors. Bisoprolol, probably the β-blocker with the highest selectivity for blockade of β1- vs. β2-adrenoceptors, does not block β2-adrenoceptors to an appreciable extent at doses in therapeutic use. Side-effects often attributed to β-blockers, such as erectile dysfunction and adverse metabolic effects are uncommon with bisoprolol and other β-blockers used at doses which only block β1-adrenoceptors. Cautious use of a cardioselective β-blocker is not contraindicated in people with chronic obstructive pulmonary disease or asthma and the outcomes benefits of β-blockers in patients with coronary heart disease or heart failure are also apparent in patients with concurrent COPD. Starting with a low dose and titrating upwards carefully is important for optimising the tolerability of a β-blocker. Most people with hypertension will receive combination antihypertensive therapy in practice, and the low-dose combination therapy approach provides a useful strategy for optimising the efficacy and tolerability of a regimen that includes a β-blocker, compared with up-titrating an existing monotherapy.
Collapse
Affiliation(s)
- Hans-Peter Marti
- Nephrology Section, Department of Medicine, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | | | - Pedro Schwartzmann
- Advanced Research Center - CAPED, Cardiology Unit, Unimed Hospital, Ribeirão Preto, Brazil
| |
Collapse
|
3
|
Zhou S, Liu Y, Huang X, Wu C, Pórszász R. Omecamtiv Mecarbil in the treatment of heart failure: the past, the present, and the future. Front Cardiovasc Med 2024; 11:1337154. [PMID: 38566963 PMCID: PMC10985333 DOI: 10.3389/fcvm.2024.1337154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 03/07/2024] [Indexed: 04/04/2024] Open
Abstract
Heart failure, a prevailing global health issue, imposes a substantial burden on both healthcare systems and patients worldwide. With an escalating prevalence of heart failure, prolonged survival rates, and an aging demographic, an increasing number of individuals are progressing to more advanced phases of this incapacitating ailment. Against this backdrop, the quest for pharmacological agents capable of addressing the diverse subtypes of heart failure becomes a paramount pursuit. From this viewpoint, the present article focuses on Omecamtiv Mecarbil (OM), an emerging chemical compound said to exert inotropic effects without altering calcium homeostasis. For the first time, as a review, the present article uniquely started from the very basic pathophysiology of heart failure, its classification, and the strategies underpinning drug design, to on-going debates of OM's underlying mechanism of action and the latest large-scale clinical trials. Furthermore, we not only saw the advantages of OM, but also exhaustively summarized the concerns in sense of its effects. These of no doubt make the present article the most systemic and informative one among the existing literature. Overall, by offering new mechanistic insights and therapeutic possibilities, OM has carved a significant niche in the treatment of heart failure, making it a compelling subject of study.
Collapse
Affiliation(s)
- Shujing Zhou
- Department of Pharmacology and Pharmacotherapy, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Ying Liu
- Department of Cardiology, Sixth Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Xufeng Huang
- Department of Pharmacology and Pharmacotherapy, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
- Faculty of Dentistry, University of Debrecen, Debrecen, Hungary
| | - Chuhan Wu
- Department of Pharmacology and Pharmacotherapy, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Róbert Pórszász
- Department of Pharmacology and Pharmacotherapy, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| |
Collapse
|
4
|
Gladwell LR, Ahiarah C, Rasheed S, Rahman SM, Choudhury M. Traditional Therapeutics and Potential Epidrugs for CVD: Why Not Both? Life (Basel) 2023; 14:23. [PMID: 38255639 PMCID: PMC10820772 DOI: 10.3390/life14010023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 12/07/2023] [Accepted: 12/18/2023] [Indexed: 01/24/2024] Open
Abstract
Cardiovascular disease (CVD) is the leading cause of death worldwide. In addition to the high mortality rate, people suffering from CVD often endure difficulties with physical activities and productivity that significantly affect their quality of life. The high prevalence of debilitating risk factors such as obesity, type 2 diabetes mellitus, smoking, hypertension, and hyperlipidemia only predicts a bleak future. Current traditional CVD interventions offer temporary respite; however, they compound the severe economic strain of health-related expenditures. Furthermore, these therapeutics can be prescribed indefinitely. Recent advances in the field of epigenetics have generated new treatment options by confronting CVD at an epigenetic level. This involves modulating gene expression by altering the organization of our genome rather than altering the DNA sequence itself. Epigenetic changes are heritable, reversible, and influenced by environmental factors such as medications. As CVD is physiologically and pathologically diverse in nature, epigenetic interventions can offer a ray of hope to replace or be combined with traditional therapeutics to provide the prospect of addressing more than just the symptoms of CVD. This review discusses various risk factors contributing to CVD, perspectives of current traditional medications in practice, and a focus on potential epigenetic therapeutics to be used as alternatives.
Collapse
Affiliation(s)
- Lauren Rae Gladwell
- Department of Pharmaceutical Sciences, Texas A&M Irma Lerma Rangel College of Pharmacy, 1114 TAMU, College Station, TX 77843, USA
| | - Chidinma Ahiarah
- Department of Pharmaceutical Sciences, Texas A&M Irma Lerma Rangel College of Pharmacy, 1114 TAMU, College Station, TX 77843, USA
| | - Shireen Rasheed
- Department of Pharmaceutical Sciences, Texas A&M Irma Lerma Rangel College of Pharmacy, 1114 TAMU, College Station, TX 77843, USA
| | - Shaikh Mizanoor Rahman
- Natural and Medical Sciences Research Center, University of Nizwa, Birkat Al-Mouz, Nizwa 616, Oman
| | - Mahua Choudhury
- Department of Pharmaceutical Sciences, Texas A&M Irma Lerma Rangel College of Pharmacy, 1114 TAMU, College Station, TX 77843, USA
| |
Collapse
|
5
|
Mehra N, Ali AH, Desai MY. Obstructive hypertrophic cardiomyopathy: a review of new therapies. Future Cardiol 2023; 19:661-670. [PMID: 37933625 DOI: 10.2217/fca-2023-0056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 09/13/2023] [Indexed: 11/08/2023] Open
Abstract
Hypertrophic cardiomyopathy (HCM) is a phenotypically heterogeneous disease with a genetic basis and variable penetrance. The hallmarks of HCM include dynamic left ventricular outflow tract obstruction, typically caused by asymmetric septal hypertrophy. However, abnormal papillary muscle placement, abnormal mitral valve and subvalvular apparatus and apical hypertrophic forms have also been described. Typical medical treatment has been stagnant for decades, although there have been significant advances in surgical treatment of patients with obstructive HCM. Herein, we describe a new class of drugs targeting the specific pathophysiology of HCM.
Collapse
Affiliation(s)
- Nandini Mehra
- Hypertrophic Cardiomyopathy Center, Heart Vascular Thoracic Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Adel Hajj Ali
- Hypertrophic Cardiomyopathy Center, Heart Vascular Thoracic Institute, Cleveland Clinic, Cleveland, OH 44195, USA
- Department of Internal Medicine, Indiana University, Indianapolis, IN 46202, USA
| | - Milind Y Desai
- Hypertrophic Cardiomyopathy Center, Heart Vascular Thoracic Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| |
Collapse
|
6
|
Humphries S, Mars K, Hofmann R, Held C, Olsson EMG. Randomized evaluation of routine beta-blocker therapy after myocardial infarction quality of life (RQoL): design and rationale of a multicentre, prospective, randomized, open, blinded endpoint study. EUROPEAN HEART JOURNAL OPEN 2023; 3:oead036. [PMID: 37265820 PMCID: PMC10230287 DOI: 10.1093/ehjopen/oead036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 02/09/2023] [Indexed: 06/03/2023]
Abstract
Aims Most cases of acute myocardial infarction (MI) in Sweden are treated with long-term β-blocker therapy as secondary prevention. Case studies and patient reports have indicated negative effects of β-blockers including symptoms of depression, fatigue, sexual dysfunction, and general low mood, all related to reduced quality of life (QoL). To date, no recent large-scale, randomized trial has explored the effects of β-blockers on these factors. Methods and results The ongoing Randomized Evaluation of Decreased Usage of beta-bloCkErs after myocardial infarction (REDUCE): quality of life (RQoL) study is a multicentre, prospective, randomized pre-specified substudy aiming to evaluate the effects of β-blockers on self-reported measures of QoL. Following randomized allocation to long-term β-blocker or no β-blocker treatment, patients complete a total of six baseline measures pertaining to QoL, sexual functioning, and perceived side effects. Data collection is optionally carried out online through a unique and secure portal and repeated again at two follow-up time points. Recruitment began in July 2018. Data from the first 100 patients showed that at the first follow-up, 93% had completed the questionnaires, which decreased to 81% at the second follow-up. The method of digital data collection was utilized by over half of the patients recruited so far. Conclusion Data from the first 100 patients indicate success in terms of study design and recruitment. The RQoL substudy investigates the effects of β-blockers on self-reported measures of QoL in MI patients and will potentially contribute to the limited knowledge of QoL-related side effects reported in conjunction with β-blocker use. Clinical trial registration Eudra CT number, 2017-002336-17; Clinical trial.gov identifier, NCT03278509.
Collapse
Affiliation(s)
| | - Katarina Mars
- Department of Clinical Science and Education, Division of Cardiology, Karolinska Institute, Stockholm, Sweden
| | - Robin Hofmann
- Department of Clinical Science and Education, Division of Cardiology, Karolinska Institute, Stockholm, Sweden
| | - Claes Held
- Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden
- Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | | |
Collapse
|
7
|
Chen Y, Cai Z, Liu Y, Zhong J, Cheng F. Assessment of risk factors and establishment of a nomogram model to predict early high-output ileostomy. Langenbecks Arch Surg 2023; 408:106. [PMID: 36840781 DOI: 10.1007/s00423-023-02850-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 02/21/2023] [Indexed: 02/26/2023]
Abstract
OBJECTIVE This study evaluated the prevalence and perioperative risk factors for early high-output ileostomy (EHOI) and developed a precise nomogram model to predict the occurrence of EHOI. METHODS 140 patients who underwent ileostomy surgery at three hospitals in Wuhan, Hubei Province, between January 2022 and May 2022 were enrolled in this prospective cohort study. By using univariate and multifactorial logistic regression, independent risk variables for the development of EHOI were examined, and the nomogram model for predicting the risk of EHOI was created by using R software. The calibration curve and area under the receiver operating characteristic curve (ROC AUC) were used to evaluate the calibration and discrimination of the prediction model, Hosmer-Lemeshow to verify the fit of the model. Clinical impact curve (CIC) and decision curve analysis (DCA) were used to assess the model's clinical efficacy. RESULTS A total of 132 patients participated in the study, and the incidence of EHOI was 25.8% (34/132). The nomogram model incorporated 3 risk factors hypertension, drinking habits, and high white blood cell (WBC) count after surgery. The AUC was 0.742, and the nomogram showed great calibration and clinical validity by comparing the calibration curve, DCA, and CIC. CONCLUSIONS Hypertension, drinking, and high WBC was significantly correlated with EHOI. The nomogram model has great clinical value in predicting the EHOI.
Collapse
Affiliation(s)
- Ying Chen
- Department of Urology, Renmin Hospital of Wuhan University, Hubei Province, Wuhan, 430060, People's Republic of China
| | - Zhongxiang Cai
- Nursing Office, Renmin Hospital of Wuhan University, Wuhan, China
| | - Yan Liu
- Nursing Office, Renmin Hospital of Wuhan University, Wuhan, China
| | - Jun Zhong
- Department of Gastroenterology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Fan Cheng
- Department of Urology, Renmin Hospital of Wuhan University, Hubei Province, Wuhan, 430060, People's Republic of China.
| |
Collapse
|
8
|
Paulussen F, Kulkarni CP, Stolz F, Lescrinier E, De Graeve S, Lambin S, Marchand A, Chaltin P, In't Veld P, Mebis J, Tavernier J, Van Dijck P, Luyten W, Thevelein JM. The β2-adrenergic receptor in the apical membrane of intestinal enterocytes senses sugars to stimulate glucose uptake from the gut. Front Cell Dev Biol 2023; 10:1041930. [PMID: 36699012 PMCID: PMC9869975 DOI: 10.3389/fcell.2022.1041930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 12/14/2022] [Indexed: 01/12/2023] Open
Abstract
The presence of sugar in the gut causes induction of SGLT1, the sodium/glucose cotransporter in intestinal epithelial cells (enterocytes), and this is accompanied by stimulation of sugar absorption. Sugar sensing was suggested to involve a G-protein coupled receptor and cAMP - protein kinase A signalling, but the sugar receptor has remained unknown. We show strong expression and co-localization with SGLT1 of the β2-adrenergic receptor (β 2-AR) at the enterocyte apical membrane and reveal its role in stimulating glucose uptake from the gut by the sodium/glucose-linked transporter, SGLT1. Upon heterologous expression in different reporter systems, the β 2-AR responds to multiple sugars in the mM range, consistent with estimated gut sugar levels after a meal. Most adrenergic receptor antagonists inhibit sugar signaling, while some differentially inhibit epinephrine and sugar responses. However, sugars did not inhibit binding of I125-cyanopindolol, a β 2-AR antagonist, to the ligand-binding site in cell-free membrane preparations. This suggests different but interdependent binding sites. Glucose uptake into everted sacs from rat intestine was stimulated by epinephrine and sugars in a β 2-AR-dependent manner. STD-NMR confirmed direct physical binding of glucose to the β 2-AR. Oral administration of glucose with a non-bioavailable β 2-AR antagonist lowered the subsequent increase in blood glucose levels, confirming a role for enterocyte apical β 2-ARs in stimulating gut glucose uptake, and suggesting enterocyte β 2-AR as novel drug target in diabetic and obese patients. Future work will have to reveal how glucose sensing by enterocytes and neuroendocrine cells is connected, and whether β 2-ARs mediate glucose sensing also in other tissues.
