Cardiovascular effects of non-cardiovascular drugs

Many drugs that were not designed to treat cardiovascular diseases may affect the cardiovascular system, causing adverse reactions. The objective of this chapter is to review in a systematic manner these adverse effects of non-cardiovascular drugs. The heart consists of four main entities that may be affected by non-cardiovascular drugs and lead to very different types of events: (1) the conduction tissue, that governs heart rate and rhythm, associated with arrhythmia and sudden death; (2) the endocardium and valves, associated with valvular disease and endocardial fibrosis; (3) the myocardium, which can directly or indirectly lead to heart failure; and (4) the coronary arteries, and in general the vascular bed, with myocardial ischaemia and infarction as main adverse events. These different elements may be affected by different drugs with different mechanisms of action, though some drugs may affect several components (e.g. myocardial infarction may result in heart failure). The objective of this chapter is not to provide exhaustive listings of all drugs ever associated with any of these events, which can be found online and will be obsolete the moment they are published, but an understanding of the typology of these events and their mechanism.

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Osteoprotegerin and RANKL-RANK-OPG-TRAIL signalling axis in heart failure and other cardiovascular diseases

Heart Failure Reviews ◽

10.1007/s10741-021-10153-2 ◽

2021 ◽

Author(s):

Mieczysław Dutka ◽

Rafał Bobiński ◽

Wojciech Wojakowski ◽

Tomasz Francuz ◽

Celina Pająk ◽

...

Keyword(s):

Myocardial Infarction ◽

Heart Failure ◽

Cardiovascular Diseases ◽

Vascular Endothelial Cells ◽

Circulatory System ◽

Prognostic Indicator ◽

High Plasma ◽

Mechanisms Of Action ◽

Left Ventricular ◽

High Ratio

AbstractOsteoprotegerin (OPG) is a glycoprotein involved in the regulation of bone remodelling. OPG regulates osteoclast activity by blocking the interaction between the receptor activator of nuclear factor kappa B (RANK) and its ligand (RANKL). More and more studies confirm the relationship between OPG and cardiovascular diseases. Numerous studies have confirmed that a high plasma concentration of OPG and a low concentration of tumour necrosis factor–related apoptosis inducing ligand (TRAIL) together with a high OPG/TRAIL ratio are predictors of poor prognosis in patients with myocardial infarction. A high plasma OPG concentration and a high ratio of OPG/TRAIL in the acute myocardial infarction are a prognostic indicator of adverse left ventricular remodelling and of the development of heart failure. Ever more data indicates the participation of OPG in the regulation of the function of vascular endothelial cells and the initiation of the atherosclerotic process in the arteries. Additionally, it has been shown that TRAIL has a protective effect on blood vessels and exerts an anti-atherosclerotic effect. The mechanisms of action of both OPG and TRAIL within the cells of the vascular wall are complex and remain largely unclear. However, these mechanisms of action as well as their interaction in the local vascular environment are of great interest to researchers. This article presents the current state of knowledge on the mechanisms of action of OPG and TRAIL in the circulatory system and their role in cardiovascular diseases. Understanding these mechanisms may allow their use as a therapeutic target in cardiovascular diseases in the future.

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Plaque erosion causing ST-elevation myocardial infarction after consumption of cannabis and N2O in a 27-year old man: a case report

BMC Cardiovascular Disorders ◽

10.1186/s12872-021-01953-3 ◽

2021 ◽

Vol 21 (1) ◽

Cited By ~ 1

Author(s):

Sarah Bär ◽

Fabien Praz ◽

Lorenz Räber

Keyword(s):

