scholarly journals Interactions between the Cyclooxygenase Metabolic Pathway and the Renin-Angiotensin-Aldosterone Systems: Their Effect on Cardiovascular Risk, from Theory to the Clinical Practice

2018 ◽  
Vol 2018 ◽  
pp. 1-10 ◽  
Author(s):  
Jakub Gawrys ◽  
Karolina Gawrys ◽  
Ewa Szahidewicz-Krupska ◽  
Arkadiusz Derkacz ◽  
Jakub Mochol ◽  
...  
Keyword(s):  
Cardiovascular Events ◽  
Combined Therapy ◽  
Cyclooxygenase Inhibitors ◽  
Low Doses ◽  
Renin Angiotensin ◽  
Complication Risk ◽  
Inflammatory Drugs ◽  
Artery Disease ◽  
High Doses

Coronary artery disease (CAD) and stroke are the most common and serious long-term complications of hypertension. Acetylsalicylic acid (ASA) significantly reduces their incidence and cardiovascular mortality. The RAAS activation plays an important role in pathogenesis of CVD, resulting in increased vascular resistance, proliferation of vascular-smooth-muscle-cells, and cardiac hypertrophy. Drugs acting on the renin-angiotensin-aldosterone system (RAAS) are demonstrated to reduce cardiovascular events in population with cardiovascular disease (CVD). The cyclooxygenase inhibitors limit the beneficial effect of RAAS-inhibitors, which in turn may be important in subjects with hypertension, CAD, and congestive heart failure. These observations apply to most of nonsteroidal anti-inflammatory drugs and ASA at high doses. Nevertheless, there is no strong evidence confirming presence of similar effects of cardioprotective ASA doses. The benefit of combined therapy with low-doses of ASA is—in some cases—significantly higher than that of monotherapy. So far, the significance of ASA in optimizing the pharmacotherapy remains not fully established. A better understanding of its influence on the particular CVD should contribute to more precise identification of patients in whom benefits of ASA outweigh the complication risk. This brief review summarizes the data regarding usefulness and safety of the ASA combination with drugs acting directly on the RAAS.

scholarly journals Nonsteroid anti-inflammatory drugs (NSAID) and risk of cardiovascular events. Literature review and clinical implications

2015 ◽  
Vol 82 (3) ◽  
Author(s):  
Pier Luigi Temporelli ◽  
Giovanni Battista Zito ◽  
Roberto Franco Pedretti ◽  
Francesco Iachini Belisarii ◽  
Giuseppe Putortì ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Cardiovascular Events ◽  
Large Body ◽  
Cyclooxygenase Inhibitors ◽  
Current Status ◽  
Analgesic Drugs ◽  
Drug Agency ◽  
Inflammatory Drugs ◽  
Anti Inflammatory ◽  
Artery Disease

Non steroid anti-inflammatory drugs (NSAIDs) are largely used for treatment of acute and chronic pain, even for long periods of time (months or years). While it is known that their use is frequently associated with gastrointestinal damage, including major bleedings from peptic ulcer, the risk of cardiovascular events related to NSAID has received much less attention. However, there is a large body of evidence showing that NSAIDs (both “traditional”, such as diclofenac or indobufen, and selective cyclooxygenase inhibitors, COX-2) are associated with a significant increase of risk of cardiovascular events, both fatal and nonfatal. Consequently, several options have been proposed for the treatment of pain, including the use of analgesic drugs with different mechanisms of action, such as the opiates. Of interest, the Italian Drug Agency (AIFA) published a few years ago a warning (Nota 66) on the careful prescription of NSAIDs in patients with overt heart disease, such as coronary artery disease and heart failure. Aim of this paper is to present the current status of knowledge on the proper use of NSAIDs and other analgesic drugs in the management of acute and chronic pain.

P6448Major cardiovascular events free survival in the long term follow up of “real world” diabetic patients with stable coronary artery disease at the beginning of the 21st century. The CICCOR Registry

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M Ruiz Ortiz ◽  
J J Sanchez Fernandez ◽  
C Ogayar Luque ◽  
E Romo Penas ◽  
M Delgado Ortega ◽  
...  
Keyword(s):  
Real World ◽  
Cardiovascular Events ◽  
Stable Coronary Artery Disease ◽  
Diabetic Patients ◽  
Free Survival ◽  
End Point ◽  
Major Cardiovascular Events ◽  
Artery Disease

