Long-Term Continuation on Cardiovascular Drug Treatment in Patients with Coronary Heart Disease

2007 ◽  
Vol 41 (10) ◽  
pp. 1644-1647 ◽  
Author(s):  
David S Wald ◽  
Geraint Morton ◽  
Kate Walker ◽  
Neil Losson ◽  
Nick P Curzen
Keyword(s):  
Coronary Heart Disease ◽  
Heart Disease ◽  
Drug Therapy ◽  
Coronary Intervention ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
Cardiovascular Drug ◽  
Channel Blockers ◽  
Converting Enzyme Inhibitors ◽  
Coronary Syndrome

Background: Combination therapy to reduce risk factors is effective in preventing recurrent cardiovascular disease events in patients with coronary heart disease (CHD), but medications need to be continued indefinitely to maximize the benefits. Objective: To evaluate the extent of long-term continuation with cardiovascular drug therapy and its expected impact on the prevention of CHD. Methods: We studied 242 patients with CHD who underwent percutaneous coronary intervention following an acute coronary syndrome over a 6 month period in 2004. We prospectively examined the extent to which specific drugs and drug combinations were continued over lime by reviewing medication use at the time of hospital discharge and after 2 years. The results were used to estimate the expected loss in preventive efficacy due to discontinuation of therapy. Results: The changes over a 2 year period in the proportions of patients taking each drug class were as follows: 15% reduction for aspirin (95% Cl, -21 to -9), 10% reduction for statins (95% Cl, -16 to 5), 19% reduction for angiotensin-converting enzyme inhibitors (95% Cl, -26 to -12), 12% reduction for β-blockers (95% Cl, -18 to -6), 0% increase for calcium-channel blockers (95% Cl, -5 to 6), 2% increase for thiazides (95% Cl, -2 to 6), and 12% increase for angiotensin-11 receptor blockers (95% Cl, 6 to 18). The combination of aspirin, statin, and at least 2 blood pressure lowering drugs was prescribed to 81% of patients, three-quarters of whom remained on this combination after 2 years. The overall expected preventive effect on CHD of the combined medication taken during hospitalization and after 2 years was 80% and 74%, respectively. Conclusions: In patients with CHD, long-term continuation of combination cardiovascular drug therapy is considerably greater than generally perceived.

scholarly journals Optimization of drug therapy of coronary heart disease and arterial hypertension: choice angiotensin-converting enzyme inhibitors

2014 ◽  
Vol 11 (1) ◽  
pp. 73-77
Author(s):  
D I Trukhan ◽  
L V Tarasova
Keyword(s):  
Coronary Heart Disease ◽  
Heart Disease ◽  
Drug Therapy ◽  
Arterial Hypertension ◽  
Ace Inhibitor ◽  
Enzyme Inhibitors ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
Converting Enzyme Inhibitors ◽  
Based Medicine ◽  
First Contact

Important problem for the cardiologist and the first contact a doctor (therapist and general practitioner) is to optimize the therapeutic and preventive aspects of drug therapy in patients with coronary heart disease and arterial hypertension. The article considers the question of choice of ACE inhibitor from the standpoint of rational pharmacotherapy and evidence-based medicine.

scholarly journals Safety and Efficacy of Ranolazine for the Treatment of Chronic Angina Pectoris

2013 ◽  
Vol 5 ◽  
pp. CMT.S7824 ◽  
Author(s):  
Mohammed Aldakkak ◽  
David F. Stowe ◽  
Amadou K.S. Camara
Keyword(s):  
Coronary Heart Disease ◽  
Blood Flow ◽  
Heart Disease ◽  
Supply And Demand ◽  
Chronic Stable Angina ◽  
The United States ◽  
Lifestyle Changes ◽  
Channel Blockers ◽  
Coronary Syndrome ◽  
Chronic Angina

Coronary heart disease is a global malady and it is the leading cause of death in the United States. Chronic stable angina is the most common manifestation of coronary heart disease and it results from the imbalance between myocardial oxygen supply and demand due to reduction in coronary blood flow. Therefore, in addition to lifestyle changes, commonly used pharmaceutical treatments for angina (nitrates, β-blockers, Ca2+ channel blockers) are aimed at increasing blood flow or decreasing O2 demand. However, patients may continue to experience symptoms of angina. Ranolazine is a relatively new drug with anti-anginal and anti-arrhythmic effects. Its anti-anginal mechanism is not clearly understood but the general consensus is that ranolazine brings about its anti-anginal effects by inhibiting the late Na+ current and the subsequent intracellular Ca2+ accumulation. Recent studies suggest other effects of ranolazine that may explain its anti-anginal and anti-arrhythmic effects. Nonetheless, clinical trials have proven the efficacy of ranolazine in treating chronic angina. It has been shown to be ineffective, however, in treating acute coronary syndrome patients. Ranolazine is a safe drug with minimal side effects. It is metabolized mainly in the liver and cleared by the kidney. Therefore, caution must be taken in patients with impaired hepatic or renal function. Due to its efficacy and safety, ranolazine was approved for the treatment of chronic angina by the Food and Drug Administration (FDA) in 2006.

