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Cardiovascular Medicine (cardiovascular + medicine)
Selected AbstractsPharmacogenomics in Cardiovascular MedicineDRUG DEVELOPMENT RESEARCH, Issue 3 2004John F. Carlquist Abstract The completion of the Human Genome Project (HGP) holds promise for further insight into how genetic differences contribute to an individual's response to a medicine(s). Even before the completion of the HGP, cardiovascular medicine was thrust into the arena of pharmacogenomics by the observation that many drugs, cardiovascular and noncardiovascular, promote cardiac arrhythmias. It is now recognized that these adverse responses as well as beneficial responses to cardiovascular medicines can be influenced by alterations in the genes for metabolizing enzymes, drug transporters, and drug targets. To the present, much basic information regarding gene,drug interactions has accumulated, but translation to clinical care has been slow. It is anticipated that the pace of clinical cardiovascular pharmacogenomics will increase as the result of better-designed studies and technological advances. The final adoption of this area of investigation into clinical practice will also be influenced by financial, psychosocial, and legal factors. Drug Dev. Res. 62:180,190, 2004. © 2004 Wiley-Liss, Inc. [source] The Isosorbide-Hydralazine Story: Is There a Case for Race-Based Cardiovascular Medicine?JOURNAL OF CLINICAL HYPERTENSION, Issue 3 2006Keith C. Ferdinand MD No abstract is available for this article. [source] Supplementary prescribing by community and primary care pharmacists: an analysis of PACT data, 2004,2006JOURNAL OF CLINICAL PHARMACY & THERAPEUTICS, Issue 1 2008L. Guillaume BA MSc PhD Summary Background and objective:, Pharmacist prescribing is a relatively new intiative in the extension of prescribing responsibilities to non-medical healthcare professionals. Pharmacist supplementary prescribing was introduced in 2003 and allowed prescribing in accordance with a clinical management plan agreed with a medical practitioner and patient to improve patient access to medicines and better utilize the skills of healthcare professionals. The objective of this research was to examine the volume, cost and trends in pharmacist prescribing in community and primary care using Prescription Analysis and Cost (PACT) data and to suggest possible reasons for the trends. Methods:, Using PACT data at national, chapter and subchapter level for 2004,2006 the volume, costs and trends for pharmacist prescribing were obtained. Supplemental data and statistical analysis from other sources, relating to prescribing of individual drugs, were also utilized. Results:, The total number of items prescribed by pharmacists in community and primary care increased from 2706 in 2004 to 31 052 in 2006. In 2006, pharmacist prescribing represented only 0·004% of all prescribing in the community and primary care setting. Cardiovascular medicines were the most frequently prescribed therapeutic class followed by central nervous system, respiratory, endocrine and gastrointestinal medicines. Conclusion:, Pharmacist prescribing is increasing but represents an extremely small proportion of primary care prescribing. PACT data between 2004 and 2006 reflects pharmacist supplementary prescribing alone and has been in the anticipated therapeutic areas of drugs which treat chronic conditions such as hypertension. [source] Adverse drug reactions in adult medical inpatients in a South African hospital serving a community with a high HIV/AIDS prevalence: prospective observational studyBRITISH JOURNAL OF CLINICAL PHARMACOLOGY, Issue 3 2008Ushma Mehta What is already known about this subject ,,Studies conducted primarily in developed countries have shown that adverse drug reactions (ADRs) are a significant cause of hospital admission, prolong hospital stay and consequently increase the cost of disease management in patients. ,,Cardiovascular medicines, hypoglycaemic agents, nonsteroidal anti-inflammatory drugs and antibiotics are the most frequently implicated medicines in these studies. ,,A large proportion of these ADRs have been shown to be preventable through improved drug prescribing, administration and monitoring for adverse effects. What this paper adds ,,This is the first Sub-Saharan African study in the HIV/AIDS era that describes the contribution of ADRs to patient morbidity, hospitalisation and mortality. ,,Cardiovascular medicines and antiretroviral therapy contributed the most to community-acquired ADRs at the time of hospital admission while medicines used for opportunistic infections (such as antifungals, antibiotics and antituberculosis medicines were most frequently implicated in hospital acquired ADRs. ,,ADRs in HIV-infected patients were less likely to be preventable. Aims To describe the frequency, nature and preventability of community-acquired and hospital-acquired