Sexual activity with and without the use of sildenafil: risk of cardiovascular events in patients with heart disease.

The data in the literature on the relationship between sexual activity, with and without the use of sildenafil, and the occurrence of cardiovascular events (ventricular arrhythmias, nonfatal myocardial infarction, stroke and death) have been reviewed in patients with heart disease. To date, only patients with ischemic heart disease (IHD) have been investigated. The prevalence of premature ventricular beats during sexual intercourse is similar to that observed during other daily activities. Therefore, sexual activity does not seem to have a relevant arrhythmogenic effect. The incidence of sustained ventricular tachycardia during sexual intercourse in unknown. The relative risk of nonfatal myocardial infarction is 2.7 in males and 1.3 in females; however, the absolute risk appears extremely low and is similar in normal subjects and in patients with and without IHD. The risk appears to be restricted to the 2-hour time period after sexual intercourse. The incidence of stroke during sexual intercourse appears very low, but clear data are lacking. The incidence of death during sexual activity is unknown; the few available data suggest that it is very low. Extramarital sexual intercourse seems to increase the risk of death. The incidence of cardiovascular events after sildenafil administration has been investigated in placebo-controlled studies in patients with IHD. The incidence of nonfatal myocardial infarction, stroke and death did not significantly differ between sildenafil-treated and placebo-treated patients; therefore, sildenafil does not appear contraindicated in subjects with IHD. However, the drug should be administered with caution in patients with recent myocardial infarction or stroke, in those with active coronary ischemia and in patients with episodes of heart failure. The drug is absolutely contraindicated in patients using nitrates.     

Sexual activity and cardiovascular disease,erectile dysfunction as a predictor of ischemic heart disease

Sexual activity affects the quality of life of patients with cardiovascular disease (CVD). The purpose of this document is to highlight the fact that sexual activity of patients with stable forms of CVD and moderate exercise tolerance is safe. Delaying resumption of sexual activity is not justified and could have a negative impact on the patient's mental status and the quality of partner life. Vasculogenic erectile dysfunction is considered an independent risk factor for coronary heart disease.     

Changes in the renin-angiotensin-aldosterone system in elderly patients with chronic ischemic heart disease. 4. The renin-angiotensin-aldosterone system in elderly patients with ischemic heart disease and cardiovascular insufficiency

The elderly chronic ischemic heart disease (IHK) patients with cardiac failure show a higher activation of the renin-angiotensin-aldosterone system compared to the younger patients. It was noted functional activity of the renin-angiotensin-aldosterone system increases with a progress of the disease (decompensation). Changes occur not only in the basal level of plasma reninactivity and circulating aldosterone concentration, but also the 24 hour rhythm to the side of an increased hormonal level during the evening hours, evidencing thus for disadaption of the renin-angiotensin-aldosterone system and its decreased reliability under conditions of habitual life activity. Administration of the converting enzyme inhibitor, Captopril, has confirmed a pathogenetic role of the renin-angiotensin-aldosterone system in the development of cardiac failure syndrome in the chronic IHK patients as well as verified a new approach in the treatment of this pathology.     

Changes in the renin-angiotensin-aldosterone system in elderly patients with chronic ischemic heart disease. 3. The renin-angiotensin-aldosterone system in elderly patients with ischemic heart disease without cardiovascular failure

As shown by the results of the investigation, there is a moderate rise in renin-angiotensin-aldosterone system activity in the elderly patients suffering from chronic IHK under normal conditions of life: basal level, changes in plasma renin activity and circulating aldosterone concentration during a 24-hour period and in response to the orthostasis. Considerable disturbances of the functional state of the renin-angiotensin-aldosterone system are seen with a physical load of the submaximal intensity. The data obtained indicate pathogenetic significance of the above changes which should be taken into consideration while prescribing therapy of such patients.     

Hemodynamic effects of sildenafil in patients with stable ischemic heart disease

Background: Recently the new specific phosphodiesterase-5 inhibitor sildenafil was introduced into therapy for erectile dysfunction. The hemodynamic effects of sildenafil may be potentially hazardous for patients with cardiac disease. Sildenafil has been reported to augment the hypotensive effects of nitrates. There is sparse information regarding the systemic and pulmonary hemodynamic effects of a single oral dose of sildenafil in patients with stable angina. Methods: Male patients referred for coronary angiography with diagnosis of chronic stable angina were enrolled in this study to assess the acute hemodynamic effects of sildenafil. Patients receiving long-acting or sublingual nitrates for the last 6 h before the study were excluded. Hemodynamic measurement were taken during right and left heart catheterization in the basal state and 60 min after 50 mg of oral sildenafil. Results: Twelve patients (age 53±7 years) were studied. All had stable angina CCS class II or III. Four had previous myocardial infarction. By coronary angiography, seven patients had at least one coronary artery with >70% stenosis, four had at least one with 50–70% stenosis, and one had only intimal irregularities. There were no significant effects of sildenafil on systemic or pulmonary arterial pressure, left ventricle endiastolic pressure, cardiac output, and systemic or pulmonary vascular resistance (P>0.05 for all). No adverse events were observed. Conclusion: A single oral dose of sildenafil had no significant hemodynamic effect in supine patients with stable angina. Isolated administration of sildenafil does not appear to be associated to adverse cardiovascular effects.     

Resting heart rate in cardiovascular disease.