scholarly journals Endovascular Treatment with Limus Eluting Stents in Patients with Acute Coronary Syndrome

2019 ◽  
Vol 8 (1) ◽  
pp. 45-52
Author(s):  
M. V. Chernyayev ◽  
A. G. Faybushevich ◽  
Y. S. Muzganova
Keyword(s):  
Coronary Heart Disease ◽  
Acute Coronary Syndrome ◽  
Heart Disease ◽  
Drug Therapy ◽  
Fatal Outcome ◽  
Drug Eluting Stent ◽  
Health State ◽  
Medium Term ◽  
Coronary Syndrome ◽  
Drug Eluting

BACKGROUND Coronary heart disease is one of the main causes of the population’s disability and mortality in Russia and abroad. Revascularization with coronary stents in the course of the most suitable drug therapy is one of the most important treatments of coronary heart disease. It is essential to pay special attention to the research results of using modern stents, in particular, the frst Russian drug-eluting stent “CALYPSO”.AIM OF STUDY To study immediate and medium-term results of Limus-eluting stents procedure in patients with acute coronary syndrome.MATERIAL AND METHODS 304 patients with acute coronary syndrome were included into the research and were divided into 2 groups. The frst group consisted of 156 patients with CALYPSO stent (Angioline, Russia). The other group consisted of 148 patients who had undergone revascularization with the XIENCE stent (Abbot Vascular, USA). Their health state was monitored via phone 3, 6, 9 and 12 months later. After the discharge from the hospital, the drug therapy was prescribed, and instrumental procedures of diagnostics were planned for the period of 9–12 months. According to the results of the examination, patients with suspected or confrmed myocardial ischemia underwent follow-up coronary angiography.RESULTS The success of implantation was 98.63% in the frst group, and 99.4% in the second group. One fatal outcome occurred in both groups during hospitalization (thus making 0.64% и 0.67%). The placement of the CALYPSO stent in distal parts of coronary arteries requested signifcantly less time and contrast. Medium-term results of stenting in both groups appeared to be comparable (thus, all cause death 3 (1.92%) and 2 (1.35%), restenosis >50% 3 (1.92%) and 3 (2 %), late thrombosis — 0 in both groups, cardiac death — 0 in both groups. End points (MACE) in both groups were 1.28% and 0.67%.CONCLUSION Taking into consideration immediate and medium-term results it can be concluded that domestic stents (CALYPSO) are comparable to stents XIENCE. The CALYPSO stent is more advantageous than the XIENCE in the delivery to the lesion focus while performing the procedure in distal flow.

scholarly journals Model for End-Stage Liver Disease Score Predicts the Mortality of Patients with Coronary Heart Disease Who Underwent Percutaneous Coronary Intervention

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
You Chen ◽  
Min Han ◽  
Ying-Ying Zheng ◽  
Feng Zhu ◽  
Aikebai Aisan ◽  
...  
Keyword(s):  
Coronary Heart Disease ◽  
Heart Disease ◽  
Liver Disease ◽  
Coronary Intervention ◽  
Meld Score ◽  
Bleeding Events ◽  
Percutaneous Coronary ◽  
End Stage ◽  
Long Term Mortality

Background. Coronary heart disease (CHD) is caused by the blockage or spasm of coronary arteries. Evidence shows that liver disease is related to CHD. However, the correlation between the Model for End-Stage Liver Disease (MELD) score and outcomes in patients after percutaneous coronary intervention (PCI) was unclear. Method. A retrospective cohort study involved 5373 patients with coronary heart disease after PCI was conducted from January 2008 to December 2016. Participants were classified to four groups according to the MELD score by quartiles. The primary endpoint was long-term mortality including all-case mortality (ACM) and cardiac mortality (CM). Secondary endpoints included bleeding events, readmission, major adverse cardiovascular events (MACE), major adverse cardiovascular, and cerebrovascular events (MACCE). The longest follow-up time was almost 10 years. Results. There were significant differences in the incidences of ACM ( p = 0.038 ) and CM ( p = 0.027 ) among the four MELD groups, but there was no significant difference in MACEs ( p = 0.496 ), MACCEs ( p = 0.234 ), readmission ( p = 0.684 ), and bleeding events ( p = 0.232 ). After adjusting the age, gender, smoking, drinking status, and diabetes by a multivariable Cox regression analysis, MELD remains independently associated with ACM (HR:1.57, 95%CI 1.052–2.354, p = 0.027 ) and CM (HR:1.434, 95% CI 1.003–2.050, p = 0.048 ). Conclusion. This study indicated that the MELD score had a strong prediction for long-term mortality in CHD patients who underwent PCI.