adverse drug reactions (ADRs) in a South African hospital serving a community with a high prevalence of human immunodeficiency virus (HIV)/ acquired immunodeficiency syndrome. Methods A 3-month prospective observational study of 665 adults admitted to two medical wards. Results Forty-one (6.3%) patients were admitted as a result of an ADR and 41 (6.3%) developed an ADR in hospital. Many of the ADRs (46.2%) were considered preventable, although less likely to be preventable in HIV-infected patients than in those with negative or unknown HIV status (community-acquired ADRs 2/24 vs. 35/42; P < 0.0001; hospital-acquired ADRs 3/25 vs. 14/26; P = 0.003). Patients admitted with ADRs were older than patients not admitted with an ADR (median 53 vs. 42 years, P = 0.003), but 60% of community-acquired ADRs at hospital admission were in patients <60 years old. Among patients <60 years old, those HIV infected were more likely to be admitted with an ADR [odds ratio (OR) 2.32, 95% confidence interval (CI) 1.17, 4.61; P = 0.017]. Among HIV-infected patients, those receiving antiretroviral therapy (ART) were more likely to be admitted with an ADR than those not receiving ART (OR 10.34, 95% CI 4.50, 23.77; P < 0.0001). No ART-related ADRs were fatal. Antibiotics and drugs used for opportunistic infections were implicated in two-thirds of hospital-acquired ADRs. Conclusions ADRs are an important, often preventable cause of hospitalizations and inpatient morbidity in South Africa, particularly among the elderly and HIV-infected. Although ART-related injury contributed to hospital admissions, many HIV-related admissions were among patients not receiving ART, and many ADRs were associated with medicines used for managing opportunistic infections. [source] Pharmacogenomics in Cardiovascular MedicineDRUG DEVELOPMENT RESEARCH, Issue 3 2004John F. Carlquist Abstract The completion of the Human Genome Project (HGP) holds promise for further insight into how genetic differences contribute to an individual's response to a medicine(s). Even before the completion of the HGP, cardiovascular medicine was thrust into the arena of pharmacogenomics by the observation that many drugs, cardiovascular and noncardiovascular, promote cardiac arrhythmias. It is now recognized that these adverse responses as well as beneficial responses to cardiovascular medicines can be influenced by alterations in the genes for metabolizing enzymes, drug transporters, and drug targets. To the present, much basic information regarding gene,drug interactions has accumulated, but translation to clinical care has been slow. It is anticipated that the pace of clinical cardiovascular pharmacogenomics will increase as the result of better-designed studies and technological advances. The final adoption of this area of investigation into clinical practice will also be influenced by financial, psychosocial, and legal factors. Drug Dev. Res. 62:180,190, 2004. © 2004 Wiley-Liss, Inc. [source] The ,3 integrin cytoplasmic tail: protein scaffold and control freakJOURNAL OF THROMBOSIS AND HAEMOSTASIS, Issue 2009S. J. SHATTIL Summary., Platelet integrin ,IIb,3 plays an essential role in thrombus formation through interactions with adhesive ligands. Successful parenteral blockade of these interactions has validated ,IIb,3 as a therapeutic target in cardiovascular medicine. However, oral ,IIb,3 antagonists have not been successful and there is an unmet need for more effective anti-platelet drugs. Growing evidence points to the cytoplasmic tails of ,IIb and ,3, and the ,3 tail in particular, as scaffolds for intracellular proteins that mediate inside-out signaling and regulate ,IIb,3 affinity for ligands. Intracellular protein interactions with the integrin cytoplasmic tails also regulate outside-in signals to the actin cytoskeleton. Here we focus on recent studies that illustrate the relevance of the ,3 cytoplasmic tail as a regulatory scaffold in vivo. We speculate that this scaffold or its interacting proteins may serve as therapeutic targets for the development of future anti-thrombotic drugs. [source] Regenerative Medicine for Cardiovascular Disorders-New Milestones: Adult Stem CellsARTIFICIAL ORGANS, Issue 4 2006A. Ruchan Akar Abstract:, Cardiovascular disorders are the leading causes of mortality and morbidity in the developed world. Cell-based modalities have received considerable scientific attention over the last decade for their potential use in this clinical arena. This review was intended as a brief overview on the subject of therapeutic potential of adult stem cells in cardiovascular medicine with basic science findings and the current status of clinical applications. The historical perspective and basic concepts are reviewed and a description of current applications and potential adverse effects in cardiovascular medicine is given. Future improvements on cell-based therapies will likely provide remarkable improvement