磺脲类降糖药对心血管系统的影响

磺脲类药物是治疗2型糖尿病的常用药物，近年来有许多临床研究显示其对心血管系统可能有不良影响。如：接受磺脲类药物治疗者更多倾向于发生心肌梗死前心绞痛，其发生心肌梗死时心肌酶谱的增高幅度小于其他患者。磺脲类药物治疗对心肌功能有不良影响，但其对心血管事件预后的影响，不同的研究结论不尽相同。对有心血管疾病的糖尿病患者，治疗应慎用磺脲类药物。     

磺脲类降糖药对心血管系统的影响

磺脲类药物是治疗2型糖尿病的常用药物,近年来有许多临床研究显示其对心血管系统可能有不良影响。如:接受磺脲类药物治疗者更多倾向于发生心肌梗死前心绞痛,其发生心肌梗死时心肌酶谱的增高幅度小于其他患者。磺脲类药物治疗对心肌功能有不良影响,但其对心血管事件预后的影响,不同的研究结论不尽相同。对有心血管疾病的糖尿病患者,治疗应慎用磺脲类药物。     

氟对心血管系统的损伤

地方性氟中毒（简称地氟病）是一种慢性全身性疾病，过量的氟摄入几乎对机体所有器官和组织均产生毒害作用。氟中毒时发生的心血管系统损伤是氟致非骨相损伤的重要组成部分，研究氟对心血管损伤并阐明其损伤机制。有助于进一步确定氟对非骨相的损伤及确定氟致非骨相损伤在氟中毒发病机制中的作用。[第一段]     

口服降糖药物对2型糖尿病患者心血管结局的影响

改善血糖控制可减少糖尿病患者的心血管并发症,不同药物的作用机制不同,其对心血管结局的影响不同.此外,继2007年对罗格列酮潜在心血管风险的认识之后,陆续开展了大量的前瞻性、随机、对照研究,评估降糖药物对糖尿病患者的心血管系统的影响.传统药物中二甲双胍及噻唑烷二酮类药物对糖尿病患者的心血管系统具有保护作用,但必须警惕噻唑烷二酮类药物可增加心力衰竭的风险;第二代及第三代磺脲类促泌剂及非磺脲类促泌剂并不增加患者心血管事件的发生风险.新型药物中并没有看到二肽基肽酶4抑制剂对心血管系统具有有利或不良影响,是否增加心力衰竭风险目前结果并不统一.而胰高血糖糖素样肽-1受体激动剂及钠-葡萄糖协同转运蛋白2可减少糖尿病患者的心血管疾病风险并降低死亡率;但由于数据有限,仍需要更广泛的研究加以证实.     

胰岛素治疗与糖尿病心血管并发症的相关性

胰岛素具有抗炎、舒张血管等重要的心血管作用。外源性胰岛素治疗在临床中能有效控制血糖，并且可能具有改善内皮损伤等抗动脉粥样硬化作用，但亦可能人为造成高胰岛素血症对心血管系统产生不良影响。     

非甾体类抗炎药与心血管事件风险的研究进展

非甾体类抗炎药是一类广泛用于消炎、镇痛的药物,根据对环氧化酶的选择性不同分为三类,研究发现其对心血管事件有一定的影响。环氧化酶-1选择性抑制剂对心血管疾病有二级预防作用,但一级预防作用尚存争议。大多环氧化酶-2选择性抑制剂增加心血管事件风险,部分尚存争议。非选择性抑制剂大多增加心血管事件风险,少部分则几乎无影响。现拟对非甾体类消炎药与心血管事件风险的研究进展做一综述。     

免疫检查点抑制剂相关心血管不良反应的机制、临床表现及管理

免疫检查点抑制剂是肿瘤免疫治疗的一类药物,在肿瘤治疗中有很好的应用前景.该药可引起多系统不良反应,其中心血管不良反应虽不常见,但是致死率高,需重视.其常见的心血管不良反应包括心肌炎、心力衰竭、心律失常、急性冠状动脉事件等.该文总结了免疫检查点抑制剂所致心血管不良反应的机制、临床表现及管理,以期提高临床医生对其的警惕性和...     

