Biomedical subjects

Judy W M Cheng

Publications and source records attributed to Judy W M Cheng.

At least 19 recordsLinked to original sources

PubMed2006

Use of non-aspirin nonsteroidal antiinflammatory drugs and the risk of cardiovascular events.

OBJECTIVE: To review published evidence on the use of nonselective, non-aspirin nonsteroidal antiinflammatory drugs (NANSAIDs) and the risks of cardiovascular events and examine the justification for Food and Drug Administration (FDA) in recommending that a cardiovascular risk warning statement be included in all NANSAIDs' product information inserts. DATA SOURCES: Peer-reviewed articles in MEDLINE (1966-August 2006) and Current Contents were identified using the key words NSAID, naproxen, ibuprofen, heart diseases, myocardial infarction, and cardiovascular events. Citations from available articles and related FDA Web sites were reviewed for additional references. STUDY SELECTION AND DATA EXTRACTION: No randomized, placebo-controlled studies have been published evaluating this subject. Epidemiologic evidence published in English was examined. Sixteen relevant studies were identified (5 cohort, 3 nested case-control, 8 case-control). DATA SYNTHESIS: Six of the 16 studies demonstrated increased risk for one or more NANSAIDs (rate or ORs varied from 1.13 to 3.08). Five studies demonstrated cardioprotective effect for one or more NANSAIDs used (rate or ORs varied from 0.48 to 0.84). None of the other studies demonstrated an association between use of NANSAIDs and risk of cardiovascular events. CONCLUSIONS: After adjustment of baseline risk factors for cardiovascular events, epidemiologic studies demonstrated conflicting results regarding the risk of cardiovascular events with long-term use of nonselective NANSAIDs. However, considering the large number of patients consuming NANSAIDs and the potential public health impact, until data from long-term, randomized, controlled trials become available, the FDA's recommendation that a warning statement be included in all nonselective NANSAIDs product package inserts is justified.

Anti-Inflammatory Agents, Non-Steroidal↗

PubMed2006

Drug therapy recommendations from the 2005 ACC/AHA guidelines for treatment of chronic heart failure.

OBJECTIVE: To review and discuss key aspects of the drug therapy recommendations in the American College of Cardiology (ACC)/American Heart Association (AHA) 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure (HF) in the Adult. DATA SOURCES: Data were obtained from the ACC/AHA 2005 Guideline Update for Chronic HF. English-language clinical trials, observational studies, and pertinent review articles evaluating the pharmacotherapy of chronic HF were identified, based on MEDLINE searches through January 2006. STUDY SELECTION: Articles presenting information that impacts the evidence base for recommendations regarding the use of various drug therapies in patients with chronic HF were evaluated. DATA SYNTHESIS: The ACC/AHA 2005 Guideline Update for HF provides revised, evidence-based recommendations for the treatment of chronic HF. The new guidelines are based on a staging system that recognizes both the development and progression of HF. Recommendations are provided for 2 stages of patients (A and B) who do not yet have clinical HF but are clearly at risk and 2 stages (C and D) that include patients with symptomatic HF. The guidelines continue to emphasize the important role of neurohormonal blockade with angiotensin-converting enzyme inhibitors, angiotensin-receptor blockers, beta-adrenergic blockers, and aldosterone antagonists. Based on recent trials, updated recommendations address the roles of combination therapy and the selective addition of hydralazine and isosorbide dinitrate. Along with specific drug recommendations, information on the practical use of various drugs is provided. Although the guidelines primarily focus on HF due to systolic dysfunction, general recommendations are also provided for patients with preserved systolic function. CONCLUSIONS: The ACC/AHA 2005 Guideline Update provides evidence-based recommendations for healthcare professionals involved in the care of adults with chronic HF. Recent clinical trial findings have further clarified the evolving role of neurohormonal-blocking drugs in the prevention and treatment of HF.

American Heart Association↗

PubMed2006

A review of isosorbide dinitrate and hydralazine in the management of heart failure in black patients, with a focus on a new fixed-dose combination.

