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Jiang Z, Cui X, Qu P, Shang C, Xiang M, Wang J. Roles and mechanisms of puerarin on cardiovascular disease:A review. Biomed Pharmacother 2022; 147:112655. [DOI: 10.1016/j.biopha.2022.112655] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 01/13/2022] [Accepted: 01/16/2022] [Indexed: 12/13/2022] Open
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Identification of Potential Bioactive Ingredients and Mechanisms of the Guanxin Suhe Pill on Angina Pectoris by Integrating Network Pharmacology and Molecular Docking. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2021; 2021:4280482. [PMID: 34422068 PMCID: PMC8373492 DOI: 10.1155/2021/4280482] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 07/15/2021] [Accepted: 07/26/2021] [Indexed: 01/09/2023]
Abstract
The Guanxin Suhe pill (GSP), a traditional Chinese medicine, has been widely used to treat angina pectoris (AP) in Chinese clinical practice. However, research on the bioactive ingredients and underlying mechanisms of GSP in AP remains scarce. In this study, a system pharmacology approach integrating gastrointestinal absorption (GA) evaluation, drug-likeness (DL) evaluation, target exploration, protein-protein-interaction analysis, Gene Ontology (GO) enrichment analysis, network construction, and molecular docking was adopted to explore its potential mechanisms. A total of 481 ingredients from five herbs were collected, and 242 were qualified based on GA and DL evaluation. Target exploration identified 107 shared targets between GSP and AP. Protein-protein interaction identified VEGFA (vascular endothelial growth factor A), TNF (tumor necrosis factor), CCL2 (C-C motif chemokine ligand 2), FN1 (fibronectin 1), MMP9 (matrix metallopeptidase 9), PTGS2 (prostaglandin-endoperoxide synthase 2), IL10 (interleukin 10), CXCL8 (C-X-C motif chemokine ligand 8), IL6 (interleukin 6), and INS (insulin) as hub targets for GSP, which were involved in the inflammatory process, ECM proteolysis, glucose metabolism, and lipid metabolism. GO enrichment identified top pathways in the biological processes, molecular functions, and cell components, explaining GSP's potential AP treatment mechanism. Positive regulation of the nitric oxide biosynthetic process and the response to hypoxia ranked highest of the biological processes; core targets that GSP can regulate in these two pathways were PTGS2 and NOS2, respectively. Molecular docking verified the interactions between the core genes in the pathway and the active ingredients. The study lays a foundation for further experimental research and clinical application.
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Yu J, Jiang Y, Tu M, Liao B, Fang J. Investigating Prescriptions and Mechanisms of Acupuncture for Chronic Stable Angina Pectoris: An Association Rule Mining and Network Analysis Study. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2020; 2020:1931839. [PMID: 33110434 PMCID: PMC7578734 DOI: 10.1155/2020/1931839] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 08/02/2020] [Accepted: 09/25/2020] [Indexed: 12/31/2022]
Abstract
Chronic stable angina pectoris (CSAP) is a worldwide cardiovascular disease that severely affects people's quality of life and causes serious cardiovascular accidents. Although acupuncture had been confirmed as a potential adjunctive treatment for CSAP, the basic rules and mechanisms of acupoints were little understood. We conducted a systematic search of the China Biology Medicine (CBM), VIP database, Wangfang database, China National Knowledge Infrastructure (CNKI), PubMed, Cochrane Library, Embase, and Web of Science to identify eligible clinical controlled trials (CCTs) and randomized controlled trials (RCTs), from their inception to 18th February 2020. The acupoint prescriptions in the treatment of CSAP were extracted and analyzed based on the association rule mining (ARM) and network analysis. In addition, potential mechanisms of acupuncture for treating CSAP were summarized by data mining. A total of 27 eligible trials were included. Analysis of acupoint prescriptions covered 36 conventional acupoints and 1 experience acupoint, distributing in 10 meridians. The top three frequently used acupoints were PC6, LU9, and ST36. The top three frequently used meridians were the pericardial meridian, lung meridian, and heart meridian. The most frequently used acupoint combinations were LU9 combined with PC6. Besides, network analysis indicated that the core acupoints included PC6, BL15, ST40, and RN17. Moreover, potential mechanisms of acupuncture for treating CSAP involved the regulation of autonomic nerve function, the content of matrix metalloproteinase-9 (MMP-9), volume and the equivalent block of coronary artery calcified plaque (CACP), endothelin (ET), and nitric oxide (NO), neutrophil-lymphocyte ratio (NLR), the content of C-reactive protein (CRP), and tumor necrosis factor-α (TNF-α). In conclusion, our findings concerning acupoint prescriptions and potential mechanisms in the acupuncture treatment of CSAP could provide an optimized acupuncture treatment plan for clinical treatment of CSAP and promote further mechanism research and network research of CSAP.