山西医科大学第一医院方便药房2002年-2004年心血管系统用药分析

目的了解医院心血管系统药物的应用状况及趋势.方法采用金额排序和对比分析方法,对山西医科大学第一医院方便药房2002年-2004年病人自费购买口服心血管系统药物前20位排名,按品种、金额及构成比进行统计分析,内容包括心血管系统药物占各年总购药金额百分比,按作用分类所占总心血管系统药物的百分率.结果心血管系统药物数量、品种逐年增加,钙通道阻滞剂年用药金额呈上升趋势,全年药品销量略有下降.结论经济、高效、副反应小的心血管系统药品是病人首选,应加强该系统药品的管理,宣传用药知识,提高合理用药水平.     

老年人心血管药物的合理应用

本文结合老年人心血管药物药代动力学及药效学特点,探讨常用心血管药物在老年人应用时易发生不良反应的机制,相应提出老年人合理应用这些药物的具体措施,对临床更加有效地治疗老年心血管疾病、减少心血管药物的不良反应有一定意义。     

自噬在天然药物活性成分抗心血管衰老中的作用

心血管系统维持着机体正常的生命活动,心血管系统衰老可引发高血压、动脉粥样硬化、心力衰竭、心肌梗死等疾病。自噬是一种溶酶体依赖性降解途径,其水平随着年龄增加而逐渐降低,一方面提高机体自噬可延缓细胞和组织衰老,另一方面自噬水平的过度激活可诱导细胞自噬性死亡、加速衰老。某些天然药物活性成分能调节自噬,并改善心血管系统衰老。它们可能是通过调节细胞自噬发挥对心血管系统衰老的保护作用。因此,文章就自噬在天然药物活性成分延缓心血管系统衰老中的作用及研究进展进行综述。     

Beta-adrenergic blockade. An update

beta-Adrenergic blockade represents a major pharmacologic advance. These drugs bind to membrane adrenergic receptors interfering with the effects of endogenous catecholamines. Eight beta-blockers are available in the United States, and others are being studied. The drugs have varying pharmacodynamic properties that may modify certain side effects: beta 1-selectivity, partial agonism, alpha-adrenergic blocking activity, membrane stabilization, and varying pharmacokinetic characteristics. The drugs have been shown to be relatively safe and useful for a wide variety of cardiovascular and noncardiovascular disease states, and their wide spectrum of therapeutic activity illustrates the importance of the sympathetic nervous system in the pathophysiology of medical illness.     

A Historical Perspective on the Development of β-Adrenergic Blockers

The introduction of β-adrenergic-blocking drugs into clinical medicine in the early 1960s represented a major advance in pharmacotherapy. The use of these drugs highlighted the importance of the sympathetic nervous system in contributing to the pathophysiology of a wide variety of cardiovascular and noncardiovascular disorders. This article summarizes the history of β-blocking agents and reviews the applications of this therapeutic class. These drugs may be useful as primary protection against cardiovascular morbidity and mortality in hypertensive patients and have proved to be beneficial in other cardiovascular conditions. Not all β-blockers have the same mechanism of action and, among them, there are pharmacologic differences that may be of clinical importance.     

Assessing Blood Pressure Responses to Noncardiovascular Drugs: The Beneficial Role of Ambulatory Blood Pressure Monitoring

It has become apparent that noncardiovascular drugs can affect blood pressure (BP) in an off‐target manner, either by raising or lowering pressure or by negating the beneficial hypotensive effect of concomitantly prescribed antihypertensives. This paper presents compelling evidence that ambulatory blood pressure monitoring (ABPM) should be used to detect BP effects during the development of noncardiovascular drugs. The requirements for standardizing ABPM to obtain the most information from the least number of participants and the many advantages of obtaining a 24‐hour BP profile are discussed. The use of ABPM in trials of antihypertensive agents, though differing in purpose (the demonstration of BP‐lowering efficacy) from the use of ABPM in trials of noncardiovascular drugs (the demonstration of any off‐target effect on BP) nonetheless provides methodological similarities that can be applied in both contexts with advantage. The paper also considers whether there are lessons to be learned from a regulatory science approach that is designed to prospectively identify unacceptable off‐target cardiac effects of noncardiac drugs and offers some thoughts on how a future paradigm of standardized use of ABPM to assess off‐target BP effects during the development of noncardiovascular drugs might benefit patient safety.     