BACKGROUND: It is estimated that 25% to 30% of patients with heart failure (HE) in the United States are black. Compared with nonblack patients, black patients have a reduced ability to produce endogenous nitric oxide, which may be associated with enhanced responsiveness to drugs that increase the delivery of nitric oxide, such as nitrates. When used with nitrates, hydralazine (HYD) acts as an antioxidant and prevents development of nitrate tolerance. OBJECTIVE: This article reviews the clinical pharmacology of isosorbide dinitrate (ISDN) and HYD and clinical trials of their use in the treatment of HF, with a particular focus on the new fixed-dose combination for the treatment of HF in black patients. METHODS: Articles or abstracts reporting the results of randomized, double-blind, controlled studies of ISDN and HYD in HF were identified through a search of the English-language literature indexed on MEDLINE and Current Contents/Clinical Medicine from 1966 to February 5, 2005, using the terms hydralazine, isosorbide dinitrate, nitrates, and heart failure. The reference lists of identified articles were reviewed for additional publications. Selected information provided by the manufacturer was also reviewed. RESULTS: The combination of ISDN and HYD was studied in 3 large randomized controlled trials, the first and second Vasodilator in Heart Failure trials (V-HeFT I and V-HeFT II), which included approximately 27% black men, and the African-American Heart Failure Trial (A-HeFT), which included 100% self-identified black patients of both sexes. In V-HeFT I, which compared ISDN 40 mg QID and HYD 75 mg QID with prazosin 20 mg/d or placebo in 642 patients with mild to severe HF (New York Heart Association [NYHA] class II-III), those receiving ISDN and HYD had a 34% reduction in mortality risk compared with those receiving placebo (P < 0.038). In V HeFT II, which compared the same dosages of ISDN and HYD with enalapril 20 mg/d in 804 patients with NYHA class II-IV HF, those receiving enalapril had a 28% reduction in mortality risk compared with those receiving ISDN and HYD (P = 0.016). A predetermined subanalysis of VHeFT I and V-HeFT II found that black patients receiving ISDN and HYD had a 47% reduction in relative mortality risk compared with nonblack patients (hazard ratio = 0.53 vs 130, respectively; P = 0.04). In A-HeFT, which compared combination ISDN/HYD 40/75 mg TID with placebo in 1050 patients with moderate to severe HF (NYHA class III-IV), ISDN/HYD was associated with fewer deaths compared with placebo (32 vs 54, respectively; P = 0.02), a lower incidence of first hospitalizations for HF (85 vs 130; P = 0.002), and a larger number of patients with marked improvement (>10 units) in quality-of-life scores, as measured on the Minnesota Living with Heart Failure Questionnaire (180 vs 166; P = 0.01). In A-HeFT, adverse events occurring with a greater incidence in the ISDN/HYD group than the placebo group were headache (49.5% vs 21.1%, respectively), dizziness (30.1% vs 13.7%), nausea and vomiting (9.7% vs 6.1%), hypotension (7.9% vs 4.4%), sinus congestion (4.3% vs 1.7%), and tachycardia (4.1% vs 2.7%). A pharmacoeconomic analysis based on health care resource utilization in A-HeFT found the ISDN/HYD combination product to be cost-effective over a wide range of acquisition costs (up to 12 US dollars/d ). CONCLUSIONS: The findings of these 3 large controlled clinical trials support the efficacy of ISDN and HYD in patients with HE Using a composite end point of mortality, HT hospitalization, and quality of life, the A-HeFT study found benefits to adding the fixed-dose ISDN/HYD combination product to standard therapy in self-identified black patients of African descent with moderate to severe HF.

Black People↗

PubMed2005

Use of biological based therapy in patients with cardiovascular diseases in a university-hospital in New York City.

