Dronedarone for atrial fibrillation therapy.
Expert Rev Cardiovasc Ther. 2011 Jun;9(6):675-83
Authors: Marzocchi M, Lombardi F
Abstract
Dronedarone is a new benzofuran derivative that has been developed as an a…

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Management of hypertension in diabetic patients: outstanding issues.
Expert Rev Cardiovasc Ther. 2011 Jun;9(6):721-8
Authors: Camafort-Babkowski M, Barrios V, Coca A
Abstract
Cardiovascular disease is the leadi…

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Recent advances in the treatment of hypertension.
Expert Rev Cardiovasc Ther. 2011 Jun;9(6):729-44
Authors: Hering D, Esler MD, Krum H, Mahfoud F, Böhm M, Sobotka PA, Schlaich MP
Abstract
Uncontrolled blood pr…

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Role of carvedilol controlled-release in cardiovascular disease.

Expert Rev Cardiovasc Ther. 2009 May;7(5):483-98

Authors: Fonarow GC

Carvedilol is a beta(1)- and beta(2)-adrenergic receptor antagonist with additional vasodilatory alpha(1)-blocking properties. Carvedilol was shown to be more efficacious than a traditional beta-blocker for treating heart failure and improving myocardial function. Carvedilol is the only agent in its class to have been demonstrated to significantly reduce mortality and morbidity in post-myocardial-infarction patients with left ventricular dysfunction. Moreover, carvedilol does not exhibit the carbohydrate and lipid disturbances observed with other beta-blockers. Originally available as a twice-daily formulation, a controlled-release, once-daily formulation of carvedilol is now available, which has equivalent efficacy and safety, as demonstrated by numerous studies. The convenience of once-daily dosing is expected to contribute to patient adherence, thereby potentially improving long-term clinical outcomes.

PMID: 19419256 [PubMed - indexed for MEDLINE]

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Management of hypertension in chronic heart failure.

Expert Rev Cardiovasc Ther. 2009 Apr;7(4):423-33

Authors: Manickavasagam S, Merla R, Koerner MM, Fujise K, Kunapuli S, Rosanio S, Barbagelata A

Chronic heart failure (CHF) is associated with frequent hospitalizations and high mortality. It affects more than 5 million individuals in the USA, and another 660,000 new cases are diagnosed each year; overall, heart failure (HF) now accounts for 7% of all deaths from cardiovascular disease. Hypertension (HTN) increases the risk of development of HF and it precedes it in 75% of cases. HF patients are nearly evenly divided between those with reduced left ventricular (LV) function or systolic dysfunction and those with preserved LV systolic function or diastolic dysfunction. The management of HTN in patients with CHF is challenging. Drugs such as beta-blockers, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, aldosterone receptor blockers, hydralazine and nitrates, which have shown mortality benefit in CHF and exert antihypertensive effects, should be used as first-line agents to control HTN in CHF. In addition, antihypertensive drugs such as alpha-receptor blockers that can increase mortality in HF should be avoided. The dihydropyridine group of calcium channel blockers are good antihypertensive medications with a neutral effect on mortality in patients with CHF. These may be used in CHF patients with refractory HTN. In patients with HF with reduced ejection fraction, HTN is treated differently in comparison to patients with HF with normal ejection fraction. This article reviews the treatment of essential HTN in patients at risk for developing HF, in the presence of HF and the latest developments in treatment that might benefit both HTN and HF management.

PMID: 19379066 [PubMed - indexed for MEDLINE]

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Focus on ivabradine: a new heart rate-controlling drug.