Abstract 4496: Percutaneous Coronary Intervention in Stable Coronary Heart Disease: Value of Nt-Probnp for Stratification of Long-Term Risk

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Pedro Carmo ◽  
Carlos Aguiar ◽  
Jorge Ferreira ◽  
Luis Raposo ◽  
Pedro Goncalves ◽  
...  
Keyword(s):  
Coronary Heart Disease ◽  
Percutaneous Coronary Intervention ◽  
Heart Disease ◽  
Coronary Intervention ◽  
Inter Quartile Range ◽  
Quartile Range ◽  
Stable Coronary Heart Disease ◽  
Percutaneous Coronary

Purpose: N-terminal fragment of the B type-natriuretic peptide (NT-proBNP) is an established tool for assessing acute dyspnoea and stratifying risk in heart failure, acute coronary syndromes (ACS), and stable coronary heart disease (SCHD). The aim of this study was to determine the value of NT-proBNP in predicting long-term risk of patients (Pts) submitted to elective percutaneous coronary intervention (PCI) in the setting of SCHD. Methods: We prospectively studied 291 Pts (age 64.3±9.6 years, 64 female) with SCHD submitted to successful elective PCI, and determined NT-proBNP immediately before PCI. Pts were divided into 2 groups according to NT-proBNP level: group T3 formed by Pts with NT-proBNP level in the highest tertile and group T1+T2 formed by all remaining Pts. The study endpoint was time to the first occurrence of death (D) or non-fatal myocardial infarction (MI) during the mean follow-up of 568 ± 322 days. Multivariable analyses were performed to adjust the prognostic value of NT-proBNP for the effects of factors known to influence NT-proBNP (age, gender, renal function, body mass index) and of other potential predictors of outcome (cardiovascular risk factors, prior cardiovascular events, left ventricular ejection fraction, and PCI characteristics). Results: NT-proBNP ranged from 5 pg/ml to 104 pg/ml in the 1st tertile (T1), 105 pg/ml to 358 pg/ml in the 2nd tertile (T2), and 364 pg/ml to 33.991 pg/ml in the 3rd tertile (T3). During follow-up, 8 Pts died and 11 suffered a non-fatal MI. NT-proBNP was significantly higher in Pts who experienced an adverse outcome (440 pg/ml [inter-quartile range, 104 –1712] vs 174 pg/ml [inter-quartile range, 78 – 460) in Pts with uneventful follow-up; P= 0.007). An NT-proBNP level ≥364 pg/ml was associated with a higher endpoint rate (13.4% vs 3.1% in group T1+T2) and independently predicted outcome: adjusted hazard ratio 3.11, 95% CI, 1.15– 8.37, P=0.025. The sensitivity, specificity, predictive positive value, and negative predictive value for the criterion NT-proBNP ≥364 pg/ml were 68.4%, 69.1%, 13.4%, and 96.9%, respectively. Conclusion: In the setting of SCHD, the level of NT-proBNP is a powerful prognostic marker even after successful PCI.

scholarly journals Role of antihypertensive drugs in the treatment of migraine

2015 ◽  
Vol 156 (5) ◽  
pp. 179-185 ◽  
Author(s):  
Gergely Fehér ◽  
Gabriella Pusch
Keyword(s):  
Enzyme Inhibitors ◽  
Beta Blockers ◽  
Angiotensin Receptor Blockers ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
Channel Blockers ◽  
Migraine Prevention ◽  
Angiotensin Receptor ◽  
Converting Enzyme Inhibitors ◽  
Receptor Blockers

The treatment of migraine depends on the frequency, severity and concomitant diseases. There are several specific drugs developed for migraine prevention in addition to the additive antimigraine effects of some other non-specific drugs. The aim of this literature-based review is to summarize the possible antimigraine properties of different antihypertensive agents (beta-blockers, calcium channel blockers, angiotensin converting enzyme inhibitors, angiotensin receptor blockers, etc.) focusing on the possible side effects (avoidance of beta blockers in the absence of heart disease, possible antiparkinson effect of calcium channel blockers, additive effect of drugs modifying the renin-angiotensin system activity, etc.). Current evidence supports the use of angiotensin converting enzyme inhibitors (mainly lisinopril) and angiotensin receptor blockers (mainly candesartan) for long-term migraine prevention and blood pressure control. Long-term beta-blocker treatment should be avoided in the absence of ischemic heart disease due to possible unfavourable cardiovascular effects. Orv. Hetil., 2015, 156(5), 179–185.

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