BACKGROUND: The use of complementary and alternative products including Biological Based Therapy (BBT) has increased among patients with various medical illnesses and conditions. The studies assessing the prevalence of BBT use among patients with cardiovascular diseases are limited. Therefore, an evaluation of BBT in this patient population would be beneficial. This was a survey designed to determine the effects of demographics on the use of Biological Based Therapy (BBT) in patients with cardiovascular diseases. The objective of this study was to determine the effect of the education level on the use of BBT in cardiovascular patients. This survey also assessed the perceptions of users regarding the safety/efficacy of BBT, types of BBT used and potential BBT-drug interactions. METHOD: The survey instrument was designed to assess the findings. Patients were interviewed from February 2001 to December 2002. 198 inpatients with cardiovascular diseases (94 BBT users and 104 non-users) in a university hospital were included in the study. RESULTS: Users had a significantly higher level of education than non-users (college graduate: 28 [30%] versus 12 [12%], p = 0.003). Top 10 BBT products used were vitamin E [41(43.6%)], vitamin C [30(31.9%)], multivitamins [24(25.5%)], calcium [19(20.2%)], vitamin B complex [17(18.1%)], fish oil [12(12.8%)], coenzyme Q10 [11(11.7%)], glucosamine [10(10.6%)], magnesium [8(8.5%)] and vitamin D [6(6.4%)]. Sixty percent of users' physicians knew of the BBT use. Compared to non-users, users believed BBT to be safer (p < 0.001) and more effective (p < 0.001) than prescription drugs. Forty-two potential drug-BBT interactions were identified. CONCLUSION: Incidence of use of BBT in cardiovascular patients is high (47.5%), as is the risk of potential drug interaction. Health care providers need to monitor BBT use in patients with cardiovascular diseases.

Adrenergic beta-Antagonists↗

PubMed2005

Effect of nesiritide on renal function: a retrospective review.

OBJECTIVES: Recent meta-analysis has demonstrated that nesiritide may worsen renal function (RF) in patients with acute decompensated heart failure (ADHF). A nesiritide utilization evaluation (NUE) performed in our institution reflected that belief of RF preservation was one reason leading to nesiritide overuse. This study examined the effect of nesiritide on RF in patients evaluated in this NUE. RESEARCH DESIGN AND METHODS: Nesiritide patient records from October 1, 2003 to March 31, 2004 were reviewed (n = 162). Pertinent demographics, laboratory and medication utilization data were obtained. MAIN OUTCOME MEASURES: Changes in creatinine clearance (CrCl) and percentage of patients demonstrating worsening RF (decrease in CrCl > or = 25%) during diuretics therapy before nesiritide initiation and during nesiritide initiation and during nesiritide therapy were compared using Wilcoxon Signed-Ranks test and Chi-Square respectively. RESULTS: Overall, the addition of nesiritide to IV furosemide did not clinically change RF as compared to the use of IV furosemide alone (% change in CrCl: 0 vs. -2.13 mL/min, p = 0.023), although the difference was statistically significant. When categorized into different RF, there is no different in CrCl changes between the nesiritide group and the IV furosemide alone group. There is also no difference in terms of number of patients experiencing > or = 25% reduction in CrCl overall. Changes in RF were also not correlated to dose or duration of therapy. CONCLUSION: Nesiritide did not demonstrate significant impact in RF. Larger studies that examine RF in a more systematic and controlled manner and relate changes in RF to clinical outcomes are necessary to further elucidate the risk versus benefit profile of nesiritide.

Adolescent↗

PubMed2004

Use of erythropoietin in heart failure management.

OBJECTIVE: To review the use of erythropoietin for anemia in heart failure (HF). DATA SOURCES: Peer-reviewed articles in MEDLINE (1966-June 2004) were identified and citations from available articles were reviewed using the search terms anemia, erythropoietin, and heart failure. DATA SYNTHESIS: Anemia worsens HF prognosis. Clinical studies in patients with New York Heart Association Class III/IV HF who had hemoglobin <12 mg/dL and were refractory to maximal medical management showed that erythropoietin improves symptoms. Larger scale studies with mortality endpoints are required to confirm the benefits. CONCLUSIONS: In selected patients with severe, chronic HF, erythropoietin may be considered for functional improvement. However, routine use of this treatment strategy is not recommended until more data are available.

Anemia↗

PubMed2004

Early experiences and clinical implications of restenosis and drug-eluting stents: Part 2.