Myocardial Infarction ◽

Case Report ◽

Adverse Effects ◽

Cardiovascular Effects ◽

Drug Eluting Stent ◽

Culprit Lesion ◽

Vascular Events ◽

The Public ◽

Plaque Erosion ◽

First Case

Abstract Background The recreational drugs cannabis and nitrous oxide (N2O) are known for pro-atherogenic effects and are associated with an elevated risk of myocardial infarction. These cardiovascular effects might be underestimated by the public. Culprit-lesion composition of myocardial infarctions associated with cannabis and N2O has been unknown so far. This case report aims to raise the awareness of the adverse cardiovascular effects of cannabis and N2O and reports, for the first time, optical coherence tomography (OCT) findings of the culprit lesion. Case presentation This is a case report of a 27-year old man with anterior ST-segment-elevation myocardial infarction (STEMI) after intoxication with cannabis and N2O. Coronary angiography and OCT revealed plaque erosion with subsequent subtotal thrombotic occlusion of the left anterior descending artery that was successfully treated with 1 drug-eluting stent. The patient was symptom free at 6 months follow-up and had been able to abstain from drug consumption. Conclusions This is the first case to demonstrate the association between cannabis and N2O abuse and plaque erosion on OCT in a young man with STEMI. In contrast to smoking, whose adverse effects are well-known, the cardiovascular effects of cannabis and N2O might be underestimated. These adverse effects should gain more awareness in the public to prevent early vascular events in young adults.

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Illuminating drug action by network integration of disease genes: a case study of myocardial infarction

Molecular BioSystems ◽

10.1039/c6mb00052e ◽

2016 ◽

Vol 12 (5) ◽

pp. 1653-1666 ◽

Cited By ~ 12

Author(s):

Rui-Sheng Wang ◽

Joseph Loscalzo

Keyword(s):

Myocardial Infarction ◽

Cardiovascular Effects ◽

Drug Action ◽

Mechanisms Of Action ◽

Disease Genes ◽

Network Integration

Illuminating the mechanisms of action of drugs used for myocardial infarction (MI) and the cardiovascular effects of non-MI drugs.

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Drugs and pacemakers for complete heart block

Drug and Therapeutics Bulletin ◽

10.1136/dtb.5.5.19 ◽

1967 ◽

Vol 5 (5) ◽

pp. 19-20

Keyword(s):

Myocardial Infarction ◽

Heart Failure ◽

Heart Rate ◽

Heart Disease ◽

Ischaemic Heart Disease ◽

Heart Block ◽

Complete Heart Block ◽

Bundle Of His

Complete heart block can occur in ischaemic heart disease, and can acutely complicate myocardial infarction. Most other cases are associated with fibrosis of the bundle of His of unknown cause, or are congenital. In some patients with chronic heart block, especially the congenital type, adequate output is maintained. In other patients chronic or intermittent heart block may cause Stokes-Adams attacks, or heart failure may not respond to digitalis and diuretics until the heart rate is increased. These require treatment by drugs or, when this fails, by use of anartifical pacemaker.

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Highlighting Exosomes' Function in Cardiovascular Diseases

Current Cardiology Reviews ◽

10.2174/1573403x17666210204153526 ◽

2021 ◽

Vol 17 ◽

Author(s):

Sidhi Laksono ◽

Budhi Setianto ◽

Ananta Siddhi Prawara ◽

Bambang Dwiputra

Keyword(s):

Myocardial Infarction ◽

Heart Failure ◽

Heart Disease ◽

Cardiovascular Diseases ◽

Prognostic Marker ◽

Therapeutic Agent ◽

Diagnostic Marker ◽

Cell Communication ◽

Surface Protein ◽

Cardiovascular Patients

: Exosomes as one of the extracellular vesicles’ subgroups played an important role in the cell to cell communication. The cargos and surface protein of exosomes have been known to affect the cardiovascular system both positively and negatively in chronic heart failure, ischemic heart disease, and atherosclerosis. There have been several exosomes that emerged as a potential diagnostic and prognostic marker in cardiovascular patients. However, the conditions affecting the patients and the method of isolation should be considered to create a standardized normal value of the exosomes and the components. CPC-derived exosomes, ADSCs-derived exosomes, and telocyte-derived exosomes have been proven to be capable ofacting as a therapeutic agent in myocardial infarction models. Exosomes have the potential to become a diagnostic marker, prognostic marker, and therapeutic agent in cardiovascular diseases.