Collapse
Affiliation(s)
- Frederik Paulussen
- 1Center for Microbiology, VIB, Leuven-Heverlee, Belgium,2Laboratory of Molecular Cell Biology, Institute of Botany and Microbiology, KU Leuven, Leuven-Heverlee, Belgium
| | - Chetan P. Kulkarni
- 1Center for Microbiology, VIB, Leuven-Heverlee, Belgium,3Functional Genomics and Proteomics Research Unit, Department of Biology, KU Leuven, Leuven, Belgium
| | - Frank Stolz
- 1Center for Microbiology, VIB, Leuven-Heverlee, Belgium,2Laboratory of Molecular Cell Biology, Institute of Botany and Microbiology, KU Leuven, Leuven-Heverlee, Belgium
| | - Eveline Lescrinier
- 4Medicinal Chemistry, Rega Institute for Medical Research, KU Leuven, Leuven, Belgium
| | - Stijn De Graeve
- 1Center for Microbiology, VIB, Leuven-Heverlee, Belgium,2Laboratory of Molecular Cell Biology, Institute of Botany and Microbiology, KU Leuven, Leuven-Heverlee, Belgium
| | - Suzan Lambin
- 1Center for Microbiology, VIB, Leuven-Heverlee, Belgium,2Laboratory of Molecular Cell Biology, Institute of Botany and Microbiology, KU Leuven, Leuven-Heverlee, Belgium
| | | | | | - Peter In't Veld
- 6Department of Pathology, Free University of Brussels, Brussels, Belgium
| | - Joseph Mebis
- 7Department of Pathology, KU Leuven, Flanders, Belgium
| | - Jan Tavernier
- 8Department of Biochemistry, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium,9Center for Medical Biotechnology, VIB, Ghent, Belgium
| | - Patrick Van Dijck
- 1Center for Microbiology, VIB, Leuven-Heverlee, Belgium,2Laboratory of Molecular Cell Biology, Institute of Botany and Microbiology, KU Leuven, Leuven-Heverlee, Belgium
| | - Walter Luyten
- 3Functional Genomics and Proteomics Research Unit, Department of Biology, KU Leuven, Leuven, Belgium
| | - Johan M. Thevelein
- 1Center for Microbiology, VIB, Leuven-Heverlee, Belgium,2Laboratory of Molecular Cell Biology, Institute of Botany and Microbiology, KU Leuven, Leuven-Heverlee, Belgium,10NovelYeast bv, Bio-Incubator BIO4, Gaston Geenslaan 3, Leuven-Heverlee,, Belgium,*Correspondence: Johan M. Thevelein,
| |
Collapse
|
9
|
Johri N, Matreja PS, Maurya A, Varshney S, Smritigandha. Role of β-blockers in Preventing Heart Failure and Major Adverse Cardiac Events Post Myocardial Infarction. Curr Cardiol Rev 2023; 19:e110123212591. [PMID: 36635926 PMCID: PMC10494272 DOI: 10.2174/1573403x19666230111143901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 10/26/2022] [Accepted: 10/31/2022] [Indexed: 01/14/2023] Open
Abstract
β-blockers have been widely utilized as a part of acute myocardial infarction (AMI) treatment for the past 40 years. Patients receiving β-adrenergic blockers for an extended period following myocardial infarction have a higher chance of surviving. Although many patients benefited from β-blockers, many do not, including those with myocardial infarction, left ventricle dysfunction, chronic pulmonary disease, and elderly people. In individuals with the post-acute coronary syndrome and normal left ventricular ejection fraction (LVEF), the appropriate duration of betablocker therapy is still unknown. There is also no time limit for those without angina and those who do not need β-blockers for arrhythmia or hypertension. Interestingly, β-blockers have been prescribed for more than four decades. The novel mechanism of action on cellular compartments has been found continually, which opens a new way for their potential application in cardiac failure and other cardiac events like post-myocardial infarction. Here, in this review, we studied β-blocker usage in these circumstances and the current recommendations for β-blocker use from clinical practice guidelines.
Collapse
Affiliation(s)
- Nishant Johri
- Department of Pharmacy Practice, Teerthanker Mahaveer College of Pharmacy, Moradabad, Uttar Pradesh, India
| | - Prithpal S. Matreja
- Department of Pharmacology, Teerthanker Mahaveer Medical College and Research Centre, Moradabad, Uttar Pradesh, India
| | - Aditya Maurya
- Department of Pharmacy Practice, Teerthanker Mahaveer College of Pharmacy, Moradabad, Uttar Pradesh, India
| | - Shivani Varshney
- Department of Pharmacy Practice, Teerthanker Mahaveer College of Pharmacy, Moradabad, Uttar Pradesh, India
| | - Smritigandha
- Department of Pharmacy Practice, Teerthanker Mahaveer College of Pharmacy, Moradabad, Uttar Pradesh, India
| |
Collapse
|
10
|
Mohammadi Zonouz A, Ghasemzadeh Rahbardar M, Hosseinzadeh H. Antidotal and protective effects of mangosteen ( Garcinia mangostana) against natural and chemical toxicities: A review. IRANIAN JOURNAL OF BASIC MEDICAL SCIENCES 2023; 26:492-503. [PMID: 37051107 PMCID: PMC10083825 DOI: 10.22038/ijbms.2023.66900.14674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 12/19/2022] [Indexed: 04/14/2023]
Abstract
Chemical and natural toxic compounds can harm human health through a variety of mechanisms. Nowadays, herbal therapy is widely accepted as a safe method of treating toxicity. Garcinia mangostana (mangosteen) is a tree in the Clusiaceae family, and isoprenylated xanthones, its main constituents, are a class of secondary metabolites having a variety of biological properties, such as anti-inflammatory, anti-oxidant, pro-apoptotic, anti-proliferative, antinociceptive, neuroprotective, hypoglycemic, and anti-obesity. In this review, the protective activities of mangosteen and its major components against natural and chemical toxicities in both in vivo and in vitro experiments were evaluated. The protective effects of mangosteen and its components are mediated primarily through oxidative stress inhibition, a decrease in the number of inflammatory cells such as lymphocytes, neutrophils, and eosinophils, reduction of inflammatory mediators such as tumor necrosis factor-alpha (TNF-α), interleukin-1 (IL-1), interleukin-6 (IL-6), interleukin-8 (IL-8), cyclooxygenase-2 (COX-2), prostaglandin (PG) E2, inducible nitric oxide synthase, and nuclear factor-ĸB (NF-ĸB), modulation of apoptosis and mitogen-activated protein kinase (MAPK) signaling pathways, reducing p65 entrance into the nucleus, α-smooth muscle actin (α-SMA), transforming growth factor β1 (TGFβ1), improving histological conditions, and inhibition in acetylcholinesterase activity.
Collapse
Affiliation(s)
| | | | - Hossein Hosseinzadeh
- Pharmaceutical Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran
- Department of Pharmacodynamics and Toxicology, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
- Corresponding author: Hossein Hosseinzadeh. Pharmaceutical Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran; Department of Pharmacodynamics and Toxicology, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran. Tel: +98-5138819042; Fax: +98-5138823251;
| |
Collapse
|
11
|
Krøll J, Butt JH, Jensen HK, Fosbøl EL, Camilla HBJ, Winkel BG, Kanters JK, Gislason GH, Torp-Pedersen C, Køber L, Bundgaard H, Tfelt-Hansen J, Weeke PE. β-blocker adherence among patients with congenital long QT syndrome: a nationwide study. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2022; 9:76-84. [PMID: 35438152 DOI: 10.1093/ehjqcco/qcac017] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 04/02/2022] [Accepted: 04/12/2022] [Indexed: 12/15/2022]
Abstract
AIM β-blockers are the first line of treatment in patients with congenital long QT syndrome (cLQTS) (class I or II recommendation) in order to prevent malignant arrhythmias. Hence, we examined long-term β-blocker adherence and associated risk factors among patients with cLQTS. METHODS AND RESULTS Danish patients with cLQTS claiming a prescription for any β-blocker after their cLQTS diagnosis were identified using data from nationwide registries and specialized inherited cardiac disease clinics (1995-2017). Patients were followed for up to 5 years. Treatment breaks >60 days were assessed (i.e. proxy for reduced adherence). Multivariable Cox regression was used to identify risk factors associated with breaks of >60 days in β-blocker treatment. Overall, 500 out of 633 (79%) patients with cLQTS claimed at least one prescription for any β-blocker after cLQTS diagnosis. During follow-up, 38.4% had a treatment break. Risk factors significantly associated with treatment breaks were implantable cardioverter defibrillator (ICD) [hazard ratio (HR) = 1.65, 95% confidence interval (CI): 1.08-2.53], β-blocker side effects (HR = 2.69, 95% CI: 1.75-4.13), and psychiatric disease (HR = 1.63, 95% CI: 1.04-2.57). In contrast, patients presenting with ventricular tachycardia/syncope as cLQTS disease manifestation were less likely to have a treatment break compared with asymptomatic patients (HR = 0.55, 95% CI: 0.33-0.92). CONCLUSION Reduced β-blocker adherence was common with more than a third of patients having a treatment break >60 days after cLQTS diagnosis. Patients with psychiatric disease, self-reported β-blocker side effects, and an ICD were more likely to display reduced adherence, whereas a severe cLQTS disease manifestation was associated with optimal β-blocker adherence.
Collapse
Affiliation(s)
- Johanna Krøll
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Jawad H Butt
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Henrik K Jensen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Health, Aarhus University, Aarhus, Denmark
| | - Emil L Fosbøl
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - H B Jespersen Camilla
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Bo G Winkel
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Jørgen K Kanters
- Laboratory of Experimental Cardiology, Depatment of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Gunnar H Gislason
- Department of Cardiology, Herlev and Gentofte Hospital, Copenhagen University Hospital, Hellerup, Denmark.,The Danish Heart Foundation, Copenhagen, Denmark
| | - Christian Torp-Pedersen
- Department of Clinical Investigation and Cardiology, Nordsjaellands Hospital, Hillerød, Denmark
| | - Lars Køber
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Henning Bundgaard
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Jacob Tfelt-Hansen
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Denmark.,Department of Forensic Medicine, Faculty of Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Peter E Weeke
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Denmark
| |
Collapse
|
12
|
Megahed MA, El-Sawy HS, Reda AM, Abd-Allah FI, Abu Elyazid SK, Lila AE, Ismael HR, El-Say KM. Effect of nanovesicular surface-functionalization via chitosan and/or PEGylation on cytotoxicity of tamoxifen in induced-breast cancer model. Life Sci 2022; 307:120908. [PMID: 36028168 DOI: 10.1016/j.lfs.2022.120908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 08/15/2022] [Accepted: 08/21/2022] [Indexed: 11/25/2022]
Abstract
AIMS The effect of surface-modification of Tamoxifen (Tam)-loaded-niosomes on drug cytotoxicity and bio-distribution, via functionalization with chitosan and/or PEGylation, was investigated. MATERIALS AND METHODS Tam-loaded hybrid-nanocarriers (Tam-loaded niosomes, chitosomes, PEGylated niosomes, and PEGylated chitosomes) were formulated and characterized. KEY FINDINGS Chitosanization with/without PEGylation proved to selectively enhance Tam-release at the cancerous-acidic micromilieu. Cytotoxic activity study showed that Tam-loaded PEGylated niosomes had a lower IC50 value on MCF-7 cell line (0.39, 0.35, and 0.27 times) than Tam-loaded PEGylated chitosomes, Tam-loaded niosomes, and Tam-loaded chitosomes, respectively. Cell cycle analysis showed that PEGylation and/or Chitosanization significantly impact Tam efficiency in inducing apoptosis, with a preferential influence of PEGylation over chitosanization. The assay of Annexin-V/PI double staining revealed that chitosanized-nanocarriers had a significant role in increasing the incidence of apoptosis over necrosis. Besides, PEGylated-nanocarriers increased apoptosis, as well as total death and necrosis percentages more than what was shown from free Tam. Moreover, the average changes in both Bax/Bcl-2 ratio and Caspase 9 were best improved in cells treated by Tam-loaded PEGylated niosomes over all other formulations. The in-vivo study involving DMBA-induced-breast cancer rats revealed that PEGylation made the highest tumor-growth inhibition (84.9 %) and breast tumor selectivity, while chitosanization had a lower accumulation tendency in the blood (62.3 ng/ml) and liver tissues (103.67 ng/ml). The histopathological specimens from the group treated with Tam-loaded PEGylated niosomes showed the best improvement over other formulations. SIGNIFICANCE All these results concluded the crucial effect of both PEGylation and chitosan-functionalization of Tam-loaded niosomes in enhancing effectiveness, targetability, and safety.