OBJECTIVE: To review early clinical experience and future implications of drug-eluting stents (DES) in percutaneous coronary interventions. DATA SOURCES: Using the search terms sirolimus, paclitaxel, and drug-eluting stents, a literature review was conducted to identify peer-reviewed articles and abstracts in MEDLINE (1966-June 2003). Recent meeting abstracts were also accessed through the American Heart Association and the American College of Cardiology Web sites. Citations from available articles were reviewed for additional references. STUDY SELECTION AND DATA EXTRACTION: Published reviews and studies showing the effects of in-stent restenosis and drug-coated and -eluting stents were evaluated and reviewed. DATA SYNTHESIS: Current antiplatelet and antithrombotic therapy have proven successful in preventing acute in-stent thrombosis, but not in-stent restenosis. Recently, stents eluted with certain antimitotic agents have demonstrated positive findings in reducing restenosis (eg, sirolimus, paclitaxel-eluting stents) compared with bare-metal stents. However, data regarding long-term benefits and adverse effects are only beginning to accumulate. CONCLUSIONS: While the current clinical efficacy and safety of DES appear promising, further investigations are required to examine long-term efficacy, safety, and cost-effectiveness. Subanalysis of the current data may help to determine the specific patient population that may benefit maximally from DES.

Angioplasty, Balloon, Coronary↗

PubMed2004

Early experiences and clinical implications of drug-eluting stents: part 1.

OBJECTIVE: To review the pathogenesis of in-stent restenosis and the evolution of drug-eluting stents (DES). DATA SOURCES: Using the search terms sirolimus, paclitaxel, and drug-eluting stents, a literature review was conducted to identify peer-reviewed articles and abstracts in MEDLINE (1966-June 2003). Recent meeting abstracts were accessed through the American Heart Association and the American College of Cardiology Web sites. Citations from available articles were also reviewed for additional references. STUDY SELECTION AND DATA EXTRACTION: Published reviews and studies showing the effects of in-stent restenosis and drug-coated and -eluting stents were evaluated and reviewed. DATA SYNTHESIS: Coronary stent implantation is a common form of percutaneous coronary interventions. Approximately 20-30% of patients undergoing stent placement develop restenosis 6 months after the procedure. The primary cause of in-stent restenosis is neointimal proliferation and subsequent accumulation of extracellular matrix, collagen, and macrophages. Eluting stents with an antimitotic agent may reduce the extent of restenosis. Research is ongoing in terms of finding the ideal combination of antimitotic agent, stent, and eluting medium to create the perfect stent. CONCLUSIONS: Research over the last decade has led to a better understanding of the pathogenesis of in-stent restenosis and ways to prevent restenosis. DES are being developed as one of the strategies to prevent restenosis.

Clinical Trials as Topic↗

PubMed2004

Rosuvastatin in the management of hyperlipidemia.

BACKGROUND: Rosuvastatin is a new statin indicated to reduce elevated levels of total cholesterol, low-density lipoprotein cholesterol (LDL-C), and triglycerides and to increase levels of high-density lipoprotein cholesterol (HDL-C) in patients with primary hypercholesterolemia, mixed dyslipidemia, and homozygous familial hypercholesterolemia. OBJECTIVE: The purpose of this article was to review the pharmacology, clinical efficacy, and tolerability of rosuvastatin as monotherapy and combination therapy for patients with hyperlipidemia. METHODS: A literature review was conducted using the search term rosuvastatin to identify English-language peer-reviewed articles and abstracts in the MEDLINE and Current Contents databases (both 1966 to March 2004). Citations from available articles were reviewed for additional references, and selected information from the manufacturer was discussed. RESULTS: Rosuvastatin 10 to 40 mg/d reduced LDL-C by 43% to 63% (P < 0.05). Compared with other statins, rosuvastatin had the highest dose-to-dose potency in lowering LDL-C (reduction of 60% vs 50% with atorvastatin, 40% with simvastatin, 30% with pravastatin or lovastatin, and 20% with fluvastatin) and better efficacy in raising HDL-C (increase of approximately 10% vs approximately 5% with other statins; P < 0.05). Rosuvastatin enabled significantly more patients to achieve the National Cholesterol Education Program (NCEP) goals for LDL-C with lower doses (P < 0.05). Rosuvastatin was well tolerated. Incidences of myopathy and liver function test abnormalities were rare and comparable to those of other statins. Because it is not metabolized by the cytochrome P-450 enzymes, rosuvastatin had fewer clinically significant drug interactions compared with other statins. Studies to assess the effect of rosuvastatin on cardiovascular outcomes are ongoing. CONCLUSIONS: Clinical studies continue to demonstrate that achieving optimal levels of LDL-C is an important goal in reducing cardiovascular events. Recent evidence suggests the need for an even lower LDL-C goal than that being recommended by the NCEP Based on the studies included in this review, rosuvastatin may help patients achieve optimal goals early with lower dosages, thus reducing the need for dose titration or combination therapy.