in survival and quality of life for millions of patients with cardiovascular disorders. [source] The off- versus on-label use of medical devices in interventional cardiovascular medicine: Clarifying the ambiguity between regulatory labeling and clinical decision-making, Part 1: PCI,CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, Issue 4 2008Matthew J. Price MD Abstract The Food and Drug Administration convened a special public meeting of the Circulatory System Devices Advisory Panel in late 2006 in response to data suggesting a small but potentially significant increased risk of stent thrombosis with drug-eluting stents (DES). This panel concluded that "off-label" DES use was associated with an increased risk of adverse outcomes compared with "on-label" use. In this commentary, we will discuss the role of product labeling in clinical decision-making during percutaneous coronary intervention, elucidate the issues that may arise from the conflation of the responsibilities of regulatory bodies and physicians, and offer a potential framework for their resolution. © 2008 Wiley-Liss, Inc. [source] Neuroprotective effect of asymmetric dimethylarginine against 1-methyl-4-phenylpyridinium ion-induced damage in PC12 cellsCLINICAL AND EXPERIMENTAL PHARMACOLOGY AND PHYSIOLOGY, Issue 5-6 2010Xiao-Qing Tang Summary 1. Asymmetric dimethylarginine (ADMA) is a well-known endogenous nitric oxide synthase (NOS) inhibitor. Although it has been shown to be a novel risk marker in cardiovascular medicine and chronic kidney disease, we speculated that in some states associated with excess of nitric oxide (NO), such as 1-methyl-4-phenylpyridinium ion (MPP+)-induced neuronal injury, ADMA might be protective by limiting the toxic effect of high concentrations of NO. 2. The aim of the present study is to explore the protection of ADMA against MPP+ -induced apoptosis and the molecular mechanisms underlying in PC12 cells. 3. We found that exogenous application of ADMA obviously protected PC12 cells against MPP+ -induced cytotoxicity and apoptosis not only by reducing the loss of mitochondrial membrane potential, but also by attenuating an increase in intracellular reactive oxygen species. Moreover, ADMA attenuated MPP+ -induced excessive activation of nitric oxide synthase and overproduction of NO. 4. The results of the present study suggest that the protection caused by ADMA is related to preserving mitochondrial membrane potential and attenuating the MPP+ -induced intracellular reactive oxygen species generation through inhibiting nitric oxide synthase activity and limiting NO generation. [source] Implantable cardioverter defibrillators for prevention of sudden cardiac DeathCLINICAL CARDIOLOGY, Issue 1 2007Rishi Sukhija M.D. Abstract Despite the multiple advances in the field of cardiovascular medicine, the incidence of sudden cardiac death (SCD) continues to rise. Of all SCDs, <25% occur in individuals deemed at high risk by current risk-stratification algorithms; hence, these risk-stratification algorithms are not satisfactory. Until better markers are identified to risk stratify patients, we will see an increasing use of implantable cardioverter defibrillators (ICDs). However, even with the increase in defibrillator use, the impact on overall incidence of SCD may only be modest, as many individuals experience SCD as the first manifestation of cardiovascular disease. Another important challenge is widespread availability of automated external defibrillators and effective utilization of public access defibrillation programs for timely and appropriate management of out-of-hospital victims with cardiac arrest. This review discusses the current understanding on SCD, risk stratification, and management aimed at reducing SCD, particularly with the use of ICDs. Copyright © 2007 John Wiley & Sons, Ltd. [source] Diltiazem: 20 Years' experience in cardiovascular medicineCLINICAL CARDIOLOGY, Issue S4 2003Timothy C. Fagan M.D. First page of article [source] Some concerns about the future of the practice of cardiovascular medicineCLINICAL CARDIOLOGY, Issue 8 2003C. Richard Conti M.D., M.A.C.C. Editor-in-Chief No abstract is available for this article. [source] Matching resources to treatment decisions for patients with acute coronary syndromesCLINICAL CARDIOLOGY, Issue S1 2002Robert M. Califf M.D. Abstract Multiple dynamic forces are having an impact on the way cardiovascular disease is treated today and will be in the future. These forces include extended life expectancy, decreased disability, and accelerated improvement in the effectiveness of medical technology. All of these forces will lead to a predictable increase in health care costs. Cardiologists must also be cognizant of the rise in health care consumerism; patients are assuming a larger role in decisions about their medical care and treatment. All of these factors are driving the climate of evidence-based