Collapse
Affiliation(s)
- Mohamed A Megahed
- Department of Pharmaceutics and Pharmaceutical Technology, Egyptian Russian University, Cairo 11829, Egypt
| | - Hossam S El-Sawy
- Department of Pharmaceutics and Pharmaceutical Technology, Egyptian Russian University, Cairo 11829, Egypt
| | - Ahmed M Reda
- Department of Biochemistry, Egyptian Russian University, Cairo 11829, Egypt
| | - Fathy I Abd-Allah
- Department of Pharmaceutics and Industrial Pharmacy, Al-Azhar University, Cairo 11651, Egypt; International Center for Bioavailability, Pharmaceutical and Clinical Research, Obour City 11828, Egypt
| | - Sherif K Abu Elyazid
- Department of Pharmaceutics and Industrial Pharmacy, Al-Azhar University, Cairo 11651, Egypt
| | - Ahmed E Lila
- Department of Pharmaceutics and Industrial Pharmacy, Al-Azhar University, Cairo 11651, Egypt
| | - Hatem R Ismael
- Department of Pharmaceutics and Industrial Pharmacy, Al-Azhar University, Cairo 11651, Egypt
| | - Khalid M El-Say
- Department of Pharmaceutics, Faculty of Pharmacy, King Abdulaziz University, Jeddah 21589, Saudi Arabia.
| |
Collapse
|
13
|
Humphries S, Wallert J, Mars K, Held C, Hofmann R, Olsson EMG. Association between β-blocker dose and quality of life after myocardial infarction: a real-world Swedish register-linked study. EUROPEAN HEART JOURNAL. ACUTE CARDIOVASCULAR CARE 2022; 11:491-500. [PMID: 35510962 PMCID: PMC9216501 DOI: 10.1093/ehjacc/zuac050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 03/10/2022] [Accepted: 04/14/2022] [Indexed: 11/12/2022]
Abstract
BACKGROUND β-blockers are routinely administered to patients following myocardial infarction (MI), yet their potential effect on health-related quality of life (HRQoL) is not entirely understood. We investigated the relationship between two different doses of β-blockers with HRQoL following MI. METHODS AND RESULTS This nationwide observational study used Swedish national registries to collate sociodemographic, clinical, medication, and HRQoL {the latter operationalized using EuroQol [European Quality of Life Five Dimensions Questionnaire (EQ-5D)]}. Estimates at 6-10 weeks and 12-14 months post-MI follow-up from pooled linear and logistic models were calculated after multiple imputation. We identified 35 612 patients with first-time MI, discharged with β-blockers, and enrolled in cardiac rehabilitation between 2006 and 2015. Upon discharge, patients were either dispensed <50% [24 082 (67.6%)] or ≥50% [11 530 (32.4%)] of the target dosage, as defined in previous trials. After adjusting for pre-defined covariates, neither the EQ-5D Index nor the Emotional Distress items were statistically different between groups. The EQ-VAS score was significantly lower in patients treated with ≥50% target β-blocker dose than those treated with <50% of the target dose [-0.87 [-1.23, -0.46], P < .001]. Results were similar at the 12-month follow-up and across sub-groups separated by sex and age. CONCLUSION No difference in HRQoL was found among patients taking <50% vs. ≥50% of the target β-blocker dose, except for the EQ-VAS in which higher scores were reported in those taking a lower dose. The clinical meaningfulness of this statistical significance is likely low.
Collapse
Affiliation(s)
- Sophia Humphries
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
| | - John Wallert
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Katarina Mars
- Department of Clinical Science and Education, Division of Cardiology, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden
| | - Claes Held
- Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden
- Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - Robin Hofmann
- Department of Clinical Science and Education, Division of Cardiology, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden
| | - Erik M G Olsson
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
| |
Collapse
|
14
|
Kronsten VT, Tranah TH, Pariante C, Shawcross DL. Gut-derived systemic inflammation as a driver of depression in chronic liver disease. J Hepatol 2022; 76:665-680. [PMID: 34800610 DOI: 10.1016/j.jhep.2021.11.008] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 10/13/2021] [Accepted: 11/08/2021] [Indexed: 02/08/2023]
Abstract
Depression and chronic liver disease (CLD) are important causes of disability, morbidity and mortality worldwide and their prevalence continues to rise. The rate of depression in CLD is high compared to that of the general population and is comparable to the increased rates observed in other medical comorbidities and chronic inflammatory conditions. Notably, a comorbid diagnosis of depression has a detrimental effect on outcomes in cirrhosis. Systemic inflammation is pivotal in cirrhosis-associated immune dysfunction - a phenomenon present in advanced CLD (cirrhosis) and implicated in the development of complications, organ failure, disease progression, increased infection rates and poor outcome. The presence of systemic inflammation is also well-documented in a cohort of patients with depression; peripheral cytokine signals can result in neuroinflammation, behavioural change and depressive symptoms via neural mechanisms, cerebral endothelial cell and circumventricular organ signalling, and peripheral immune cell-to-brain signalling. Gut dysbiosis has been observed in both patients with cirrhosis and depression. It leads to intestinal barrier dysfunction resulting in increased bacterial translocation, in turn activating circulating immune cells, leading to cytokine production and systemic inflammation. A perturbed gut-liver-brain axis may therefore explain the high rates of depression in patients with cirrhosis. The underlying mechanisms explaining the critical relationship between depression and cirrhosis remain to be fully elucidated. Several other psychosocial and biological factors are likely to be involved, and therefore the cause is probably multifactorial. However, the role of the dysfunctional gut-liver-brain axis as a driver of gut-derived systemic inflammation requires further exploration and consideration as a target for the treatment of depression in patients with cirrhosis.
Collapse
Affiliation(s)
- Victoria T Kronsten
- Institute of Liver Studies, 1(st) Floor James Black Centre, School of Immunology and Microbial Sciences, Faculty of Life Sciences and Medicine, King's College London, 125 Coldharbour Lane, London, SE5 9NU, UK.
| | - Thomas H Tranah
- Institute of Liver Studies, 1(st) Floor James Black Centre, School of Immunology and Microbial Sciences, Faculty of Life Sciences and Medicine, King's College London, 125 Coldharbour Lane, London, SE5 9NU, UK
| | - Carmine Pariante
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, The Maurice Wohl Clinical Neuroscience Institute, Cutcombe Road, London, SE5 9RT, UK
| | - Debbie L Shawcross
- Institute of Liver Studies, 1(st) Floor James Black Centre, School of Immunology and Microbial Sciences, Faculty of Life Sciences and Medicine, King's College London, 125 Coldharbour Lane, London, SE5 9NU, UK
| |
Collapse
|
15
|
Karam M, Fahs D, Maatouk B, Safi B, Jaffa AA, Mhanna R. Polymeric nanoparticles in the diagnosis and treatment of myocardial infarction: Challenges and future prospects. Mater Today Bio 2022; 14:100249. [PMID: 35434594 PMCID: PMC9006854 DOI: 10.1016/j.mtbio.2022.100249] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 03/28/2022] [Accepted: 03/30/2022] [Indexed: 11/26/2022] Open
Abstract
Myocardial infarction (MI) is the leading cause of morbidity and mortality worldwide. Despite extensive efforts to provide early diagnosis and adequate treatment regimens, detection of MI still faces major limitations and pathological MI complications continue to threaten the recovery of survivors. Polymeric nanoparticles (NPs) represent novel noninvasive drug delivery systems for the diagnosis and treatment of MI and subsequent prevention of fatal heart failure. In this review, we cover the recent advances in polymeric NP-based diagnostic and therapeutic approaches for MI and their application as multifunctional theranostic tools. We also discuss the in vivo behavior and toxicity profile of polymeric NPs, their application in noninvasive imaging, passive, and active drug delivery, and use in cardiac regenerative therapy. We conclude with the challenges faced with polymeric nanosystems and suggest future efforts needed for clinical translation.
Collapse
Affiliation(s)
- Mia Karam
- Biomedical Engineering Program, Maroun Semaan Faculty of Engineering and Architecture, Lebanon
- Department of Biochemistry and Molecular Genetics, Faculty of Medicine, American University of Beirut, P.O. Box 11-0236, Beirut, Lebanon
| | - Duaa Fahs
- Biomedical Engineering Program, Maroun Semaan Faculty of Engineering and Architecture, Lebanon
- Department of Biochemistry and Molecular Genetics, Faculty of Medicine, American University of Beirut, P.O. Box 11-0236, Beirut, Lebanon
| | - Batoul Maatouk
- Biomedical Engineering Program, Maroun Semaan Faculty of Engineering and Architecture, Lebanon
- Department of Biochemistry and Molecular Genetics, Faculty of Medicine, American University of Beirut, P.O. Box 11-0236, Beirut, Lebanon
| | - Brouna Safi
- Department of Chemical Engineering, Maroun Semaan Faculty of Engineering and Architecture, Lebanon
| | - Ayad A. Jaffa
- Department of Biochemistry and Molecular Genetics, Faculty of Medicine, American University of Beirut, P.O. Box 11-0236, Beirut, Lebanon
| | - Rami Mhanna
- Biomedical Engineering Program, Maroun Semaan Faculty of Engineering and Architecture, Lebanon
| |
Collapse
|
16
|
Sunayama T, Maeda D, Matsue Y, Kagiyama N, Jujo K, Saito K, Kamiya K, Saito H, Ogasawara Y, Maekawa E, Konishi M, Kitai T, Iwata K, Wada H, Hiki M, Dotare T, Kasai T, Nagamatsu H, Ozawa T, Izawa K, Yamamoto S, Aizawa N, Yonezawa R, Oka K, Momomura SI, Minamino T. Prognostic value of postural hypotension in hospitalized patients with heart failure. Sci Rep 2022; 12:2802. [PMID: 35181724 PMCID: PMC8857283 DOI: 10.1038/s41598-022-06760-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 02/04/2022] [Indexed: 11/08/2022] Open
Abstract
Although postural hypotension (PH) is reportedly associated with mortality in the general population, the prognostic value for heart failure is unclear. This was a post-hoc analysis of FRAGILE-HF, a prospective multicenter observational study focusing on frailty in elderly patients with heart failure. Overall, 730 patients aged ≥ 65 years who were hospitalized with heart failure were enrolled. PH was defined by evaluating seated PH, and was defined as a fall of ≥ 20 mmHg in systolic and/or ≥ 10 mmHg in diastolic blood pressure within 3 min after transition from a supine to sitting position. The study endpoints were all-cause death and heart failure readmission at 1 year. Predictive variables for the presence of PH were also evaluated. PH was observed in 160 patients (21.9%). Patients with PH were more likely than those without PH to be male with a New York Heart Association classification of III/IV. Logistic regression analysis showed that male sex, severe heart failure symptoms, and lack of administration of angiotensin-converting enzyme inhibitors were independently associated with PH. PH was not associated with 1-year mortality, but was associated with a lower incidence of readmission after discharge after adjustment for other covariates. In conclusion, PH was associated with reduced risk of heart failure readmission but not with 1-year mortality in older patients with heart failure.
Collapse
Affiliation(s)
- Tsutomu Sunayama
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Daichi Maeda
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
- Department of Cardiology, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Yuya Matsue
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.
- Cardiovascular Respiratory Sleep Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan.
| | - Nobuyuki Kagiyama
- Department of Cardiology, The Sakakibara Heart Institute of Okayama, Okayama, Japan
- Department of Digital Health and Telemedicine R&D, Juntendo University, Tokyo, Japan
- Department of Cardiovascular Biology and Medicine, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Kentaro Jujo
- Department of Cardiology, Nishiarai Heart Center Hospital, Tokyo, Japan
| | - Kazuya Saito
- Department of Rehabilitation, The Sakakibara Heart Institute of Okayama, Okayama, Japan
| | - Kentaro Kamiya
- Department of Rehabilitation, School of Allied Health Sciences, Kitasato University, Sagamihara, Japan
| | - Hiroshi Saito
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
- Department of Rehabilitation, Kameda Medical Center, Kamogawa, Japan
| | - Yuki Ogasawara
- Department of Nursing, The Sakakibara Heart Institute of Okayama, Okayama, Japan
| | - Emi Maekawa
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan
| | - Masaaki Konishi
- Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan
| | - Takeshi Kitai
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
- Department of Rehabilitation, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Kentaro Iwata
- Department of Rehabilitation, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Hiroshi Wada
- Department of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Masaru Hiki
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Taishi Dotare
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Takatoshi Kasai
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
- Cardiovascular Respiratory Sleep Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Hirofumi Nagamatsu
- Department of Cardiology, Tokai University School of Medicine, Isehara, Japan
| | - Tetsuya Ozawa
- Department of Rehabilitation, Odawara Municipal Hospital, Odawara, Japan
| | - Katsuya Izawa
- Department of Rehabilitation, Kasukabe Chuo General Hospital, Kasukabe, Japan
| | - Shuhei Yamamoto
- Department of Rehabilitation, Shinshu University Hospital, Matsumoto, Japan
| | - Naoki Aizawa
- Department of Cardiovascular Medicine, Nephrology and Neurology, University of the Ryukyus, Okinawa, Japan
| | - Ryusuke Yonezawa
- Rehabilitation Center, Kitasato University Medical Center, Kitamoto, Japan
| | - Kazuhiro Oka
- Department of Rehabilitation, Saitama Citizens Medical Center, Saitama, Japan
| | | | - Tohru Minamino
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
- Japan Agency for Medical Research and Development-Core Research for Evolutionary Medical Science and Technology (AMED-CREST), Japan Agency for Medical Research and Development, Tokyo, Japan
| |
Collapse
|
17
|
Ruderstam H, Ohlsson B. Self-reported IBS and gastrointestinal symptoms in the general population are associated with asthma, drug consumption and a family history of gastrointestinal diseases. Scand J Gastroenterol 2022:1-11. [PMID: 35104172 DOI: 10.1080/00365521.2022.2031281] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 01/11/2022] [Accepted: 01/12/2022] [Indexed: 02/04/2023]
Abstract
OBJECTIVE The prevalence of functional gastrointestinal (FGI) symptoms and irritable bowel syndrome (IBS) is high in the society, but the etiology is mainly unknown. This population-based, cross-sectional study aimed to examine the associations between self-reported IBS or gastrointestinal (GI) symptoms within the past 2 weeks and concomitant diseases, drug consumption and family history of diseases. MATERIAL AND METHODS Participants from the Malmö Offspring Study (MOS) answered a questionnaire about lifestyle habits, medical history and GI symptoms. Associations between self-reported IBS or GI symptoms and other diseases, drugs, and family history of diseases were calculated by logistic regression, adjusted for false discovery rate (FDR; q < 0.05). RESULTS Of 2648 included patients, 316 had IBS and 459 had GI symptoms. There was an association between IBS and asthma (OR: 1.66; 95% confidence interval [CI]: 1.19-2.32; q = 0.018), and between IBS and using of prescription (OR: 1.44; 95% CI: 1.10-1.89; q = 0.028) and nonprescription drugs (OR: 1.92; 95% CI: 1.43-2.59; q < 0.001), specifically adrenergic beta-antagonists, antihistamines and hypnotics. Regarding family history, GI disease in the family (OR: 2.44; 95% CI: 1.78-3.35; q < 0.001) and the subgroups celiac disease, gastric ulcer, functional dyspepsia, IBS and reflux, as well as prostate cancer were associated with IBS, while GI diseases (OR: 2.56; 95% CI: 1.89-3.46; q < 0.001), joint diseases (OR: 1.61; 95% CI: 1.19-2.16; q = 0.009), and myocardial infarction (OR: 1.48; 95% CI: 1.09-2.99; q = 0.043) were associated with GI symptoms. Abdominal pain was the specific symptom with strongest associations. CONCLUSIONS IBS and GI symptoms were mainly associated with GI diseases in the family and drug consumption. To take a family and drug history is pertinent to all clinical history taking, irrespective of the symptomatology.