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Mineralocorticoid receptor antagonists

ESC CardioMed ◽

10.1093/med/9780198784906.003.0032 ◽

2018 ◽

pp. 167-173

Author(s):

Faiez Zannad ◽

João Pedro Ferreira

Keyword(s):

Myocardial Infarction ◽

Heart Failure ◽

Adverse Effects ◽

Beneficial Effect ◽

Mechanism Of Action ◽

Mineralocorticoid Receptor ◽

Post Myocardial Infarction ◽

Mineralocorticoid Receptor Antagonists ◽

Receptor Antagonists ◽

Clinical Syndromes

Hypertension, post-myocardial infarction, and heart failure are the cardiovascular clinical syndromes where mineralocorticoid receptor antagonists (MRAs) have shown a beneficial effect. Most guidelines while recommending a MRA do not make a clear recommendation as to which MRA should be used, how doses should be titrated, or which monitorization is indicated. This chapter provides an appraisal of the different types of MRA drugs and their pharmacological differences with respect to mechanism of action, pharmacokinetics, monitoring, adverse effects, and drug interactions.

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Interleukin-1 and the Inflammasome as Therapeutic Targets in Cardiovascular Disease

Circulation Research ◽

10.1161/circresaha.120.315937 ◽

2020 ◽

Vol 126 (9) ◽

pp. 1260-1280 ◽

Cited By ~ 32

Author(s):

Antonio Abbate ◽

Stefano Toldo ◽

Carlo Marchetti ◽

Jordana Kron ◽

Benjamin W. Van Tassell ◽

...

Keyword(s):

Myocardial Infarction ◽

Heart Failure ◽

Acute Myocardial Infarction ◽

Cardiovascular Diseases ◽

Phase Ii ◽

Nlrp3 Inflammasome ◽

Wide Spectrum ◽

Phase Iii ◽

Intracellular Sensing ◽

Inflammasome Inhibitors

The intracellular sensing protein termed NLRP3 (for NACHT, LRR, and PYD domains-containing protein 3) forms a macromolecular structure called the NLRP3 inflammasome. The NLRP3 inflammasome plays a major role in inflammation, particularly in the production of IL (interleukin)-1β. IL-1β is the most studied of the IL-1 family of cytokines, including 11 members, among which are IL-1α and IL-18. Here, we summarize preclinical and clinical findings supporting the key pathogenetic role of the NLRP3 inflammasome and IL-1 cytokines in the formation, progression, and complications of atherosclerosis, in ischemic (acute myocardial infarction), and nonischemic injury to the myocardium (myocarditis) and the progression to heart failure. We also review the clinically available IL-1 inhibitors, although not currently approved for cardiovascular indications, and discuss other IL-1 inhibitors, not currently approved, as well as oral NLRP3 inflammasome inhibitors currently in clinical development. Canakinumab, IL-1β antibody, prevented the recurrence of ischemic events in patients with prior acute myocardial infarction in a large phase III clinical trial, including 10 061 patients world-wide. Phase II clinical trials show promising data with anakinra, recombinant IL-1 receptor antagonist, in patients with ST-segment–elevation acute myocardial infarction or heart failure with reduced ejection fraction. Anakinra also improved outcomes in patients with pericarditis, and it is now considered standard of care as second-line treatment for patients with recurrent/refractory pericarditis. Rilonacept, a soluble IL-1 receptor chimeric fusion protein neutralizing IL-1α and IL-1β, has also shown promising results in a phase II study in recurrent/refractory pericarditis. In conclusion, there is overwhelming evidence linking the NLRP3 inflammasome and the IL-1 cytokines with the pathogenesis of cardiovascular diseases. The future will likely include targeted inhibitors to block the IL-1 isoforms, and possibly oral NLRP3 inflammasome inhibitors, across a wide spectrum of cardiovascular diseases.

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