Abstract Background Safety trials of antidiabetic drugs have included a main endpoint of cardiovascular morbidity and mortality. However, “real world” data on long term prognosis of diabetic patients with stable coronary artery disease (sCAD) are limited. This study aimed to assess long-term incidence of major cardiovascular events in this population and to identify clinical predictors of this end-point. Methods The CICCOR registry is a prospective, monocentric, cohort study. From February 1, 2000 to January 31, 2004, all consecutive patients with sCAD attended at two outpatient cardiology clinics in a city of the south of Spain were included in the study and prospectively followed. Patients with type 2 diabetes mellitus were selected for this analysis. None of these patients received sodium-glucose cotransporter-2 inhibitors at first visit, as they were not commercially available at that time. Survival free of major cardiovascular events (combined end-point: acute myocardial infarction, stroke, or cardiovascular death) and variables associated with this end-point were investigated. Results The study sample included 394 patients (mean age 68±9 years, 61% male). After up to 17 years of follow-up (median 9 years, IQR 4–14 years, only 2 patients lost in follow-up, with a total of 3517 patients-years of observation), 66 had an acute myocardial infarction, 55 had an stroke and 165 died for cardiovascular causes. Survival free of major cardiovascular events was 88%, 70%, 57%, 47% and 32% at 3, 6, 9, 12 and 15 years. Multivariate predictors of the combined end-point are shown in the table. Predictors of major cardiovascular event Variable Hazard Ratio (95% CI) p value Age (year) 1.06 (1.04–1.08) <0.0005 Tobacco use 0.02 Never smoker 1 (reference) Ex-smoker 1.43 (1.02–1.99) 0.04 Active smoker 2.23 (1.16–4.30) 0.02 Functional Class ≥II (angina) 1.57 (1.14–2.16) 0.006 Resting heart rate (10 bpm increase) 1.12 (1.01–1.24) 0.04 Diuretic treatment at first visit 1.71 (1.26–2.30) 0.001 Conclusions Probability of major event-free survival was only 47% at 12 years in this “real world” cohort of diabetic patients with sCAD followed in the first 17 years of this century in a single center in the south of Spain. Simple clinical variables can identify patients at higher risk of events. Acknowledgement/Funding This work has been partially financed by an investigational grant by Boehringher Ingelheim

THE ASSOCIATION BETWEEN MEASUREMENTS OF BODY COMPOSITION AND LONG-TERM CARDIOVASCULAR EVENTS IN PATIENTS WITHOUT CORONARY ARTERY DISEASE

2019 ◽  
Vol 73 (9) ◽  
pp. 1876
Author(s):  
Jose Medina-Inojosa ◽  
Hannah Perez ◽  
Andrea De Leon Tejada ◽  
John Batsis ◽  
Farzane Saeidifard ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Body Composition ◽  
Coronary Artery ◽  
Cardiovascular Events ◽  
Artery Disease

P6157Indexed coronary volume - A potential novel low-dose CCTA derived predictor for cardiovascular events

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
G Benetos ◽  
M Goncalves ◽  
E Von Felten ◽  
G Rampidis ◽  
O Clerc ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Events ◽  
Low Dose ◽  
Cox Regression ◽  
Calcium Score ◽  
Kaplan Meier ◽  
Lv Mass ◽  
Traditional Risk Factors ◽  
Artery Disease

Abstract Background Coronary computed tomography angiography (CCTA) provides incremental prognostic information over traditional risk factors in patients with suspected coronary artery disease. However, little is known about the long-term predictive performance of CCTA-derived coronary volumes and mid-diastolic left ventricular (LV) mass. Purpose To assess long-term prognostic value of coronary volumes and mid-diastolic LV mass as novel potential imaging predictors derived from low-dose prospectively ECG-triggered CCTA. Methods Consecutive patients with suspected or known coronary artery disease, referred for low-dose CCTA, were included. Patients with previous revascularization were excluded. The following parameters were evaluated: calcium score, segment involvement score (SIS: 1 point for each coronary segment with presence of plaque), coronary volume, mid-diastolic LV mass and coronary volume indexed to LV mass. Major adverse cardiovascular events (MACE) were defined as all-cause death, non-fatal myocardial infarction and revascularization (PCI or CABG). The association between CCTA measures and the occurrence of events was quantified using cox regression hazard and Kaplan Meier analysis. Results A total of 147 consecutive patients were included in the study. Of them, 93 (63.3%) were male and 79 (53.7%) hat one or more traditional cardiovascular risk factors. There was a weak but statistical significant inverse correlation between indexed coronary volume and both calcium score (R=-0.3, p=0.01) and SIS (R=-0.24, p=0.005). After a median follow-up of 5.8 years 30 MACE occurred in 25 patients, including 3 deaths, 26 revascularizations and 1 non-fatal myocardial infarction. In univariate cox regression hazard analysis calcium score (HR=12.69, 95% CI 2.99–53.83, p<0.001), SIS (HR=1.66, 95% CI 1.43–1.94, p<0.001), LV mass (HR=1.02, 95% CI 1.01–1.03, p=0.007) and indexed coronary volume (HR=0.89, 95% 0.82–0.96, p=0.004) were associated with outcome. In multivariate analysis, indexed coronary volume, remained an independent predictor for MACE when adjusted for traditional risk factors and SIS (HR=0.93, 95% CI 0.87–1.00, p=0.05), while LV mass did not reach statistical significance (p=0.46). By ROC curve analysis, a value of 21.85 mm3/gr was defined as optimal cutoff for indexed coronary volume. In Kaplan Meier plots, patients with low indexed coronary volume (<21.85 mm3/gr) showed higher event rates (log rank p<0.001) compared to high indexed coronary volume (≥21.85 mm3/gr). Conclusions Indexed coronary volume, derived from low-dose CCTA, independently predicts cardiovascular events. Larger studies are mandated to confirm the predictive value of this potential new biomarker.