medicine, particularly in the cardiovascular field. Payers and the government are beginning to require the clinical community to define quality. In turn, these third parties are beginning to measure quality as defined by the profession and to hold providers accountable for the quality of what they do. Although the frontier of genetic prediction in therapeutics will serve as an intellectual focus for bringing these issues closer to the forefront in cardiovascular medicine, the fundamental provision of value in health care (high quality at reasonable cost) cannot wait on genomics. Because the amount of evidence in acute coronary syndromes (ACS) exceeds other areas of medicine, therapies for ACS will undergo increasingly intense scrutiny. [source] Economics and quality of care for patients with acute coronary syndromes: The impending crisisCLINICAL CARDIOLOGY, Issue S1 2002Eric J. Topol M.D. Abstract Several factors are placing significant financial burdens on the health care system today. These include the growing older population, the obesity and type II diabetes epidemics, and the attendant increased prevalence of heart disease, which remains the leading cause of death in the United States. In response, cardiovascular medicine is undergoing sweeping change in the use of advanced technology and interventions. In addition, biomarkers, such as troponin, are emerging as critical predictors of responses to therapy, particularly for coronary stenting. Future trends in the treatment of acute coronary syndromes (ACS) will embrace the use of genomic solutions, such as gene expression profiling, to predict therapeutic outcomes. Careful consideration will need to be given to these innovative approaches to ensure they are cost effective. [source] Pharmacogenomics in Cardiovascular MedicineDRUG DEVELOPMENT RESEARCH, Issue 3 2004John F. Carlquist Abstract The completion of the Human Genome Project (HGP) holds promise for further insight into how genetic differences contribute to an individual's response to a medicine(s). Even before the completion of the HGP, cardiovascular medicine was thrust into the arena of pharmacogenomics by the observation that many drugs, cardiovascular and noncardiovascular, promote cardiac arrhythmias. It is now recognized that these adverse responses as well as beneficial responses to cardiovascular medicines can be influenced by alterations in the genes for metabolizing enzymes, drug transporters, and drug targets. To the present, much basic information regarding gene,drug interactions has accumulated, but translation to clinical care has been slow. It is anticipated that the pace of clinical cardiovascular pharmacogenomics will increase as the result of better-designed studies and technological advances. The final adoption of this area of investigation into clinical practice will also be influenced by financial, psychosocial, and legal factors. Drug Dev. Res. 62:180,190, 2004. © 2004 Wiley-Liss, Inc. [source] Increased risk of hip fracture in the elderly associated with prochlorperazine: is a prescribing cascade contributing?,PHARMACOEPIDEMIOLOGY AND DRUG SAFETY, Issue 9 2010Gillian E. Caughey Abstract Purpose To examine the prescribing of prochlorperazine secondary to the prescribing of a medicine which could lead to symptoms for which prochlorperazine is indicated and commonly used. Given the range of potential hypotensive, sedative, dystonic and other extra-pyramidal side effects associated with prochlorperazine, its association with hip fracture was also examined. Methods Prescription/event sequence symmetry analyses were undertaken from 1st January 2003 to 31st December 2006, using administrative claims data from the Department of Veterans' Affairs, Australia. This method assesses asymmetry in the distribution of an incident event (either prescription of another medicine or hospitalization) before and after the initiation of prochlorperazine. Crude and adjusted sequence ratios (ASR) with 95% confidence intervals (CI) were calculated. Results A total of 34,235 persons with incident use of prochlorperazine were identified during the study period. Statistically significant positive associations were found for a number of commonly used medicines, including cardiovascular medicines, NSAIDs, opioids and sedatives and the subsequent initiation of prochlorperazine that ranged from 1.07 (95%CI 1.01,1.14) for diuretics to 1.50 (95%CI 1.40,1.61) for statins. Prescription event analysis showed a 49% (95%CI 1.19,1.86) increased risk of hospitalisation for hip fracture following dispensing of prochlorperazine. Conclusions Prescribers should consider the possible contributing role of newly initiated medicines with the potential to cause of dizziness, and where possible address this through dose reduction or cessation of the medicine, rather than prescribing prochlorperazine. Copyright © 2010 John Wiley & Sons, Ltd. [source] | ||||||||||||||||||||||