Collapse
Affiliation(s)
- Hanna Ruderstam
- Department of Internal Medicine, Skåne University Hospital, Malmö, Sweden
| | - Bodil Ohlsson
- Department of Internal Medicine, Skåne University Hospital, Malmö, Sweden
- Department of Clinical Sciences, Lund University, Malmö, Sweden
| |
Collapse
|
18
|
Ohta H, Miyake T, Ueki T, Kojima M, Kawasaki M, Tatsuta T, Iuchi T, Kamitani S, Shimizu T, Mekata E, Tani M. Predictors and clinical impact of postoperative diarrhea after colorectal cancer surgery: a prospective, multicenter, observational study (SHISA-1602). Int J Colorectal Dis 2022; 37:657-664. [PMID: 35080636 PMCID: PMC8885501 DOI: 10.1007/s00384-022-04097-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/13/2022] [Indexed: 02/04/2023]
Abstract
PURPOSE Postoperative diarrhea, including high-output stoma (HOS), frequently occurs after colorectal surgery; its risk factors and clinical implications on subsequent complications remain unknown. This study aimed to evaluate the risk factors and clinical implications of postoperative diarrhea after primary colorectal cancer (CRC) surgery. METHODS This prospective observational study included patients with CRC who underwent radical surgery at six hospitals between June 2016 and December 2017. The patients were categorized into three groups (non-stoma, colostoma, and ileostoma groups). RESULTS A total of 178 patients participated in the study. In the non-stoma group, the incidence of postoperative diarrhea was 18.4% (27/147). The incidence of HOS was 28.6% (4/14) in the ileostoma group, and 0% in the colostoma group. Multivariable analyses of the incidence of diarrhea in the non-stoma group indicated that habitual smoking and hypertension were significantly associated with postoperative diarrhea (P = 0.012 and P = 0.0274, respectively). Postoperative diarrhea was more likely to occur in patients with rectal cancer than in those with colon cancer (P = 0.0501). In the non-stoma and ileostoma groups, the probability of the occurrence of other complications with Clavien-Dindo (C-D) grades II or higher was significantly higher in patients with C-D grade I diarrhea, including HOS, than in patients without diarrhea (39.3% vs. 14.6%, P = 0.0061). CONCLUSIONS Smoking and hypertension are the independent predictors of postoperative diarrhea after an elective CRC surgery. Rectal cancer surgery seems to be associated with postoperative diarrhea more than colon cancer surgery does. Mild postoperative diarrhea may lead to more severe complications.
Collapse
Affiliation(s)
- Hiroyuki Ohta
- Department of Comprehensive Surgery, Shiga University of Medical Science, Seta-tsukinowacho, Otsu, Shiga 520-2192 Japan ,Department of Surgery, Higashi-Ohmi General Medical Center, Higashi-ohmi, Japan
| | - Toru Miyake
- Department of Gastrointestinal Surgery, Shiga University of Medical Science, Otsu, Japan
| | - Tomoyuki Ueki
- Department of Gastrointestinal Surgery, Shiga University of Medical Science, Otsu, Japan
| | - Masatsugu Kojima
- Department of Gastrointestinal Surgery, Shiga University of Medical Science, Otsu, Japan
| | | | - Takeshi Tatsuta
- Department of Surgery, Tesseikai Neurosurgical Hospital, Sijounawate, Japan
| | - Takekazu Iuchi
- Department of Surgery, Toyosato Hospital, Toyosato, Inukami-gun Japan
| | | | - Tomoharu Shimizu
- Department of Medical Safety, Shiga University of Medical Science, Otsu, Japan
| | - Eiji Mekata
- Department of Comprehensive Surgery, Shiga University of Medical Science, Seta-tsukinowacho, Otsu, Shiga 520-2192 Japan ,Department of Surgery, Higashi-Ohmi General Medical Center, Higashi-ohmi, Japan
| | - Masaji Tani
- Department of Gastrointestinal Surgery, Shiga University of Medical Science, Otsu, Japan
| |
Collapse
|
19
|
Kronsten VT, Shawcross DL. Hepatic encephalopathy and depression in chronic liver disease: is the common link systemic inflammation? Anal Biochem 2021; 636:114437. [PMID: 34715068 DOI: 10.1016/j.ab.2021.114437] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 09/26/2021] [Accepted: 10/22/2021] [Indexed: 02/08/2023]
Abstract
Hepatic encephalopathy and depression share a number of clinical features, such as cognitive impairment and psychomotor retardation, and are highly prevalent in patients with chronic liver disease. Both conditions signify a poor prognosis, carry an increased mortality and are major determinants of reduced health related quality of life. The pathophysiology of hepatic encephalopathy is complex. Whilst cerebral accumulation of ammonia is well-recognised as being central to the development of hepatic encephalopathy, systemic inflammation, which acts in synergy with hyperammonaemia, is emerging as a key driver in its development. The pro-inflammatory state is also widely documented in depression, and peripheral to brain communication occurs resulting in central inflammation, behavioural changes and depressive symptoms. Gut dysbiosis, with a similar reduction in beneficial bacteria, increase in pathogens and decreased bacterial diversity, has been observed in both hepatic encephalopathy and depression, and it may be that the resultant increased bacterial translocation causes their shared inflammatory pathophysiology. Whilst the literature on a positive association between hepatic encephalopathy and depression in cirrhosis remains to be substantiated, there is evolving evidence that treatment with psychobiotics may be of dual benefit, improving cognition and mood in cirrhosis.
Collapse
Affiliation(s)
- Victoria Tatiana Kronsten
- Institute of Liver Studies, School of Immunology and Microbial Sciences, Faculty of Life Sciences and Medicine, King's College London, UK.
| | - Debbie Lindsay Shawcross
- Institute of Liver Studies, School of Immunology and Microbial Sciences, Faculty of Life Sciences and Medicine, King's College London, UK
| |
Collapse
|
20
|
Frimpong EK, Asong JA, Aremu AO. A Review on Medicinal Plants Used in the Management of Headache in Africa. PLANTS 2021; 10:plants10102038. [PMID: 34685845 PMCID: PMC8539318 DOI: 10.3390/plants10102038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 08/28/2021] [Accepted: 09/04/2021] [Indexed: 01/29/2023]
Abstract
The use of medicinal plants in the management of diverse ailments is entrenched in the culture of indigenous people in African communities. This review provides a critical appraisal of the ethnobotanical uses of medicinal plants for the management of headache in Africa. Research articles published from 2010 (Jan) to 2021 (July) with keywords such as Africa, ethnobotany, headache, medicinal plant and traditional medicine were assessed for eligibility based on sets of pre-defined criteria. A total of 117 plants, representing 56 families, were documented from the 87 eligible studies. Asteraceae (10%), Fabaceae (10%), Lamiaceae (9%) and Mimosaceae (5%) were the most represented plant families. The most popular plant species used in the management of headache were Ocimum gratissimum L. (n = 7), Allium sativum L. (n = 3), Ricinus communis L. (n = 3) and Artemisia afra Jack. ex. Wild (n = 2). The leaves (49%), roots (20%) and bark (12%) were the most common plant parts used. Decoction (40%) and infusion (16%) were the preferred methods of preparation, whereas the oral route (52%) was the most preferred route of administration. The data revealed that medicinal plants continue to play vital roles in the management of headache in African communities. In an attempt to fully explore the benefits from the therapeutic potential of indigenous flora for common ailments, further studies are essential to generate empirical evidence on their efficacies, using appropriate test systems/models. This approach may assist with the ongoing drive towards the integration of African traditional medicine within mainstream healthcare systems.
Collapse
Affiliation(s)
- Ebenezer Kwabena Frimpong
- Indigenous Knowledge Systems Centre, Faculty of Natural and Agricultural Sciences, North-West University, Private Bag X2046, Mmabatho 2790, South Africa;
- Correspondence: (E.K.F.); (A.O.A.); Tel.: +27-18-389-2573 (A.O.A.)
| | - John Awungnjia Asong
- Indigenous Knowledge Systems Centre, Faculty of Natural and Agricultural Sciences, North-West University, Private Bag X2046, Mmabatho 2790, South Africa;
| | - Adeyemi Oladapo Aremu
- Indigenous Knowledge Systems Centre, Faculty of Natural and Agricultural Sciences, North-West University, Private Bag X2046, Mmabatho 2790, South Africa;
- Food Security and Safety Niche Area, Faculty of Natural and Agricultural Sciences, North-West University, Private Bag X2046, Mmabatho 2790, South Africa
- Correspondence: (E.K.F.); (A.O.A.); Tel.: +27-18-389-2573 (A.O.A.)
| |
Collapse
|
21
|
Howard JP, Wood FA, Finegold JA, Nowbar AN, Thompson DM, Arnold AD, Rajkumar CA, Connolly S, Cegla J, Stride C, Sever P, Norton C, Thom SAM, Shun-Shin MJ, Francis DP. Side Effect Patterns in a Crossover Trial of Statin, Placebo, and No Treatment. J Am Coll Cardiol 2021; 78:1210-1222. [PMID: 34531021 PMCID: PMC8453640 DOI: 10.1016/j.jacc.2021.07.022] [Citation(s) in RCA: 92] [Impact Index Per Article: 30.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 07/07/2021] [Accepted: 07/14/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Most people who begin statins abandon them, most commonly because of side effects. OBJECTIVES The purpose of this study was to assess daily symptom scores on statin, placebo, and no treatment in participants who had abandoned statins. METHODS Participants received 12 1-month medication bottles, 4 containing atorvastatin 20 mg, 4 placebo, and 4 empty. We measured daily symptom intensity for each using an app (scale 1-100). We also measured the "nocebo" ratio: the ratio of symptoms induced by taking statin that was also induced by taking placebo. RESULTS A total of 60 participants were randomized and 49 completed the 12-month protocol. Mean symptom score was 8.0 (95% CI: 4.7-11.3) in no-tablet months. It was higher in statin months (16.3; 95% CI: 13.0-19.6; P < 0.001), but also in placebo months (15.4; 95% CI: 12.1-18.7; P < 0.001), with no difference between the 2 (P = 0.388). The corresponding nocebo ratio was 0.90. In the individual-patient daily data, neither symptom intensity on starting (OR: 1.02; 95% CI: 0.98-1.06; P = 0.28) nor extent of symptom relief on stopping (OR: 1.01; 95% CI: 0.98-1.05; P = 0.48) distinguished between statin and placebo. Stopping was no more frequent for statin than placebo (P = 0.173), and subsequent symptom relief was similar between statin and placebo. At 6 months after the trial, 30 of 60 (50%) participants were back taking statins. CONCLUSIONS The majority of symptoms caused by statin tablets were nocebo. Clinicians should not interpret symptom intensity or timing of symptom onset or offset (on starting or stopping statin tablets) as indicating pharmacological causation, because the pattern is identical for placebo. (Self-Assessment Method for Statin Side-effects Or Nocebo [SAMSON]; NCT02668016).
Collapse
Affiliation(s)
- James P Howard
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Frances A Wood
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Judith A Finegold
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Alexandra N Nowbar
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - David M Thompson
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Ahran D Arnold
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | | | - Susan Connolly
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Jaimini Cegla
- Lipid and Cardiovascular Risk Service, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Chris Stride
- Management School, University of Sheffield, Sheffield, United Kingdom
| | - Peter Sever
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Christine Norton
- Division of Care for Long Term Conditions, King's College London, London, United Kingdom
| | - Simon A M Thom
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Matthew J Shun-Shin
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Darrel P Francis
- National Heart and Lung Institute, Imperial College London, London, United Kingdom.
| |
Collapse
|
22
|
The Use of β-Adrenergic Receptor Antagonists in Psychiatry: A Review. J Acad Consult Liaison Psychiatry 2021; 62:404-412. [PMID: 34210401 DOI: 10.1016/j.jaclp.2020.12.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 12/19/2020] [Accepted: 12/20/2020] [Indexed: 01/05/2023]
Abstract
BACKGROUND β-Blockers (BBs) are a widely used class of medications with a number of medical indications. Their ability to suppress the adrenergic response has made them a target of investigation for treating a variety of psychiatric symptoms. OBJECTIVE The aim of this review is to identify evidence regarding the use of BBs for various psychiatric disorders including anxiety disorders, mood disorders, psychosis, and posttraumatic stress disorder. We also review the evidence for use for aggression and agitation and for extrapyramidal side effects of psychiatric medications. METHODS A search of PubMed and Google Scholar was conducted with search terms relevant to the use of BBs for psychiatric conditions. Studies were selected based on relevance to the review objective, focusing on systematic reviews and meta-analyses. Case reports were included and are clearly identified when referenced in this review. RESULTS A total of 44 publications were included that examined the use of BBs as treatment for the following psychiatric symptoms and conditions: anxiety disorders, depression and mood disorders, acute stress disorder and postraumatic stress disorder, psychotic disorders and extrapyramidal symptoms, as well as aggression and agitation. Additionally, adverse effects and drug-drug interactions were reviewed. CONCLUSION Well-characterized psychiatric uses of BBs include treating symptoms of performance anxiety and akathisia. Some positive evidence exists for BB therapy in other disorders such as specific phobia, panic disorder, and for aggression in patients with psychosis, acquired brain injury, or intellectual disability. Most of the evidence on the role of BBs in psychiatry is as adjunctive treatment for management of somatic symptoms rather than as monotherapy. Outside of performance anxiety and akathisia, the role of BBs in psychiatry has not been subjected to careful study, and further investigative trials are needed.