Dose-Response Relationship, Drug↗

PubMed2004

Key articles and guidelines in pharmacotherapeutic management of arrhythmias.

Clinical studies are among the most important literature published in the area of cardiovascular pharmacotherapy and are the basis of many of the standards of practice today. We compiled a list of these clinical trials, as well as well-written, up-to-date review articles and important treatment guidelines, that focus on pharmacotherapeutic management of arrhythmias. This list should be useful not only to practitioners and trainees in cardiovascular pharmacotherapy, but also to other clinicians as an update.

Anti-Arrhythmia Agents↗

PubMed2003

Pharmacology and therapeutics of ezetimibe (SCH 58235), a cholesterol-absorption inhibitor.

BACKGROUND: Ezetimibe is the first of a new class of antihyperlipidemic agents, the cholesterol-absorption inhibitors. It is indicated for monotherapy or in combination with 3-hydroxy-3-methylglutaryl coenzyme A-reductase inhibitors (statins) in patients with primary hypercholesterolemia, in combination with simvastatin or atorvastatin in patients with homozygous familial hypercholesterolemia, and as monotherapy in patients with homozygous familial sitosterolemia. OBJECTIVE: This article reviews available data on the clinical pharmacology, clinical efficacy, and tolerability of ezetimibe. METHODS: A literature review was conducted using the search terms ezetimibe and SCH 58235 to identify articles and abstracts indexed in MEDLINE and the Iowa Drug Information Service from 1966 to February 2003. The reference lists of the identified articles were reviewed for additional publications. RESULTS: In adults, ezetimibe 10 mg PO given once daily has been reported to reduce intestinal cholesterol absorption by 54% from baseline in association with a compensatory increase in endogenous cholesterol synthesis. Within 2 weeks of its initiation, ezetimibe monotherapy produced a 17% to 20% reduction from baseline in low-density lipoprotein cholesterol (LDL-C); in combination with statins, ezetimibe produced a reduction in LDL-C of up to 40% over the same period. Based on studies performed to date, ezetimibe appears to be well tolerated, with a safety profile similar to that of placebo. Because ezetimibe is eliminated primarily by glucuronidation and not by cytochrome P450 (CYP) oxidation, it is subject to minimal drug interactions involving the CYP enzyme system. CONCLUSIONS: Ezetimibe is an option for monotherapy in patients with mild hypercholesterolemia or in those requiring adjunctive drug therapy for reduction of LDL-C levels. It may be useful in patients at risk for adverse events (eg, liver toxicity, myopathy) from other hypocholesterolemic agents. Additive LDL-C-lowering effects of ezetimibe may allow use of lower doses of conventional agents (eg, statins, fibric acid derivatives, niacin) to achieve an equivalent effect, thereby reducing the potential for adverse events and drug interactions. However, because trials have lasted no longer than 12 weeks, the long-term effect of ezetimibe on cardiovascular morbidity and mortality remains to be determined.

Animals↗

PubMed2002

Efficacy of glycoprotein IIb/IIIa-receptor inhibitors during percutaneous coronary intervention.

The clinical efficacy of glycoprotein (GP) IIb/IIIa-receptor inhibitors is discussed. Over the past 10 years, GP IIb/IIIa-receptor inhibitors have become the standard of care for patients undergoing percutaneous coronary intervention (PCI). Abciximab, a monoclonal antibody fragment inhibitor of GP IIb/IIIa receptors, has been found to significantly reduce the frequency of death or myocardial infarction in patients undergoing PCI in several large trials. Board use of abciximab for this indication was precluded by the high cost of this agent. Significant benefits of the small-molecule GP IIb/IIIa-receptor inhibitor epitifibatide in patients undergoing PCI led to substantially greater use of GP IIb/IIIa-receptor inhibitors in these patients because of the considerably lower cost of this agent. Positive results of trials of abciximab and eptifibatide in patients receiving PCI can be attributed to the fact that the dosage regimens of these agents in large trials consistently inhibited > 80% of platelet aggregation, particularly during the critical periprocedural period. In contrast, the nonpeptide GP IIb/IIIa-receptor inhibitor tirofiban yielded negative results in two large trials, probably because of < 80% inhibition of platelet aggregation with the dosage regimen used, especially during the first hour of therapy when PCI is performed. Large clinical trials strongly support the use of abciximab or eptifibatide, but not tirofiban, in patients undergoing PCI.