Expert Rev Cardiovasc Ther. 2009 Feb;7(2):107-13

Authors: Riccioni G

Angina pectoris is a cardiac condition characterized by an insufficient perfusion to meet myocardial metabolic demand. A high heart rate represents an important factor in the induction of myocardial ischemia and subsequent angina. beta-blocker drugs are effective at reducing angina pectoris by decreasing the heart rate and are usually preferred as initial therapy in the absence of contraindication or intolerance. Ivabradine, a new oral drug for the symptomatic treatment of chronic stable angina pectoris, decreases the resting heart rate of patients with normal sinus rhythm. In many clinical trials, ivabradine has been directly compared with placebo, beta-blocker drugs (e.g., atenolol and propranolol) and calcium channel blockers (e.g., amlodipine). These studies have demonstrated ivabradine, given in doses of 5-10 mg twice daily, to be more effective than placebo for increasing time to angina onset and noninferior to atenolol 50-100 mg daily and amlodipine 10 mg daily for increasing total exercise duration in patients with chronic stable angina. Visual symptoms, a transient, enhanced brightness in a limited area of the visual field known as luminous phenomena or phosphenes, were the most common adverse effects in clinical trials. This article aims to provide a research update regarding this new drug, based on a literature search.

PMID: 19210206 [PubMed - indexed for MEDLINE]

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Tailored antithrombotic therapy for acute coronary syndromes.

Expert Rev Cardiovasc Ther. 2008 Aug;6(7):935-44

Authors: Fitchett D

Acute coronary syndromes usually result from thrombotic occlusion of a coronary artery at the site of atherosclerotic plaque disruption. The mainstay of treatment is the use of antiplatelet and antithrombotic therapy to maintain patency of the artery. In patients with non-ST segment elevation acute coronary syndromes, antithrombotic therapy followed by coronary revascularization (when feasible in patients with high-risk features) is the optimal management strategy. In the patient with ST elevation acute coronary syndromes who receives a fibrinolytic agent antithrombotic agents, are also important to prevent reocclusion. Bleeding complications of antithrombotic therapy are associated with a substantial increase in adverse short- and long-term outcomes. Hence, the selection of the most appropriate antithrombotic agent aims to minimize both ischemic and hemorrhagic complications. Factors that are associated with increased bleeding risk and need to be considered when selecting an antithrombotic agent include decreased renal function, short time to invasive procedure (<24 h), and the overall bleeding risk. For patients who will undergo later cardiac catheterization and are not at high bleeding risk, either enoxaparin or fondaparinux are acceptable choices. For patients who are likely to undergo early catheterization or have an increased bleeding risk, either fondaparinux or unfractionated heparin are the optimal choice. Patients with severe impairment of renal function should receive unfractionated heparin.

PMID: 18666844 [PubMed - indexed for MEDLINE]

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Predicting and preventing the cardiotoxicity of cancer therapy.

Expert Rev Cardiovasc Ther. 2008 Aug;6(7):1023-33

Authors: Anderson B, Sawyer DB

For the past 40 years, cardiovascular disease and malignant neoplasms have been the leading causes of death in the USA. As treatments for cancer, cardiovascular disease, diabetes and other chronic illnesses improve, we are seeing more complicated patients in our clinics. Cancer therapies such as anthracyclines and radiation therapy continue to pose a risk for delayed-onset cardiovascular disease, in spite of decades of research. It has been reported that the risk of congestive heart failure is the second most common, late, long-term disabling health condition among cancer survivors. Improved understanding of an individual’s risk for cardiovascular complications of these therapies and earlier intervention for selected patients may help to improve the overall outcome for patients requiring these therapies. New therapies targeting oncogenes and the process of angiogenesis have ‘off-target’ effects regarding the cardiovascular system that remain poorly understood. Our knowledge and experience in the cardiovascular care of patients with cancer must continue to grow if we are to assure the best possible outcome for these people. The aim of this review is to highlight the risk of chemotherapy-induced cardiotoxicity among several of the most commonly used cancer therapies, various ways to screen for patients at highest risk of cardiotoxicity and management of cardiac complications of cancer therapy. We spend a disproportionate amount of space and time on the subject of anthracycline toxicity due to its often devastating nature, and its persistence as a clinical problem despite decades of use and research.

PMID: 18666852 [PubMed - indexed for MEDLINE]

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