Collapse
|
23
|
AlHabeeb W, Mrabeti S, Abdelsalam AAI. Therapeutic Properties of Highly Selective β-blockers With or Without Additional Vasodilator Properties: Focus on Bisoprolol and Nebivolol in Patients With Cardiovascular Disease. Cardiovasc Drugs Ther 2021; 36:959-971. [PMID: 34106365 PMCID: PMC9519665 DOI: 10.1007/s10557-021-07205-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/20/2021] [Indexed: 02/07/2023]
Abstract
Bisoprolol and nebivolol are highly selective β1-adrenoceptor antagonists, with clinical indications in many countries within the management of heart failure with reduced left ventricular ejection fraction (HFrEF), ischaemic heart disease (IHD), and hypertension. Nebivolol has additional vasodilator actions, related to enhanced release of NO in the vascular wall. In principle, this additional mechanism compared with bisoprolol might lead to more potent vasodilatation, which in turn might influence the effectiveness of nebivolol in the management of HFrEF, IHD and hypertension. In this article, we review the therapeutic properties of bisoprolol and nebivolol, as representatives of “second generation” and “third generation” β-blockers, respectively. Although head-to-head trials are largely lacking, there is no clear indication from published studies of an additional effect of nebivolol on clinical outcomes in patients with HFrEF or the magnitude of reductions of BP in patients with hypertension.
Collapse
Affiliation(s)
- Waleed AlHabeeb
- Cardiac Sciences Department, King Saud University, Riyadh, 12372, Saudi Arabia.
| | - Sanaa Mrabeti
- General Medicine and Endocrinology, Medical Affairs EMEA, Merck Serono Middle East FZ-LLC, Dubai, United Arab Emirates
| | | |
Collapse
|
24
|
Pathak A, Mrabeti S. β-Blockade for Patients with Hypertension, Ischemic Heart Disease or Heart Failure: Where are We Now? Vasc Health Risk Manag 2021; 17:337-348. [PMID: 34135591 PMCID: PMC8197620 DOI: 10.2147/vhrm.s285907] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 04/13/2021] [Indexed: 11/23/2022] Open
Abstract
β-blockers are a heterogeneous class of drugs, with varying selectivity/specificity for β1 vs β2 receptors, intrinsic sympathomimetic activity (ISA), and vasodilatory properties (through β2 stimulation, α receptor blockade or nitric oxide release). These drugs are indicated for the management of arterial hypertension, heart failure or ischemic heart disease (IHD; eg angina pectoris or prior myocardial infarction). Most of the benefit of β-blockade in these conditions arises from blockade of the β1 receptor, and, in practice, the addition of ISA appears to reduce the potential for improved clinical outcomes in people with heart failure or IHD. Aspects of the benefit/risk balance of β-blockers remain controversial, and recent meta-analyses have shed new light on this issue. We have reviewed the current place of cardioselective β-blockade in hypertension, IHD and heart failure, with special reference to the therapeutic profile of a highly selective β1-adrenoceptor blocker, bisoprolol.
Collapse
Affiliation(s)
- Atul Pathak
- Department of Cardiovascular Medicine, Centre Hospitalier Princesse Grace, Monaco
| | - Sanaa Mrabeti
- Medical Affairs EMEA, Merck Serono Middle East FZ-LLC, Dubai, United Arab Emirates
| |
Collapse
|
25
|
Carlos-Escalante JA, de Jesús-Sánchez M, Rivas-Castro A, Pichardo-Rojas PS, Arce C, Wegman-Ostrosky T. The Use of Antihypertensive Drugs as Coadjuvant Therapy in Cancer. Front Oncol 2021; 11:660943. [PMID: 34094953 PMCID: PMC8173186 DOI: 10.3389/fonc.2021.660943] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 04/19/2021] [Indexed: 12/23/2022] Open
Abstract
Cancer is a complex group of diseases that constitute the second largest cause of mortality worldwide. The development of new drugs for treating this disease is a long and costly process, from the discovery of the molecule through testing in phase III clinical trials, a process during which most candidate molecules fail. The use of drugs currently employed for the management of other diseases (drug repurposing) represents an alternative for developing new medical treatments. Repurposing existing drugs is, in principle, cheaper and faster than developing new drugs. Antihypertensive drugs, primarily belonging to the pharmacological categories of angiotensin-converting enzyme inhibitors, angiotensin II receptors, direct aldosterone antagonists, β-blockers and calcium channel blockers, are commonly prescribed and have well-known safety profiles. Additionally, some of these drugs have exhibited pharmacological properties useful for the treatment of cancer, rendering them candidates for drug repurposing. In this review, we examine the preclinical and clinical evidence for utilizing antihypertensive agents in the treatment of cancer.
Collapse
Affiliation(s)
- José A. Carlos-Escalante
- Plan de Estudios Combinados En Medicina (PECEM) (MD/PhD), Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Marcela de Jesús-Sánchez
- Facultad de Ciencias Biológicas y Agropecuarias, Universidad Veracruzana, Orizaba-Córdoba, Mexico
| | - Alejandro Rivas-Castro
- Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Mexico City, Mexico
| | | | - Claudia Arce
- Medical Oncology/Breast Tumors, Instituto Nacional de Cancerología, Mexico City, Mexico
| | - Talia Wegman-Ostrosky
- Basic Research Subdirection, Instituto Nacional de Cancerología, Mexico City, Mexico
| |
Collapse
|
26
|
Riemer TG, Villagomez Fuentes LE, Algharably EAE, Schäfer MS, Mangelsen E, Fürtig MA, Bittner N, Bär A, Zaidi Touis L, Wachtell K, Majic T, Dinges MJ, Kreutz R. Do β-Blockers Cause Depression?: Systematic Review and Meta-Analysis of Psychiatric Adverse Events During β-Blocker Therapy. Hypertension 2021; 77:1539-1548. [PMID: 33719510 DOI: 10.1161/hypertensionaha.120.16590] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
[Figure: see text].
Collapse
Affiliation(s)
- Thomas G Riemer
- From the Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Germany (T.G.R., L.E.V.F., E.A.E.A., M.S.S., E.M., M.-A.F., A.B., L.Z.T., T.M., R.K.).,Institute of Clinical Pharmacology and Toxicology (T.G.R., L.E.V.F., E.A.E.A., M.S.S., E.M., M.-A.F., A.B., L.Z.T., R.K.), Berlin Institute of Health, Germany.,Department of Psychiatry and Psychotherapy (T.G.R., T.M.), Berlin Institute of Health, Germany
| | - Linda E Villagomez Fuentes
- From the Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Germany (T.G.R., L.E.V.F., E.A.E.A., M.S.S., E.M., M.-A.F., A.B., L.Z.T., T.M., R.K.).,Institute of Clinical Pharmacology and Toxicology (T.G.R., L.E.V.F., E.A.E.A., M.S.S., E.M., M.-A.F., A.B., L.Z.T., R.K.), Berlin Institute of Health, Germany
| | - Engi A E Algharably
- From the Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Germany (T.G.R., L.E.V.F., E.A.E.A., M.S.S., E.M., M.-A.F., A.B., L.Z.T., T.M., R.K.).,Institute of Clinical Pharmacology and Toxicology (T.G.R., L.E.V.F., E.A.E.A., M.S.S., E.M., M.-A.F., A.B., L.Z.T., R.K.), Berlin Institute of Health, Germany
| | - Marie S Schäfer
- From the Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Germany (T.G.R., L.E.V.F., E.A.E.A., M.S.S., E.M., M.-A.F., A.B., L.Z.T., T.M., R.K.).,Institute of Clinical Pharmacology and Toxicology (T.G.R., L.E.V.F., E.A.E.A., M.S.S., E.M., M.-A.F., A.B., L.Z.T., R.K.), Berlin Institute of Health, Germany
| | - Eva Mangelsen
- From the Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Germany (T.G.R., L.E.V.F., E.A.E.A., M.S.S., E.M., M.-A.F., A.B., L.Z.T., T.M., R.K.).,Institute of Clinical Pharmacology and Toxicology (T.G.R., L.E.V.F., E.A.E.A., M.S.S., E.M., M.-A.F., A.B., L.Z.T., R.K.), Berlin Institute of Health, Germany
| | - Marc-Alexander Fürtig
- From the Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Germany (T.G.R., L.E.V.F., E.A.E.A., M.S.S., E.M., M.-A.F., A.B., L.Z.T., T.M., R.K.).,Institute of Clinical Pharmacology and Toxicology (T.G.R., L.E.V.F., E.A.E.A., M.S.S., E.M., M.-A.F., A.B., L.Z.T., R.K.), Berlin Institute of Health, Germany
| | - Nadine Bittner
- Evangelisches Krankenhaus Königin Elisabeth Herzberge gGmbH, Psychiatrie, Psychotherapie, Psychosomatik, Berlin, Germany (N.B., M.J.D.)
| | - Annalena Bär
- From the Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Germany (T.G.R., L.E.V.F., E.A.E.A., M.S.S., E.M., M.-A.F., A.B., L.Z.T., T.M., R.K.).,Institute of Clinical Pharmacology and Toxicology (T.G.R., L.E.V.F., E.A.E.A., M.S.S., E.M., M.-A.F., A.B., L.Z.T., R.K.), Berlin Institute of Health, Germany
| | - Laila Zaidi Touis
- From the Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Germany (T.G.R., L.E.V.F., E.A.E.A., M.S.S., E.M., M.-A.F., A.B., L.Z.T., T.M., R.K.).,Institute of Clinical Pharmacology and Toxicology (T.G.R., L.E.V.F., E.A.E.A., M.S.S., E.M., M.-A.F., A.B., L.Z.T., R.K.), Berlin Institute of Health, Germany
| | | | - Tomislav Majic
- From the Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Germany (T.G.R., L.E.V.F., E.A.E.A., M.S.S., E.M., M.-A.F., A.B., L.Z.T., T.M., R.K.).,Department of Psychiatry and Psychotherapy (T.G.R., T.M.), Berlin Institute of Health, Germany
| | - Martin J Dinges
- Evangelisches Krankenhaus Königin Elisabeth Herzberge gGmbH, Psychiatrie, Psychotherapie, Psychosomatik, Berlin, Germany (N.B., M.J.D.)
| | - Reinhold Kreutz
- From the Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Germany (T.G.R., L.E.V.F., E.A.E.A., M.S.S., E.M., M.-A.F., A.B., L.Z.T., T.M., R.K.).,Institute of Clinical Pharmacology and Toxicology (T.G.R., L.E.V.F., E.A.E.A., M.S.S., E.M., M.-A.F., A.B., L.Z.T., R.K.), Berlin Institute of Health, Germany.,DZHK (German Centre for Cardiovascular Research), partner site, Berlin, Germany (R.K.)
| |
Collapse
|
27
|
Abstract
Traumatic brain injury is an increasing cause of morbidity worldwide. Neuropsychiatric impairments, such as behavioral dysregulation and depression, have significant impacts on recovery, functional outcomes, and quality of life of patients with traumatic brain injuries. Three patient cases, existing literature, and expert opinion are used to select pharmacotherapy for the treatment of target symptoms while balancing safety and tolerability.
Collapse
|
28
|
The Unintended Consequences of Adverse Event Information on Medicines' Risks and Label Content. Pharmaceut Med 2020; 34:369-380. [PMID: 33196966 DOI: 10.1007/s40290-020-00367-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2020] [Indexed: 10/23/2022]
Abstract
Patients and prescribers need to be aware of adverse drug events to minimize the risk of their occurrence and the severity with which they appear. However, numerous studies show that being informed about adverse events can increase the possibility of suffering from them. Patients tend to overestimate the likelihood of experiencing the adverse events included in the label, and this can contribute to worsening the negative expectations which are at the root of the nocebo effect. In fact, patients can become anxious after reading the undesirable effects section of the leaflet and, in addition to suffering from the nocebo effect, might not take a drug they could benefit from due to the fear of experiencing adverse events. In addition, patients' attention can focus towards non-specific symptoms of daily living that can be misattributed to the drug and included in the labelling. This article proposes a number of suggestions to reduce the abovementioned unintended effects associated with labelling, namely, an increased focus on the excess risk of experiencing adverse events rather than crude incidence, using attribute framing to help patients to better understand the risk of experiencing adverse events, dividing the undesirable effect section of the leaflet into subsections according to the level of evidence supporting causal relationships and, finally, restricting the addition of non-specific adverse events that are also symptoms of daily living to only those where there is enough evidence to show they have been caused by the drug. More studies on how to minimize the nocebo effect induced by adverse event information should be performed, and these should be done in collaboration with health authorities, to reach a shared consensus on how to better present adverse event information in the label.