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Affiliation(s)
- Jie Yu
- Department of Neurobiology and Acupuncture Research, The Third Clinical Medical College, Zhejiang Chinese Medical University, Key Laboratory of Acupuncture and Neurology of Zhejiang Province, Hangzhou 310053, China
| | - Yongliang Jiang
- Department of Neurobiology and Acupuncture Research, The Third Clinical Medical College, Zhejiang Chinese Medical University, Key Laboratory of Acupuncture and Neurology of Zhejiang Province, Hangzhou 310053, China
| | - Mingqi Tu
- Department of Neurobiology and Acupuncture Research, The Third Clinical Medical College, Zhejiang Chinese Medical University, Key Laboratory of Acupuncture and Neurology of Zhejiang Province, Hangzhou 310053, China
| | - Binjun Liao
- Department of Neurobiology and Acupuncture Research, The Third Clinical Medical College, Zhejiang Chinese Medical University, Key Laboratory of Acupuncture and Neurology of Zhejiang Province, Hangzhou 310053, China
| | - Jianqiao Fang
- Department of Neurobiology and Acupuncture Research, The Third Clinical Medical College, Zhejiang Chinese Medical University, Key Laboratory of Acupuncture and Neurology of Zhejiang Province, Hangzhou 310053, China
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Pei L, Shen X, Qu K, Tan C, Zou J, Wang Y, Ping F. Exploration of the Two-Way Adjustment Mechanism of Rhei Radix et Rhizoma for Cardiovascular Diseases. Comb Chem High Throughput Screen 2020; 23:1100-1112. [PMID: 32436824 DOI: 10.2174/1386207323666200521120308] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Revised: 01/22/2020] [Accepted: 02/08/2020] [Indexed: 11/22/2022]
Abstract
AIM AND OBJECTIVE Myocardial infarction, cerebral infarction, and other diseases caused by vascular obstruction have always jeopardized human life and health. Several reports indicate that Rhei Radix et Rhizoma has a good clinical effect in the prevention and treatment of cardiovascular diseases. Owing to the complexity of herbal medicine, the pharmacodynamic mechanism of Rhei Radix et Rhizoma is still unclear. The objectives of this study were to explore the two-way adjustment mechanism of Rhei Radix et Rhizoma and provide a new solution for the prevention and treatment of cardiovascular disease. MATERIALS AND METHODS This study used data mining, reverse pharmacophore matching, network construction, GO and KEGG Analysis, and molecular docking to investigate the two-way adjustment mechanism of Rhei Radix et Rhizoma. The methods used were based on systems pharmacology and big data analysis technology. RESULTS The results suggest that Rhei Radix et Rhizoma uses a two-way adjustment of activating blood circulation, as well as blood coagulation in the prevention and treatment of cardiovascular diseases. The components involved in activating blood circulation are mainly anthraquinone components. The corresponding targets are NOS2, NOS3, CALM1, and the corresponding pathways are calcium signaling pathway, VEGF signaling pathway, platelet activation, and the PI3K-Akt signaling pathway. For blood coagulation, the components are mainly tannin components; the corresponding targets are F2, F10, ELANE, and the corresponding pathways are the neuroactive ligand-receptor interaction, complement and coagulation cascades. CONCLUSION This study indicated that Rhei Radix et Rhizoma exerts the two-way adjustment of activating blood circulation and blood coagulation in the prevention and treatment of cardiovascular diseases. It can make up for the side effects of the existing blood circulation drugs for cardiovascular disease, only activating blood circulation, and the uncontrollable large-area bleeding due to the long-term use of the drugs. This study provides a material basis for the development of new blood-activating drugs based on natural medicine.