The importance of resting heart rate (HR) as a prognostic factor and potential therapeutic target is not yet generally accepted. Recent large epidemiologic studies have confirmed earlier studies that showed resting HR to be an independent predictor of cardiovascular and all-cause mortality in men and women with and without diagnosed cardiovascular disease. Clinical trial data suggest that HR reduction itself is an important mechanism of benefit of beta-blockers and other heart-rate lowering drugs used after acute myocardial infarction, in chronic heart failure, and in stable angina pectoris. Pathophysiological studies indicate that a relatively high HR has direct detrimental effects on the progression of coronary atherosclerosis, on the occurrence of myocardial ischemia and ventricular arrhythmias, and on left ventricular function. Studies have found a continuous increase in risk with HR above 60 beats/min. Although it may be difficult to define an optimal HR for a given individual, it seems desirable to maintain resting HR substantially below the traditionally defined tachycardia threshold of 90 or 100 beats/min. These findings suggest that the potential role of HR and its modulation should be considered in future cardiovascular guidance documents.     

Use of complementary therapies in patients with cardiovascular disease

Previous studies have suggested that patients with chronic medical conditions use complementary and alternative medicine (CAM) at a higher rate than the general population. Despite recent interest in CAM for cardiovascular disease, few data are available regarding patterns of use in patients with cardiovascular disease in the United States. This study used the 2002 National Health Interview Survey and analyzed data on CAM use in 10,572 respondents with cardiovascular disease. Among those with cardiovascular disease, 36% had used CAM (excluding prayer) in the previous 12 months. The most commonly used therapies were herbal products (18%) and mind-body therapies (17%). Among herbs, echinacea, garlic, ginseng, ginkgo biloba, and glucosamine with or without chondroitin were most commonly used. Among mind-body therapies, deep-breathing exercises and meditation were most commonly used. Overall, CAM was used most frequently for musculoskeletal complaints (24% of respondents who used mind-body therapies, 22% who used herbs, 45% who used any CAM). Mind-body therapies were also used for anxiety or depression (23%) and stress or emotional health and wellness (16%). Herbs were commonly used for head and chest colds (22%). Fewer respondents (10%) used CAM specifically for their cardiovascular conditions (5% for hypertension, 2% for coronary disease, 3% for vascular insufficiency, < 1% for heart failure or stroke). Most, however, who used CAM for their cardiovascular condition perceived the therapies to be helpful (80% for herbs, 94% for mind-body therapies). CAM use was more common in younger respondents, women, Asians, and those with more education and greater incomes. In conclusion, CAM use, particularly herbs and mind-body therapies, is common in the United States in patients with cardiovascular disease and mirrors use in the general population. CAM use specifically to treat cardiovascular conditions, however, is less common.     

老年动脉粥样硬化性心血管疾病患者他汀类药物使用现状

目的探讨他汀类药物在老年动脉粥样硬化性心血管疾病(ASCVD)患者中的使用现状。方法筛选医院电子病历数据,选择2014年1月~2018年12月在解放军第九六〇医院和德州市第二人民医院收治的年龄≥60岁的ASCVD患者15751例,按患者的年龄分为60~69岁组6230例,70~79岁组5192例和≥80岁组4329例。调查3组患者他汀类药物使用现状,分析他汀类药物使用的影响因素,比较患者LDL-C、非HDL-C控制达标的情况。结果≥80岁组外周动脉粥样硬化疾病比例明显高于60~69岁组和70~79岁组(1.6%vs 1.1%和0.8%,P=0.000)。所有患者他汀类药物使用率为67.4%,急性冠状动脉综合征(ACS)患者他汀类药物使用率99.2%、PCI后为98.3%、冠状动脉旁路移植术(CABG)后为95.2%。多因素logistic回归分析显示,ACS、PCI后、CABG后、住院科室、入院时间是影响他汀类药物使用的独立危险因素(P<0.05,P<0.01)。与60~69岁组和70~79岁组比较,≥80岁组LDL-C达标率(48.07%vs 32.98%和30.97%)及非HDL-C达标率(38.99%vs 30.99%和28.76%)均明显升高(P<0.01)。结论他汀类药物在老年ASCVD急症患者中使用率较高,但在慢病管理中的使用及血脂达标情况仍有待提高。     

Use of the variation pulsimetry in the evaluation of diurnal dynamics of cardiac rhythm in patients with ischemic heart disease and functional disorders of the cardiovascular system

The results of employing the method of variation pulsimetry and dynamic electrocardiography in 30 patients are discussed. Analysis of the circadian dynamics of the statistical characteristics of cardiac rhythm showed that the activity of the sympathetic part of the vegetative nervous system was higher in patients with ischemic heart disease than in those with functional disorders. Disbalance of neurohumoral control of cardiac rhythm in various types of arrhythmias was disclosed.     

老年患者静息心率与心血管疾病的研究现状

静息心率是指安静或不活动时的心率。在全身状态相对稳定的情况下,心率的改变直接反映了心脏的功能状态和交感神经张力,所以静息心率增快不仅参与了中老年患者冠心病、急性心肌梗死、心力衰竭、高血压等心血管疾病的发生发展,还和心血管事件及死亡有直接的因果关系。应用β受体阻滞剂适当减慢心率可在一定程度上降低心血管疾病的死亡风险,对应用β受体阻滞剂受限的老年患者,可使用单纯降低心率的药物伊伐布雷定,该药除降低心率以外,还可改善心肌重构。