Collapse
|
29
|
Van Someren EJW. Brain mechanisms of insomnia: new perspectives on causes and consequences. Physiol Rev 2020; 101:995-1046. [PMID: 32790576 DOI: 10.1152/physrev.00046.2019] [Citation(s) in RCA: 169] [Impact Index Per Article: 42.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
While insomnia is the second most common mental disorder, progress in our understanding of underlying neurobiological mechanisms has been limited. The present review addresses the definition and prevalence of insomnia and explores its subjective and objective characteristics across the 24-hour day. Subsequently, the review extensively addresses how the vulnerability to develop insomnia is affected by genetic variants, early life stress, major life events, and brain structure and function. Further supported by the clear mental health risks conveyed by insomnia, the integrated findings suggest that the vulnerability to develop insomnia could rather be found in brain circuits regulating emotion and arousal than in circuits involved in circadian and homeostatic sleep regulation. Finally, a testable model is presented. The model proposes that in people with a vulnerability to develop insomnia, the locus coeruleus is more sensitive to-or receives more input from-the salience network and related circuits, even during rapid eye movement sleep, when it should normally be sound asleep. This vulnerability may ignite a downward spiral of insufficient overnight adaptation to distress, resulting in accumulating hyperarousal, which, in turn, impedes restful sleep and moreover increases the risk of other mental health adversity. Sensitized brain circuits are likely to be subjectively experienced as "sleeping with one eye open". The proposed model opens up the possibility for novel intervention studies and animal studies, thus accelerating the ignition of a neuroscience of insomnia, which is direly needed for better treatment.
Collapse
Affiliation(s)
- Eus J W Van Someren
- Department of Sleep and Cognition, Netherlands Institute for Neuroscience, Royal Netherlands Academy of Arts and Sciences, Amsterdam, The Netherlands; Department of Integrative Neurophysiology, Center for Neurogenomics and Cognitive Research, Amsterdam Neuroscience, Vrije Universiteit University Amsterdam, Amsterdam, The Netherlands; and Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Neuroscience, Amsterdam, The Netherlands
| |
Collapse
|
30
|
Skarsfeldt MA, Liin SI, Larsson HP, Bentzen BH. Polyunsaturated fatty acid-derived I Ks channel activators shorten the QT interval ex-vivo and in-vivo. Acta Physiol (Oxf) 2020; 229:e13471. [PMID: 32223014 PMCID: PMC8633721 DOI: 10.1111/apha.13471] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 03/17/2020] [Accepted: 03/18/2020] [Indexed: 12/16/2022]
Abstract
AIM We aimed to assess the ability of natural and modified polyunsaturated fatty acids (PUFAs) to shorten QT interval in ex-vivo and in-vivo guinea pig hearts. METHODS The effect of one natural (docosahexaenoic acid [DHA]) and three modified (linoleoyl glycine [Lin-GLY], docosahexaenoyl glycine [DHA-GLY], N-arachidonoyl taurine [N-AT]) PUFAs on ventricular action potential duration (APD) and QT interval was studied in a E4031 drug-induced long QT2 model of ex-vivo guinea pig hearts. The effect of DHA-GLY on QT interval was also studied in in-vivo guinea pig hearts upon intravenous administration. The effect of modified PUFAs on IKs was studied using Xenopus laevis oocytes expressing human KCNQ1 and KCNE1. RESULTS All tested PUFAs shortened ADP and QT interval in ex-vivo guinea pig hearts, however, with different ability in restoring baseline APD/QT interval with specific modified PUFAs being most efficacious. Despite comparable ability in activating the human KCNQ1/KCNE1 channel, Lin-GLY was not as effective in shortening APD/QT interval as DHA-GLY in ex-vivo hearts. By constructing a guinea pig-like KCNE1, we found Lin-GLY to induce less activating effect compared with DHA-GLY on human KCNQ1 co-expressed with guinea pig-like KCNE1. Docosahexaenoyl glycine was studied in more detail and was found to shorten QT interval in in-vivo guinea pig hearts. CONCLUSION Our results show that specific PUFAs shorten QT interval in guinea pig hearts. The tendency of modified PUFAs with pronounced IKs channel activating effect to better restore QT interval suggests that modifying PUFAs to target the IKs channel is a means to improve the QT-shortening effect.
Collapse
Affiliation(s)
- Mark A Skarsfeldt
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- Department of Physiology and Biophysics, University of Miami, Miami, FL, USA
| | - Sara I Liin
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Hans P Larsson
- Department of Physiology and Biophysics, University of Miami, Miami, FL, USA
| | - Bo H Bentzen
- The Danish Arrhythmia Research Centre and Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
31
|
Ziff OJ, Samra M, Howard JP, Bromage DI, Ruschitzka F, Francis DP, Kotecha D. Beta-blocker efficacy across different cardiovascular indications: an umbrella review and meta-analytic assessment. BMC Med 2020; 18:103. [PMID: 32366251 PMCID: PMC7199339 DOI: 10.1186/s12916-020-01564-3] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 03/17/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Beta-blockers are widely used for many cardiovascular conditions; however, their efficacy in contemporary clinical practice remains uncertain. METHODS We performed a prospectively designed, umbrella review of meta-analyses of randomised controlled trials (RCTs) investigating the evidence of beta-blockers in the contemporary management of coronary artery disease (CAD), heart failure (HF), patients undergoing surgery or hypertension (registration: PROSPERO CRD42016038375). We searched MEDLINE, EMBASE and the Cochrane Library from inception until December 2018. Outcomes were analysed as beta-blockers versus control for all-cause mortality, myocardial infarction (MI), incident HF or stroke. Two independent investigators abstracted the data, assessed the quality of the evidence and rated the certainty of evidence. RESULTS We identified 98 meta-analyses, including 284 unique RCTs and 1,617,523 patient-years of follow-up. In CAD, 12 meta-analyses (93 RCTs, 103,481 patients) showed that beta-blockers reduced mortality in analyses before routine reperfusion, but there was a lack of benefit in contemporary studies where ≥ 50% of patients received thrombolytics or intervention. Beta-blockers reduced incident MI at the expense of increased HF. In HF with reduced ejection fraction, 34 meta-analyses (66 RCTs, 35,383 patients) demonstrated a reduction in mortality and HF hospitalisation with beta-blockers in sinus rhythm, but not in atrial fibrillation. In patients undergoing surgery, 23 meta-analyses (89 RCTs, 19,211 patients) showed no effect of beta-blockers on mortality for cardiac surgery, but increased mortality in non-cardiac surgery. In non-cardiac surgery, beta-blockers reduced MI after surgery but increased the risk of stroke. In hypertension, 27 meta-analyses (36 RCTs, 260,549 patients) identified no benefit versus placebo, but beta-blockers were inferior to other agents for preventing mortality and stroke. CONCLUSIONS Beta-blockers substantially reduce mortality in HF patients in sinus rhythm, but for other conditions, clinicians need to weigh up both benefit and potential risk.
Collapse
Affiliation(s)
- Oliver J Ziff
- University of Birmingham Institute of Cardiovascular Sciences, Medical School, Birmingham, B15 2TT, UK.,University College London, London, WC1E 6BT, UK
| | | | | | - Daniel I Bromage
- University College London, London, WC1E 6BT, UK.,Kings College London, London, WC2R 2LS, UK
| | | | | | - Dipak Kotecha
- University of Birmingham Institute of Cardiovascular Sciences, Medical School, Birmingham, B15 2TT, UK. .,Monash Centre of Cardiovascular Research & Education in Therapeutics, Monash University, Melbourne, Victoria, 3004, Australia. .,University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Institute of Translational Medicine, Birmingham, B15 2GW, UK.
| |
Collapse
|
32
|
Beta-blocker therapy and risk of vascular dementia: A population-based prospective study. Vascul Pharmacol 2020; 125-126:106649. [PMID: 31958512 DOI: 10.1016/j.vph.2020.106649] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 12/29/2019] [Accepted: 01/16/2020] [Indexed: 02/07/2023]
Abstract
There are a few studies that report cognitive impairment as a complication of treatment with beta- blockers. We aimed to evaluate the longitudinal association between use of beta-blockers, as a class, and incident risk of all-cause dementia, vascular dementia, Alzheimer's and mixed dementia in the prospective population-based Malmö Preventive Project. We included 18,063 individuals (mean age 68.2, males 63.4%) followed up for 84,506 person-years. Dementia cases were retrieved from the Swedish National Patient Register and validated by review of medical records and neuroimaging data. We performed propensity score matching analysis, resulting in 3720 matched pairs of beta-blocker users and non-users at baseline, and multivariable Cox proportional-hazards regression. Overall, 122 study participants (1.6%) were diagnosed with dementia during the follow-up. Beta-blocker therapy was independently associated with increased risk of developing vascular dementia, regardless of confounding factors (HR: 1.72, 95%CI 1.01-3.78; p = .048). Conversely, treatment with beta-blockers was not associated with increased risk of all-cause, Alzheimer's and mixed dementia (HR:1.15; 95%CI 0.80-1.66; p = .44; HR:0.85; 95%CI 0.48-1.54; P = .59 and HR:1.35; 95%CI 0.56-3.27; p = .50, respectively). We observed that use of beta-blockers, as a class, is associated with increased longitudinal risk of vascular dementia in the general elderly population, regardless of cardiovascular risk factors, prevalent or incident history of atrial fibrillation, stroke, coronary events and heart failure. Further studies are needed to confirm our findings in the general population and to explore the mechanisms underlying the relationship between use of beta- blockers and increased risk of vascular dementia.
Collapse
|
33
|
Coutinho E Silva RDS, Zanoni FL, Simas R, Martins da Silva MHF, Armstrong Junior R, Correia CDJ, Breithaupt Faloppa AC, Moreira LFP. Effect of bilateral sympathectomy in a rat model of dilated cardiomyopathy induced by doxorubicin. J Thorac Cardiovasc Surg 2019; 160:e135-e144. [PMID: 31653422 DOI: 10.1016/j.jtcvs.2019.09.031] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 08/20/2019] [Accepted: 09/06/2019] [Indexed: 01/08/2023]
Abstract
OBJECTIVE The study objective was to evaluate the effect of bilateral sympathectomy on ventricular remodeling and function in a rat model of dilated cardiomyopathy induced by doxorubicin. METHODS Dilated cardiomyopathy was induced in male Wistar rats by weekly intraperitoneal injection of doxorubicin (2 mg/kg) for 9 weeks. Animals were divided into 4 groups: dilated cardiomyopathy; bilateral sympathectomy, submitted on day 15 of the protocol to bilateral sympathectomy; angiotensin-converting enzyme inhibitor, treated with enalapril through day 15 until the end of the experimental protocol; and sham, nonsubmitted through doxorubicin protocol, with weekly intraperitoneal injections of saline solution (0.9%). The left ventricular function was assessed, and the heart was collected for posterior analyses. RESULTS The dilated cardiomyopathy group presented a significant decrease in the myocardial efficiency when compared with the sham group (33.4% vs 71.2%). Only the bilateral sympathectomy group was able to preserve it (57.5%; P = .0001). A significant dilatation in the left ventricular chamber was observed in the dilated cardiomyopathy group (15.9 μm2) compared with the sham group (10.2 μm2; P = .0053). Sympathectomy and enalapril prevented ventricular remodeling (9.5 and 9.6 μm2, respectively; P = .0034). There was a significant increase in interstitial myocardial fibrosis in the dilated cardiomyopathy group (14.8%) when compared with the sham group (2.4%; P = .0001). This process was significantly reduced with sympathectomy and enalapril (8.7 and 3.9%, respectively; P = .0001). CONCLUSIONS Bilateral sympathectomy was effective in preventing remodeling and left ventricular dysfunction in a rat model of dilated cardiomyopathy induced by doxorubicin.
Collapse
Affiliation(s)
- Raphael Dos Santos Coutinho E Silva
- Laboratório Cirúrgico de Pesquisa Cardiovascular (LIM-11), Instituto do Coração (Incor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Fernando Luiz Zanoni
- Laboratório Cirúrgico de Pesquisa Cardiovascular (LIM-11), Instituto do Coração (Incor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Rafael Simas
- Laboratório Cirúrgico de Pesquisa Cardiovascular (LIM-11), Instituto do Coração (Incor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Mateus Henrique Fernandes Martins da Silva
- Laboratório Cirúrgico de Pesquisa Cardiovascular (LIM-11), Instituto do Coração (Incor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Roberto Armstrong Junior
- Laboratório Cirúrgico de Pesquisa Cardiovascular (LIM-11), Instituto do Coração (Incor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Cristiano de Jesus Correia
- Laboratório Cirúrgico de Pesquisa Cardiovascular (LIM-11), Instituto do Coração (Incor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Ana Cristina Breithaupt Faloppa
- Laboratório Cirúrgico de Pesquisa Cardiovascular (LIM-11), Instituto do Coração (Incor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Luiz Felipe Pinho Moreira
- Laboratório Cirúrgico de Pesquisa Cardiovascular (LIM-11), Instituto do Coração (Incor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.
| |
Collapse
|
34
|
|
35
|
Leal Rato M, Duarte GS, Ferreira AN, Alves M, Mainoli B, Teodoro T, Mestre TA, Costa J, Ferreira JJ. Nocebo response in Parkinson's disease: A systematic review and meta-analysis. Parkinsonism Relat Disord 2019; 65:13-19. [DOI: 10.1016/j.parkreldis.2019.04.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Revised: 02/23/2019] [Accepted: 04/19/2019] [Indexed: 12/19/2022]
|
36
|
Joseph P, Swedberg K, Leong DP, Yusuf S. The Evolution of β-Blockers in Coronary Artery Disease and Heart Failure (Part 1/5). J Am Coll Cardiol 2019; 74:672-682. [DOI: 10.1016/j.jacc.2019.04.067] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Revised: 04/02/2019] [Accepted: 04/03/2019] [Indexed: 01/09/2023]
|
37
|
Qintar M, Hirai T, Arnold SV, Sheehy J, Sapontis J, Jones P, Tang Y, Lombardi W, Karmpaliotis D, Moses J, Patterson C, Nicholson WJ, Cohen DJ, Spertus JA, Grantham JA, Salisbury AC. De-escalation of antianginal medications after successful chronic total occlusion percutaneous coronary intervention: Frequency and relationship with health status. Am Heart J 2019; 214:1-8. [PMID: 31152872 DOI: 10.1016/j.ahj.2019.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 04/19/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Successful chronic total occlusion (CTO) percutaneous coronary intervention (PCI) can markedly reduce angina symptom burden, but many patients often remain on multiple antianginal medications (AAMs) after the procedure. It is unclear when, or if, AAMs can be de-escalated to prevent adverse effects or limit polypharmacy. We examined the association of de-escalation of AAMs after CTO PCI with long-term health status. METHODS In a 12-center registry of consecutive CTO PCI patients, health status was assessed at 6 months after successful CTO PCI with the Seattle Angina Questionnaire and the Rose Dyspnea Scale. Among patients with technical CTO PCI success, we examined the association of AAM de-escalation with 6-month health status using multivariable models adjusting for revascularization completeness and predicted risk of post-PCI angina (using a validated risk model). We also examined predictors and variability of AAMs de-escalation. RESULTS Of 669 patients with technical success of CTO PCI, AAMs were de-escalated in 276 (35.9%) patients at 1 month. Patients with AAM de-escalation reported similar angina and dyspnea rates at 6 months compared with those whose AAMs were reduced (any angina: 22.5% vs 20%, P = .43; any dyspnea: 51.8% vs 50.1%, P = .40). In a multivariable model adjusting for complete revascularization and predicted risk of post-PCI angina, de-escalation of AAMs at 1 month was not associated with an increased risk of angina, dyspnea, or worse health status at 6 months. CONCLUSIONS Among patients with successful CTO PCI, de-escalation of AAMs occurred in about one-third of patients at 1 month and was not associated with worse long-term health status.