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Affiliation(s)
- Lishan Pei
- School of Pharmacy, Shaanxi University of Chinese Medicine, Xianyang, Shaanxi, China
| | - Xia Shen
- School of Pharmacy, Shaanxi University of Chinese Medicine, Xianyang, Shaanxi, China
| | - Kai Qu
- Shaanxi Hospital of Chinese Medicine, Xi' an, Shaanxi, China
| | - Conge Tan
- Basic Medical College, Shaanxi University of Chinese Medicine, Xianyang, Shaanxi, China
| | - Junbo Zou
- School of Pharmacy, Shaanxi University of Chinese Medicine, Xianyang, Shaanxi, China
| | - Yanxia Wang
- School of Pharmacy, Shaanxi University of Chinese Medicine, Xianyang, Shaanxi, China
| | - Fan Ping
- School of Pharmacy, Shaanxi University of Chinese Medicine, Xianyang, Shaanxi, China
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Thadani U. Trimetazidine for stable and unstable ischemic heart diseases and for heart failure: Is its routine use justified from available data? Int J Cardiol 2020; 300:45-46. [DOI: 10.1016/j.ijcard.2019.07.093] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 07/30/2019] [Indexed: 01/06/2023]
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Zhou Y, Wang J, Meng Z, Zhou S, Peng J, Chen S, Wang Q, Sun K. Pharmacology of Ivabradine and the Effect on Chronic Heart Failure. Curr Top Med Chem 2019; 19:1878-1901. [PMID: 31400267 DOI: 10.2174/1568026619666190809093144] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Revised: 07/02/2019] [Accepted: 07/25/2019] [Indexed: 11/22/2022]
Abstract
Chronic Heart Failure (CHF) is a complex clinical syndrome with a high incidence worldwide. Although various types of pharmacological and device therapies are available for CHF, the prognosis is not ideal, for which, the control of increased Heart Rate (HR) is critical. Recently, a bradycardic agent, ivabradine, is found to reduce HR by inhibiting the funny current (If). The underlying mechanism states that ivabradine can enter the Hyperpolarization-activated Cyclic Nucleotide-gated (HCN) channels and bind to the intracellular side, subsequently inhibiting the If. This phenomenon can prolong the slow spontaneous phase in the diastolic depolarization, and thus, reduce HR. The clinical trials demonstrated the significant effects of the drug on reducing HR and improving the symptoms of CHF with fewer adverse effects. This review primarily introduces the chemical features and pharmacological characteristics of ivabradine and the mechanism of treating CHF. Also, some expected therapeutic effects on different diseases were also concluded. However, ivabradine, as a typical If channel inhibitor, necessitates additional research to verify its pharmacological functions.
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Affiliation(s)
- Yue Zhou
- Department of Pediatric Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200092, China
| | - Jian Wang
- Department of Pediatric Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200092, China
| | - Zhuo Meng
- Department of Pediatric Cardiology, the Second Affiliated Hospital&Yuying Children's Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - Shuang Zhou
- Department of Pediatric Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200092, China
| | - Jiayu Peng
- Department of Pediatric Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200092, China
| | - Sun Chen
- Department of Pediatric Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200092, China
| | - Qingjie Wang
- Department of Pediatric Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200092, China
| | - Kun Sun
- Department of Pediatric Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200092, China
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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.