Abciximab↗

PubMed2002

Fondaparinux: a new antithrombotic agent.

BACKGROUND: Venous thrombosis is usually triggered by a low-flow state, as in prolonged periods of bed rest after hip or knee surgery. Antithrombotic agents are the drugs of choice in such circumstances. The new factor Xa inhibitor fondaparinux has been approved by the US Food and Drug Administration for the prevention of venous thromboembolism in patients undergoing hip fracture surgery, hip replacement surgery, or knee replacement surgery. OBJECTIVE: The aim of this article was to review the clinical pharmacology of fondaparinux and summarize the data from available clinical trials of this agent. METHODS: The terms fondaparinux, SR90107A/ORG31540, and factor Xa were used to search MEDLINE and Current Contents/Clinical Medicine for English-language studies in humans published between 1996 and May 2002. Unpublished data were provided by the manufacturer of fondaparinux, and additional information was obtained from abstracts presented at the 2001 congress of the International Society on Thrombosis and Haemostasis in Paris. RESULTS: Fondaparinux is a synthetic pentasaccharide that selectively binds to antithrombin III, inducing a conformational change that increases anti-factor Xa activity. Phase III studies to date have reported that fondaparinux had greater efficacy compared with enoxaparin in terms of prevention of venous thromboembolism after hip or knee replacement surgery. Preliminary studies have suggested that this agent may have efficacy in the treatment of deep vein thrombosis, as well as in the management of acute coronary syndromes. However, 1 study reported a significant increase in the risk of major bleeding with fondaparinux compared with enoxaparin (2.1% vs 0.2%, respectively; P = 0.006), and another reported a significant increase in the risk of minor bleeding (4.1% vs 2.1%; P = 0.02). CONCLUSIONS: Fondaparinux has shown efficacy in the prevention of venous thromboembolism in patients undergoing hip or knee replacement surgery. Large-scale clinical trials of its potential efficacy in deep vein thrombosis and acute coronary syndromes are ongoing. Use of fondaparinux may be associated with an increased bleeding risk, and patients should be assessed individually to ensure that the possible benefits outweigh the risks. Routine use of fondaparinux as a replacement for low-molecular-weight heparin is not recommended at this time.

Arthroplasty, Replacement, Hip↗

PubMed2002

Glucose-insulin-potassium solution for acute myocardial infarction.

OBJECTIVE: To review the role of glucose-insulin-potassium (GIK) solution in the management of acute myocardial infarction (AMI). DATA SOURCES: MEDLINE (1966-October 2001) database, using the search terms glucose, insulin, potassium, and myocardial infarction. STUDY SELECTION: Relevant English-language human studies and meta-analyses. DATA SYNTHESIS: Most studies that have investigated the use of GIK in AMI have been from the prethrombolytic era. Although most data trended toward favoring GIK in improving mortality and morbidity of AMI, the Polish GIK study was terminated prematurely because of an increase in mortality in patients treated with GIK. Dosage, duration of treatment, and route of administration of GIK varied among studies. CONCLUSIONS: Until results from larger-scale studies become available, the routine use of GIK infusion in AMI patients is not recommended.

Clinical Trials as Topic↗

PubMed2002

Pharmacotherapeutic options for the management of myocardial infarction.