Collapse
|
38
|
Zullo AR, Olean M, Berry SD, Lee Y, Tjia J, Steinman MA. Patient-Important Adverse Events of β-blockers in Frail Older Adults after Acute Myocardial Infarction. J Gerontol A Biol Sci Med Sci 2019; 74:1277-1281. [PMID: 30137259 PMCID: PMC6625583 DOI: 10.1093/gerona/gly191] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND We evaluated the burden of adverse events caused by β-blocker use after acute myocardial infarction (AMI) in frail, older nursing home (NH) residents. METHODS This retrospective cohort study used national Medicare claims linked to Minimum Data Set assessments. The study population was individuals aged ≥65 years who resided in a U.S. NH for ≥30 days, had a hospitalized AMI between May 2007 and March 2010, and returned to the NH. Exposure was new use of β-blockers versus nonuse post-AMI. Orthostasis, general hypotension, falls, dizziness, syncope, and breathlessness outcomes were measured over 90 days of follow-up. Odds ratios (ORs) with 95% confidence intervals (CIs) for outcomes were estimated using multinomial logistic regression models after 1:1 propensity score-matching of β-blocker users to nonusers. RESULTS Among the 10,992 NH propensity score-matched residents with an AMI, the mean age was 84 years and 70.9% were female. β-blocker users were more likely than nonusers to be hospitalized for hypotension (OR = 1.20, 95% CI 1.03-1.39) or experience breathlessness (OR = 1.10, 95% CI 1.01-1.20) after AMI. With the exception of falls, other outcome estimates, though imprecise, were compatible with a potential elevated risk of orthostasis (OR = 1.14, 95% CI 0.96-1.35), syncope, (OR = 1.24, 95% CI 0.55-2.77), and dizziness (OR = 1.28, 95% CI 0.82-1.99) among β-blocker users. CONCLUSIONS Considered alongside prior evidence that β-blockers may worsen functional outcomes in NH residents with poor baseline functional and cognitive status, our results suggest that providers should exercise caution when prescribing for these vulnerable groups, balancing the mortality benefit against the potential for causing adverse events.
Collapse
Affiliation(s)
- Andrew R Zullo
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island
- Center of Innovation in Long-Term Services and Supports, Providence Veterans Affairs Medical Center, Rhode Island
- Department of Pharmacy, Rhode Island Hospital, Providence
| | - Matthew Olean
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island
- Department of Pharmacy, Rhode Island Hospital, Providence
- University of Rhode Island College of Pharmacy, Kingston
| | - Sarah D Berry
- Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts
| | - Yoojin Lee
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island
| | - Jennifer Tjia
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester
| | - Michael A Steinman
- Division of Geriatrics, University of California, San Francisco and San Francisco VA Medical Center
| |
Collapse
|
39
|
Roth J, Müller N, Kuniss N, Wolf G, Müller UA. Association Between Glycaemic Control and the Intake of Thiazide Diuretics, Beta Blockers and Levothyroxine in People Without Diabetes. Exp Clin Endocrinol Diabetes 2019; 129:443-448. [PMID: 31261409 DOI: 10.1055/a-0919-4525] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE The pharmacological additional information for many medications includes warnings stating that the blood sugar control may be worsened by the intake of certain drugs. However a quantification of the effects is missing. This may result in confusion for patients as well as for their physicians. The aim of this study was to assess a potential association between medication (beta blockers, thiazides, levothyroxine) and HbA1c in people without diabetes. METHODS In this cross-sectional study we analysed data from 2 921 people (7 699 visits) without diabetes (age 46.6 y; 69.1% women; BMI 27.6±6.4 kg/m²; HbA1c 5.2%) who had at least one HbA1c determination and a complete documentation of their drug intake. An oral glucose tolerance test was not performed. The participants were divided in 8 groups (no regular drug intake, levothyroxine alone, beta blockers alone, thiazides alone, combination 2 of 3, combination of all 3). Patients with known distorting influences of the HbA1c were excluded. RESULTS People with no regular drug intake had an HbA1c of 5.4% [35.8 mmol/mol]. The HbA1c of the group that took all 3 drugs in combination was 5.6% [38.2 mmol/mol]. A multiple linear mixed model showed an increase in HbA1c for thiazides (β=0.0558, p=0.025) and a decrease for combination of levothyroxine and thiazide (β=-0.0765, p=0.010). CONCLUSION Thiazides and the combination of levothyroxine and thiazides were associated with slight changes in HbA1c. In this study there was no association between the intake of beta blockers and HbA1c. At least for people without diabetes these effects seem to be of minor importance.
Collapse
Affiliation(s)
- Johannes Roth
- Department of Anesthesia and Intensive Care, Jena University Hospital, Jena, Germany.,Jena University Hospital, Department of Internal Medicine III, Division of Endocrinology and Metabolic Diseases, Jena, Germany
| | - Nicole Müller
- Jena University Hospital, Department of Internal Medicine III, Division of Endocrinology and Metabolic Diseases, Jena, Germany
| | - Nadine Kuniss
- Jena University Hospital, Department of Internal Medicine III, Division of Endocrinology and Metabolic Diseases, Jena, Germany
| | - Gunter Wolf
- Jena University Hospital, Department of Internal Medicine III, Division of Endocrinology and Metabolic Diseases, Jena, Germany
| | - Ulrich Alfons Müller
- Jena University Hospital, Department of Internal Medicine III, Division of Endocrinology and Metabolic Diseases, Jena, Germany
| |
Collapse
|
40
|
AlTurki A, Proietti R, Russo V, Dhanjal T, Banerjee P, Essebag V. Anti-arrhythmic drug therapy in implantable cardioverter-defibrillator recipients. Pharmacol Res 2019; 143:133-142. [PMID: 30914300 DOI: 10.1016/j.phrs.2019.03.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 03/20/2019] [Accepted: 03/22/2019] [Indexed: 01/14/2023]
Abstract
Implantable cardioverter-defibrillators (ICDs) have revolutionized the primary and secondary prevention of patients with ventricular arrhythmias. However, the adverse effects of appropriate or inappropriate shocks may require the adjunctive use of anti-arrhythmic drugs (AADs). Beta blockers are the cornerstone of pharmacological primary and secondary prevention of ventricular arrhythmias. In addition to their established efficacy at reducing the incidence of ventricular arrhythmias, beta-blockers are safe with few side effects. Amiodarone is superior to beta blockers and sotalol for the prevention of ventricular arrhythmia recurrence. However, long-term amiodarone use is associated with significant side effects that limit its utility. Sotalol and mexiletine are the main alternatives to amiodarone with a better side effect profile though they are less efficacious at preventing ventricular arrhythmia recurrence. Dofetilide, azimilide and ranolazine are emerging as therapeutic options for secondary prevention; more studies are needed to assess efficacy and safety in comparison to currently used agents. Beta blockers and amiodarone are the mainstay of therapy in patients experiencing electrical storm; their use reduces the frequency of ventricular arrhythmias and ICD intervention as well as affording time until catheter ablation can be considered.
Collapse
Affiliation(s)
- Ahmed AlTurki
- Division of Cardiology, McGill University Health Center, Quebec, Canada.
| | - Riccardo Proietti
- Department of Cardiac, Thoracic, and Vascular Sciences, Padua, Italy
| | - Vincenzo Russo
- Chair of Cardiology, University of Campania, Ospedale Monaldi, Naples, Italy
| | - Tarvinder Dhanjal
- Cardiology Department, University Hospital Coventry & Warwickshire, Coventry, UK
| | - Prithwish Banerjee
- Cardiology Department, University Hospital Coventry & Warwickshire, Coventry, UK
| | - Vidal Essebag
- Division of Cardiology, McGill University Health Center, Quebec, Canada; Hôpital Sacré-Coeur de Montréal, Montreal, Quebec, Canada
| |
Collapse
|
41
|
|
42
|
Sheehy JP, Qintar M, Arnold SV, Hirai T, Sapontis J, Jones PG, Tang Y, Lombardi W, Karmpaliotis D, Moses JW, Patterson C, Cohen DJ, Amin AP, Nicholson WJ, Spertus JA, Grantham JA, Salisbury AC. Anti-anginal medication titration among patients with residual angina 6-months after chronic total occlusion percutaneous coronary intervention: insights from OPEN CTO registry. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2019; 5:370-379. [DOI: 10.1093/ehjqcco/qcz015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 03/05/2019] [Accepted: 03/18/2019] [Indexed: 01/09/2023]
Abstract
Abstract
Aims
Chronic total occlusion (CTO) percutaneous coronary intervention (PCI) has been shown to reduce angina and improve quality of life, but the frequency of new or residual angina after CTO PCI and its relationship with titration of anti-anginal medications (AAMs) has not been described.
Methods and results
Among consecutive CTO PCI patients treated at 12 US centres in the OPEN CTO registry, angina was assessed 6 months after the index PCI using the Seattle Angina Questionnaire (SAQ) Angina Frequency scale (a score <100 defined new or residual angina). We then compared the proportion of patients with AAM escalation (defined as an increase in the number or dosage of AAMs between discharge and follow-up) between those with and without 6-month angina. Of 901 patients who underwent CTO PCI, 197 (21.9%) reported angina at 6-months, of whom 80 (40.6%) had de-escalation, 66 (33.5%) had no change, and only 51 (25.9%) had escalation of their AAM by the 6-month follow-up. Rates of AAM escalation were similar when stratifying patients by the ultimate success of the CTO PCI, completeness of physiologic revascularization, presence or absence of angina at baseline, history of heart failure, and by degree of symptomatic improvement after CTO PCI.
Conclusions
One in five patients reported angina 6 months after CTO PCI. Although patients with new or residual angina were more likely to have escalation of AAMs in follow-up compared with those without residual symptoms, only one in four patients with residual angina had escalation of AAMs. Although it is unclear whether this finding reflects maximal tolerated therapy at baseline or therapeutic inertia, these findings suggest an important potential opportunity to further improve symptom control in patients with complex stable ischaemic heart disease.