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Rousan TA, Thadani U. Stable Angina Medical Therapy Management Guidelines: A Critical Review of Guidelines from the European Society of Cardiology and National Institute for Health and Care Excellence. Eur Cardiol 2019; 14:18-22. [PMID: 31131033 PMCID: PMC6523058 DOI: 10.15420/ecr.2018.26.1] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Most patients with stable angina can be managed with lifestyle changes, especially smoking cessation and regular exercise, along with taking antianginal drugs. Randomised controlled trials show that antianginal drugs are equally effective and none of them reduced mortality or the risk of MI, yet guidelines prefer the use of beta-blockers and calcium channel blockers as a first-line treatment. The European Society of Cardiology guidelines for the management of stable coronary artery disease provide classes of recommendation with levels of evidence that are well defined. The National Institute for Health and Care Excellence (NICE) guidelines for the management of stable angina provide guidelines based on cost and effectiveness using the terms first-line and second-line therapy. Both guidelines recommend using low-dose aspirin and statins as disease-modifying agents. The aim of this article is to critically appraise the guidelines’ pharmacological recommendations for managing patients with stable angina.
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Affiliation(s)
- Talla A Rousan
- University of Oklahoma Health Sciences Center and Veteran Affairs Medical Center, Oklahoma City Oklahoma, US
| | - Udho Thadani
- University of Oklahoma Health Sciences Center and Veteran Affairs Medical Center, Oklahoma City Oklahoma, US
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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.
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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
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Kassie GM, Nguyen TA, Kalisch Ellett LM, Pratt NL, Roughead EE. Preoperative medication use and postoperative delirium: a systematic review. BMC Geriatr 2017; 17:298. [PMID: 29284416 PMCID: PMC5747155 DOI: 10.1186/s12877-017-0695-x] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 12/18/2017] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Medications are frequently reported as both predisposing factors and inducers of delirium. This review evaluated the available evidence and determined the magnitude of risk of postoperative delirium associated with preoperative medication use. METHODS A systematic search in Medline and EMBASE was conducted using MeSH terms and keywords for postoperative delirium and medication. Studies which included patients 18 years and older who underwent major surgery were included. The methodological quality of included studies was assessed independently by two authors using the Newcastle-Ottawa quality assessment scale for cohort studies. RESULTS Twenty-nine studies; 25 prospective cohort, three retrospective cohort and one post hoc analysis of RCT data were included. Only four specifically aimed to assess medicines as an independent predictor of delirium, all other studies included medicines among a number of potential predictors of delirium. Of the studies specifically testing the association with a medication class, preoperative use of beta-blockers (OR = 2.06[1.18-3.60]) in vascular surgery and benzodiazepines RR 2.10 (1.23-3.59) prior to orthopedic surgery were significant. However, evidence is from single studies only. Where medicines were included as one possible factor among many, hypnotics had a similar risk estimate to the benzodiazepine study, with one significant and one non-significant result. Nifedipine use prior to cardiac surgery was found to be significantly associated with delirium. The non-specific grouping of psychoactive medication use preoperatively was generally higher with an associated two-to-seven-fold higher risk of postoperative delirium, while only two studies included narcotics without other agents, with one significant and one non-significant result. CONCLUSIONS There was a limited number of high quality studies in the literature quantifying the direct association between preoperative medication use and postsurgical delirium. More studies are required to evaluate the association of specific preoperative medications on the risk of postoperative delirium so that comprehensive guidelines for medicine use prior to surgery can be developed to aid delirium prevention. TRIAL REGISTRATION This systematic review has been registered on PROSPERO International prospective register of systematic reviews (Registration number: CRD42016051245 ).
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Affiliation(s)
- Gizat M Kassie
- Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Sciences, Sansom Institute for Health Research, University of South Australia, Adelaide, South Australia, 5001, Australia.
| | - Tuan A Nguyen
- Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Sciences, Sansom Institute for Health Research, University of South Australia, Adelaide, South Australia, 5001, Australia
| | - Lisa M Kalisch Ellett
- Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Sciences, Sansom Institute for Health Research, University of South Australia, Adelaide, South Australia, 5001, Australia
| | - Nicole L Pratt
- Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Sciences, Sansom Institute for Health Research, University of South Australia, Adelaide, South Australia, 5001, Australia
| | - Elizabeth E Roughead
- Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Sciences, Sansom Institute for Health Research, University of South Australia, Adelaide, South Australia, 5001, Australia
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