The pharmacological treatment of acute coronary syndrome (ACS), including unstable angina, non-ST- and ST-segment elevation myocardial infarction (MI) is dynamic and continues to evolve. Expert guidelines based on the results of clinical trials for the management of different types of ACS have been published. In both ST-segment elevation and non-ST-segment elevation MI, aspirin/clopidogrel, heparin/low molecular weight heparin/direct thrombin inhibitors, beta-blockers and angiotensin converting enzyme inhibitors are part of the routine regimens. In patients with ST-segment elevation MI, eligibility for thrombolytic therapy needs to be determined and utilised as soon as possible. In patients with non-ST-segment elevation MI, the risks of thrombolytic therapy outweigh the benefits. The use of glycoprotein IIb/IIIa inhibitors has become increasingly important. The use of antihyperlipidaemic agents for the prevention of secondary events in both types of patients continue to be essential and the early aggressive use of lipid-lowering therapy also plays a role in improving endothelial function and stabilising atherosclerotic plaques.

Anti-Inflammatory Agents, Non-Steroidal↗

PubMed2002

Use of alternative pharmacotherapy in management of cardiovascular diseases.

OBJECTIVES: To review use of alternative pharmacotherapy (AP) in patients with cardiovascular disease (CVD) and significant drug interactions between AP and traditional CVD medications. STUDY DESIGN: A literature search of MEDLINE and the National Complementary and Alternative Medicine database was done using these search terms: supplements, vitamins, garlic, fish oil, L-arginine, soy, coenzyme Q10, herbs, phytosterols, chelation therapy, alternative medicine, and CVD. PATIENTS AND METHODS: English human clinical trials measuring surrogate and clinical end points. RESULTS: Antioxidants have not been consistently proven beneficial in reducing cardiovascular mortality. Fish oils may be beneficial in patients with hypertension and hypercholesterolemia, but therapeutic doses need to be defined. Use of coenzyme Q10 in patients with heart failure has not demonstrated consistent benefits. Garlic may lower blood pressure and cholesterol levels, but also may increase bleeding, so its use in CVD patients should be monitored. Clinical studies with small sample sizes have demonstrated that L-arginine may be useful to prevent and treat CVD. The Food and Drug Administration recommends 25 g/day of soy protein as part of a diet low in saturated fats for cholesterol reduction. Plant sterols are recommended by the American Heart Association and the National Cholesterol Education Program Expert Panel as adjunct therapy to reduce low-density lipoprotein. No data support use of chelation therapy. Some APs interact with common prescription CVD medications (eg, gingko and ginseng with warfarin, St. John's Wort with digoxin). CONCLUSIONS: The benefits of APs as part of the treatment for CVD are controversial. Routine use is not recommended.

Antioxidants↗

PubMedDate not supplied

Nesiritide: review of clinical pharmacology and role in heart failure management.

Nesiritide mimics the actions of endogenous B-type natriuretic peptides. Clinical studies on patients who had acute decompensated heart failure demonstrated rapid-onset dose-related vasodilatory effects. Nesiritide reduces pulmonary capillary wedge pressure and improves dypsnea. These effects compared favorably to standard treatments. It decreases preload and afterload and suppresses the renin-angiotensin-aldosterone axis and the release of norepinephrine. Nesiritide also promotes diuresis and has no proarrhythmic effects. Nesiritide is a valuable therapeutic option in the treatment of patients hospitalized for decompensated heart failure. On-going studies target the examination of its long-term effects on mortality and morbidity and its pharmacoeconomic benefits to the healthcare system.

Biological Availability↗

PubMedDate not supplied

Tezosentan in the management of decompensated heart failure.

Decompensated heart failure continues to significantly impact the economics of our healthcare system. In recent years, the focus on management of decompensated heart failure has changed from solely improving hemodynamics to modifying neurohormones. Endothelin (ET) is one of the important mediators in heart failure. This article reviews the clinical pharmacology, clinical efficacy, and tolerability of tezosentan, a dual-action ET-1 receptor antagonist. Using the search term tezosentan, a literature review was conducted to identify peer-reviewed articles and abstracts in MEDLINE (1966 to April 2004) and Current Content (1966 to April 2004) databases. Citations from available articles were also reviewed for additional references. When given as an intravenous infusion, tezosentan achieves steady-state concentration within the first 6 hours. Tezosentan is excreted almost entirely through the bile (>95%) and has a terminal elimination half-life of 3 hours. The side effects of tezosentan include headache, nausea, and hypotension. Clinical studies demonstrated mixed results for tezosentan regarding its efficacy and tolerability in the management of decompensated heart failure. The role or tezosentan in treating heart failure is yet to be defined.

Drug Tolerance↗