Collapse
Affiliation(s)
- Justin P Sheehy
- Cardiovascular Division, University of Missouri-Kansas City, 2464 Charlotte St., Kansas City, MO, USA
| | - Mohammed Qintar
- Cardiovascular Division, University of Missouri-Kansas City, 2464 Charlotte St., Kansas City, MO, USA
| | - Suzanne V Arnold
- Cardiovascular Division, University of Missouri-Kansas City, 2464 Charlotte St., Kansas City, MO, USA
- Saint Luke’s Mid America Heart Institute, 4401 Wornall Road, CV Research 9th floor, Kansas City, MO, USA
| | - Taishi Hirai
- Section of Cardiology, University of Chicago Medical Center, 924 East 57th Street, Chicago, IL, USA
| | - James Sapontis
- Monash Heart, Cardiovascular Research Centre, Monash Medical Centre, 246 Clayton Road, Clayton Victoria, Australia
| | - Philip G Jones
- Cardiovascular Division, University of Missouri-Kansas City, 2464 Charlotte St., Kansas City, MO, USA
- Saint Luke’s Mid America Heart Institute, 4401 Wornall Road, CV Research 9th floor, Kansas City, MO, USA
| | - Yuanyuan Tang
- Saint Luke’s Mid America Heart Institute, 4401 Wornall Road, CV Research 9th floor, Kansas City, MO, USA
| | - William Lombardi
- Division of Cardiology, University of Washington School of Medicine, 1959 NE Pacific St, Seattle, WA, USA
| | - Dimitiri Karmpaliotis
- Division of Cardiology, New York Presbyterian Hospital, 161 Fort Washington Ave, New York, NY, NY, USA
| | - Jeffrey W Moses
- Division of Cardiology, New York Presbyterian Hospital, 161 Fort Washington Ave, New York, NY, NY, USA
| | - Christian Patterson
- Cardiovascular Division, University of Missouri-Kansas City, 2464 Charlotte St., Kansas City, MO, USA
- Saint Luke’s Mid America Heart Institute, 4401 Wornall Road, CV Research 9th floor, Kansas City, MO, USA
| | - David J Cohen
- Cardiovascular Division, University of Missouri-Kansas City, 2464 Charlotte St., Kansas City, MO, USA
- Saint Luke’s Mid America Heart Institute, 4401 Wornall Road, CV Research 9th floor, Kansas City, MO, USA
| | - Amit P Amin
- Division of Cardiology, Washington University in Saint Louis, 660 S Euclid Ave, St. Louis, MO, USA
| | | | - John A Spertus
- Cardiovascular Division, University of Missouri-Kansas City, 2464 Charlotte St., Kansas City, MO, USA
- Saint Luke’s Mid America Heart Institute, 4401 Wornall Road, CV Research 9th floor, Kansas City, MO, USA
| | - James Aaron Grantham
- Cardiovascular Division, University of Missouri-Kansas City, 2464 Charlotte St., Kansas City, MO, USA
- Saint Luke’s Mid America Heart Institute, 4401 Wornall Road, CV Research 9th floor, Kansas City, MO, USA
| | - Adam C Salisbury
- Cardiovascular Division, University of Missouri-Kansas City, 2464 Charlotte St., Kansas City, MO, USA
- Saint Luke’s Mid America Heart Institute, 4401 Wornall Road, CV Research 9th floor, Kansas City, MO, USA
| |
Collapse
|
43
|
Ray M, Moore J. Accuracy of Side Effect Reporting in Australian Prescribing Information. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
44
|
Mühlbauer V, Prinz R, Mühlhauser I, Wegwarth O. Alternative package leaflets improve people's understanding of drug side effects-A randomized controlled exploratory survey. PLoS One 2018; 13:e0203800. [PMID: 30212555 PMCID: PMC6136776 DOI: 10.1371/journal.pone.0203800] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 08/28/2018] [Indexed: 11/18/2022] Open
Abstract
Background Current German and EU package leaflets (PLs) do not distinguish to what extent listed side effects are indeed side effects caused by drug intake or instead symptoms that occur regardless of drug use. We recently showed that most health professionals misinterpret the frequencies of listed side effects as solely caused by the drug. The present study investigated whether (1) these misinterpretations also prevail among laypeople and (2) alternative PLs reduce these misinterpretations. Methods In March 2017, 397 out of 400 laypeople approached completed an online survey. They were randomized to one of four PL formats: three alternative PLs (drug facts box with/without reading instruction, narrative format with numbers) and one standard PL. Each PL listed four side effects for a fictitious drug: two were presented as occurring more often, one as equally often, and one as less often with drug intake. The alternative formats (interventions) included information on frequencies with and without drug intake and included a statement on the causal relation. The standard PL (control) only included information on frequency ranges with drug intake. Questions were asked on general occurrence and causality of side effects. Results Participants randomized to the standard PL were unable to answer questions on causality. For side effects occurring more often (equally; less often) with drug intake, only 1.9% to 2.8% (equally: 1.9%; less often: 1.9%) provided correct responses about the causal nature of side effects, compared to 55.0% to 81.9% (equally: 23.8% to 70.5%; less often: 21.0% to 43.2%) of participants who received alternative PLs. It remains unclear whether one alternative format is superior to the others. Conclusion In conclusion, information on the frequency of side effects in current package leaflets is misleading. Comparative presentation of frequencies for side effects with and without drug intake including statements on the causal relation significantly improves understanding.
Collapse
Affiliation(s)
- Viktoria Mühlbauer
- Health Sciences and Education, MIN Faculty, University of Hamburg, Hamburg, Germany
- * E-mail:
| | - Roman Prinz
- Harding Center for Risk Literacy, Max Planck Institute for Human Development, Berlin, Germany
| | - Ingrid Mühlhauser
- Health Sciences and Education, MIN Faculty, University of Hamburg, Hamburg, Germany
| | - Odette Wegwarth
- Harding Center for Risk Literacy, Max Planck Institute for Human Development, Berlin, Germany
- Center for Adaptive Rationality, Max Planck Institute for Human Development, Berlin, Germany
| |
Collapse
|
45
|
Na Z, Qiao X, Hao X, Fan L, Xiao Y, Shao Y, Sun M, Feng Z, Guo W, Li J, Li J, Li D. The effects of beta-blocker use on cancer prognosis: a meta-analysis based on 319,006 patients. Onco Targets Ther 2018; 11:4913-4944. [PMID: 30174436 PMCID: PMC6109661 DOI: 10.2147/ott.s167422] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Beta-blockers are antihypertensive drugs and have shown potential in cancer prognosis. However, this benefit has not been well defined due to inconsistent results from the published studies. METHODS To investigate the association between administration of beta-blocker and cancer prognosis, we performed a meta-analysis. A literature search of PubMed, Embase, Cochrane Library, and Web of Science was conducted to identify all relevant studies published up to September 1, 2017. Thirty-six studies involving 319,006 patients were included. Hazard ratios were pooled using a random-effects model. Subgroup analyses were conducted by stratifying ethnicity, duration of drug use, cancer stage, sample size, beta-blocker type, chronological order of drug use, and different types of cancers. RESULTS Overall, there was no evidence to suggest an association between beta-blocker use and overall survival (HR=0.94, 95% CI: 0.87-1.03), all-cause mortality (HR=0.99, 95% CI: 0.94-1.05), disease-free survival (HR=0.59, 95% CI: 0.30-1.17), progression-free survival (HR=0.90, 95% CI: 0.79-1.02), and recurrence-free survival (HR=0.99, 95% CI: 0.76-1.28), as well. In contrast, beta-blocker use was significantly associated with better cancer-specific survival (CSS) (HR=0.78, 95% CI: 0.65-0.95). Subgroup analysis generally supported main results. But there is still heterogeneity among cancer types that beta-blocker use is associated with improved survival among patients with ovarian cancer, pancreatic cancer, and melanoma. CONCLUSION The present meta-analysis generally demonstrates no association between beta-blocker use and cancer prognosis except for CSS in all population groups examined. High-quality studies should be conducted to confirm this conclusion in future.
Collapse
Affiliation(s)
- Zhijing Na
- Department of Post-graduate, Shengjing Hospital of China Medical University, Shenyang, Liaoning 110004, People's Republic of China
| | - Xinbo Qiao
- Department of Post-graduate, Shengjing Hospital of China Medical University, Shenyang, Liaoning 110004, People's Republic of China
| | - Xuanyu Hao
- Department of Rheumatology and Immunology, Shengjing Hospital of China Medical University, Shenyang, Liaoning 110022, People's Republic of China
| | - Ling Fan
- Department of Nursing, Shengjing Hospital of China Medical University, Shenyang, Liaoning 110004, People's Republic of China
| | - Yao Xiao
- The First Clinical Department of China Medical University, Shenyang, Liaoning 110122, People's Republic of China
| | - Yining Shao
- The First Clinical Department of China Medical University, Shenyang, Liaoning 110122, People's Republic of China
| | - Mingwei Sun
- The First Clinical Department of China Medical University, Shenyang, Liaoning 110122, People's Republic of China
| | - Ziyi Feng
- The First Clinical Department of China Medical University, Shenyang, Liaoning 110122, People's Republic of China
| | - Wen Guo
- The First Clinical Department of China Medical University, Shenyang, Liaoning 110122, People's Republic of China
| | - Jiapo Li
- Department of Post-graduate, Shengjing Hospital of China Medical University, Shenyang, Liaoning 110004, People's Republic of China
| | - Jiatong Li
- Department of Undergraduate, The First Clinical Academy of China Medical University, Shenyang, Liaoning 110001, People's Republic of China
| | - Dongyang Li
- Department of Urology, Shengjing Hospital of China Medical University, Shenyang, Liaoning 110004, People's Republic of China,
| |
Collapse
|
46
|
Abstract
Pharmacogenetics is an emerging area of medicine, and more work is needed to fully integrate it into a clinical setting for the benefit of patients. Genetic markers can influence the action of many drugs, including those that prevent and treat cardiovascular conditions. Genotyping is not yet commonplace, but guidelines are being put in place to help practitioners determine the effect a genetic marker may have on certain drugs. With advancements in genetic technology and falling costs, genotyping could be available to all patients via a simple saliva test. This would be a cost-effective way for practitioners to determine the most effective treatment for individuals, reducing "trial and error," adverse effects, and rehospitalization rates and increasing patient compliance. Cardiovascular diseases are the leading causes of death worldwide, so using the most effective medication to treat or prevent them is of utmost importance in reducing incidence and mortality.
Collapse
|
47
|
Duarte GS, Rodrigues FB, Ferreira JJ, Costa J. Adverse events with botulinum toxin treatment in cervical dystonia: How much should we blame placebo? Parkinsonism Relat Disord 2018; 56:16-19. [PMID: 29910156 DOI: 10.1016/j.parkreldis.2018.06.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 05/23/2018] [Accepted: 06/09/2018] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Botulinum toxin (BoNT) is the first line therapy for cervical dystonia (CD), with most patients receiving many treatment sessions, and so come to recognize and expect the benefits and harms of BoNT, making it difficult to separate which adverse events (AEs) are driven by BoNT and which come from patients' expectations. METHODS Using the results of three Cochrane systematic reviews of randomized controlled trials (RCTs) we pooled results to calculate the risk of general and specific AEs associated with BoNT, and the proportion of AEs that cannot be pharmacologically attributed to BoNT. RESULTS Fifteen RCTs, enrolling 1604 patients, were included. BoNT was associated with an increased risk of AEs, but 79% of this increased risk cannot be pharmacologically attributed to BoNT. CONCLUSIONS Patients with CD attach a considerable expectation of harm due to BoNT, reflected in the large proportion of non-pharmacologically-mediated AEs.
Collapse
Affiliation(s)
- Gonçalo S Duarte
- Laboratory of Clinical Pharmacology and Therapeutics, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal; Instituto de Medicina Molecular, Lisbon, Portugal; Center for Evidence-Based Medicine, Faculty of Medicine, University of Lisbon, Lisbon, Portugal.
| | - Filipe B Rodrigues
- Laboratory of Clinical Pharmacology and Therapeutics, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal; Instituto de Medicina Molecular, Lisbon, Portugal; Huntington's Disease Centre, University College London, UK
| | - Joaquim J Ferreira
- Laboratory of Clinical Pharmacology and Therapeutics, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal; Instituto de Medicina Molecular, Lisbon, Portugal; CNS - Campus Neurológico Sénior, Torres Vedras, Portugal
| | - João Costa
- Laboratory of Clinical Pharmacology and Therapeutics, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal; Instituto de Medicina Molecular, Lisbon, Portugal; Center for Evidence-Based Medicine, Faculty of Medicine, University of Lisbon, Lisbon, Portugal; Portuguese Collaborating Centre of the IberoAmerican Cochrane Network-Cochrane Portugal Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| |
Collapse
|
48
|
Hosny KM, El-Say KM, Alkhalidi HM. Quality by design approach to screen the formulation and process variables influencing the characteristics of carvedilol solid lipid nanoparticles. J Drug Deliv Sci Technol 2018. [DOI: 10.1016/j.jddst.2018.03.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
49
|
Kassem MA, Megahed MA, Abu Elyazid SK, Abd-Allah FI, Abdelghany TM, Al-Abd AM, El-Say KM. Enhancing the Therapeutic Efficacy of Tamoxifen Citrate Loaded Span-Based Nano-Vesicles on Human Breast Adenocarcinoma Cells. AAPS PharmSciTech 2018; 19:1529-1543. [PMID: 29470829 DOI: 10.1208/s12249-018-0962-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 01/23/2018] [Indexed: 11/30/2022] Open
Abstract
Serious adverse effects and low selectivity to cancer cells are the main obstacles of long term therapy with Tamoxifen (Tmx). This study aimed to develop Tmx-loaded span-based nano-vesicles for delivery to malignant tissues with maximum efficacy. The effect of three variables on vesicle size (Y1), zeta potential (Y2), entrapment efficiency (Y3) and the cumulative percent release after 24 h (Y4) were optimized using Box-Behnken design. The optimized formula was prepared and tested for its stability in different storage conditions. The observed values for the optimized formula were 310.2 nm, - 42.09 mV, 75.45 and 71.70% for Y1, Y2, Y3, and Y4, respectively. The examination using electron microscopy confirmed the formation of rounded vesicles with distinctive bilayer structure. Moreover, the cytotoxic activity of the optimized formula on both breast cancer cells (MCF-7) and normal cells (BHK) showed enhanced selectivity (9.4 folds) on cancerous cells with IC50 values 4.7 ± 1.5 and 44.3 ± 1.3 μg/ml on cancer and normal cells, respectively. While, free Tmx exhibited lower selectivity (2.5 folds) than optimized nano-vesicles on cancer cells with IC50 values of 9.0 ± 1.1 μg/ml and 22.5 ± 5.3 μg/ml on MCF-7 and BHK cells, respectively. The promising prepared vesicular system, with greater efficacy and selectivity, provides a marvelous tool to overcome breast cancer treatment challenges.
Collapse
|
50
|
Hylind RJ, Ladouceur VB, Fynn-Thompson F, Hourigan SE, Bezzerides VJ, Abrams DJ. Genotype-phenotype-guided medical and surgical intervention in long QT syndrome. HeartRhythm Case Rep 2018; 4:14-17. [PMID: 29379719 PMCID: PMC5775440 DOI: 10.1016/j.hrcr.2017.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Robyn J Hylind
- Inherited Cardiac Arrhythmia Program, Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts
| | | | - Francis Fynn-Thompson
- Department of Cardiovascular Surgery, Boston Children's Hospital, Boston, Massachusetts
| | - Shannon E Hourigan
- Department of Psychiatry, Boston Children's Hospital, Boston, Massachusetts
| | - Vassilios J Bezzerides
- Inherited Cardiac Arrhythmia Program, Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts
| | - Dominic J Abrams
- Inherited Cardiac Arrhythmia Program, Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts
| |
Collapse
|