ALBUMINURIA AS A LONG-TERM PREDICTOR OF CARDIOVASCULAR EVENTS AMONG PATIENTS WITH DIABETES AND CORONARY ARTERY DISEASE: MASS REGISTRY INSIGHTS

2019 ◽  
Vol 73 (9) ◽  
pp. 180
Author(s):  
Eduardo Gomes Lima ◽  
Whady Hueb ◽  
Jaime Linhares Filho ◽  
Daniel Valente Batista ◽  
Rafael Silva ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Cardiovascular Events ◽  
Patients With Diabetes ◽  
Artery Disease

scholarly journals Metamizole/dipyrone for the relief of cancer pain: A systematic review and evidence-based recommendations for clinical practice

2016 ◽  
Vol 31 (1) ◽  
pp. 26-34 ◽  
Author(s):  
Jan Gaertner ◽  
Ulrike M Stamer ◽  
Constanze Remi ◽  
Raymond Voltz ◽  
Claudia Bausewein ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cancer Pain ◽  
Pain Intensity ◽  
Oral Morphine ◽  
Cochrane Library ◽  
Evidence Based ◽  
Low Doses ◽  
Inflammatory Drugs ◽  
Anti Inflammatory

Background: Dipyrone (metamizole) is one of the most widely used non-opioid analgesics for the treatment of cancer pain. Aim: Because evidence-based recommendations are not yet available, a systematic review was conducted for the German Guideline Program in Oncology to provide recommendations for the use of dipyrone in cancer pain. Design: First, a systematic review for clinical trials assessing dipyrone in adult patients with cancer pain was conducted. Endpoints were pain intensity, opioid-sparing effects, safety, and quality of life. Data sources: The search was performed in MedLine, Embase (via Ovid), and the Cochrane Library (1948–2013) and additional hand search was conducted. Finally, recommendations were developed and agreed in a formal structured consensus process by 53 representatives of scientific medical societies and 49 experts. Results: Of 177 retrieved studies, 4 could be included (3 randomized controlled trials and 1 cohort study, n = 252 patients): dipyrone significantly decreased pain intensity compared to placebo, even if low doses (1.5–2 g/day) were used. Higher doses (3 × 2 g/day) were more effective than low doses (3 × 1 g/day), but equally effective as 60 mg oral morphine/day. Pain reduction of dipyrone and non-steroidal anti-inflammatory drugs did not differ significantly. Compared to placebo, non-steroidal anti-inflammatory drugs, and morphine, the incidence of adverse effects was not increased. Conclusion: Dipyrone can be recommended for the treatment of cancer pain as an alternative to other non-opioids either alone or in combination with opioids. It can be preferred over non-steroidal anti-inflammatory drugs due to the presumably favorable side effect profile in long-term use, but comparative studies are not available for long-term use.

scholarly journals Diuretics in treatment of patients with arterial hypertension

2009 ◽  
Vol 6 (4) ◽  
pp. 9-12
Author(s):  
Irina Evgen'evna Chazova ◽  
Lyudmila Gennadievna Ratova
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Coronary Artery Disease ◽  
Cardiovascular Risk ◽  
Arterial Hypertension ◽  
Disease Process ◽  
Low Doses ◽  
Treatment Of Hypertension ◽  
Artery Disease ◽  
High Doses

Since all cardiovascular risk factors contribute to coronary artery disease in patients with arterial hypertension, they should all be considered in the management of this disease process. Thiazides diuretics when used at high doses, negatively impact lipid and glucose metabolism. These findings have resulted in decreased use of diuretics in favor of newer agents such as ACE inhibitors and calcium antagonists. However, recent data have demonstrated that when used at low doses (6.25 or 25 mg of hydrochlorothiazide), diuretics lack significant metabolic side effects while bringing about significant reductions in blood pressure. Thus, at these doses, hydrochlorothiazide is a useful drug in the treatment of hypertension, both as monotherapy and in combination therapy.

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