Medikamentöse Therapie von Herz- und Lungenerkrankungen

Many patients suffer from both heart and lung diseases. The choice of medical drugs should not only be driven by the clinical and prognostic effects on the target organ but should also be selected based on the effects on the respective other organ. Beta blockers and statins have both beneficial and harmful effects on the respiratory system. Angiotensin-converting enzyme (ACE) inhibitors and amiodarone can cause severe lung damage. Low-dose thiazides and calcium antagonists are first-line medications in hypertensive asthma patients but beta blockers should be avoided. Theophyline should be used with caution in patients with known cardiac disease. Glucocorticosteroids can cause cardiovascular symptoms while the phosphodiesterase inhibitor roflumilast appears to have no relevant cardiovascular side effects. Anticholinergic drugs have both favorable and unfavorable cardiovascular (side) effects. Short-acting beta-2 sympathomimetic drugs (SABA) and macrolides in particular can trigger arrhythmia and some SABAs are associated with a higher incidence of myocardial infarction. Detailed knowledge of the effects of drugs used for the treatment of lung and heart diseases on the respective other organ and the associated complications and long-term effects are essential in providing optimal medical care to the many patients who present with both respiratory and cardiovascular diseases.     

Leptin,sympathetic nervous system,and baroreflex function

In addition to its direct effects on energy metabolism and caloric intake, leptin exerts several circulatory effects that appear to be mediated by an interaction with the sympathetic nervous system and the major reflexogenic area involved in cardiovascular homeostatic control—that is, the arterial baroreflex. In this paper, the relationships between the adipocyte hormone and the neuroadrenergic function are reviewed, taking into account data collected in experimental animal models as well as in human cardiovascular (hypertension and heart failure) and noncardiovascular (obesity) diseases that are characterized by a hyperadrenergic state coupled with a hyperleptinemia.     

Impact of diabetes and previous myocardial infarction on long-term survival: 25-year mortality follow-up of primary screenees of the Multiple Risk Factor Intervention Trial

BACKGROUND: The magnitude of coronary mortality risk associated with diabetes or prior myocardial infarction (MI) is debatable. Modulating effects of age, risk factors, and duration of follow-up may explain discrepancies in previous research. Associations with noncardiovascular mortality are little explored. OBJECTIVES: To compare mortality patterns in men with a history of diabetes or MI and to assess modulating effects on mortality of age, cardiovascular risk factors, and follow-up duration. METHODS: We compared the 25-year mortality of 4809 men with diabetes only and 4625 men with MI only (all men aged 35-57 years). RESULTS: The adjusted hazard ratio (HR) for all-cause mortality for those with MI only vs those with diabetes only was 0.97 (95% confidence interval, 0.92-1.03; P =.32). The pattern of deaths was different: higher coronary mortality (HR = 1.37; P<.001) and lower mortality from noncardiovascular causes (HR = 0.66; P<.001) in those with MI only compared with those with diabetes only. This finding prevailed across all ages and levels of cardiovascular risk factors. Hazard ratios for coronary mortality significantly declined over follow-up (2.7, 1.7, 1.2, 1.1, and 1.0 for < or =5, 6-10, 11-15, 16-20, and >20 years of follow-up, respectively), whereas HRs for noncardiovascular mortality remained relatively constant. CONCLUSIONS: Overall, diabetes and MI were similarly strong predictors of total mortality. Higher mortality from noncardiovascular causes was observed in those with diabetes only, whereas prior MI was more strongly predictive of coronary mortality than diabetes at any age and level of cardiovascular risk factors. The difference in coronary mortality between the 2 groups was most evident in the first 10 years of follow-up.     

Effects of noncardiovascular comorbidities on antihypertensive use in elderly hypertensives

Although the benefits of antihypertensive drugs have been clearly established, they remain underused by vulnerable older populations. We examined whether the presence of noncardiovascular comorbidity deters use of antihypertensives in elderly with hypertension. We conducted a retrospective cohort study among 51,517 patients > or =65 years of age in the Pennsylvania Pharmaceutical Assistance Contract for the Elderly (PACE) Program during 1999 and 2000. All were hypertensive and had diagnoses and used treatments during 1999 to qualify for entry into 1 of the following 5 mutually exclusive cohorts: asthma/chronic obstructive pulmonary disease (COPD), depression, gastrointestinal (GI) disorders, osteoarthritis, or none of the 4 comorbidities. Proportions using antihypertensives in 2000 were assessed. Logistic regression analysis was used to identify the independent effects on antihypertensive use of the 4 comorbidities of interest, sociodemographic characteristics, other cardiovascular and noncardiovascular comorbidity, and health care utilization variables. After adjustments in multivariable analyses, antihypertensive use was consistently lower in patients with asthma/COPD (odds ratio [OR], 0.43; 95% confidence interval [CI], 0.40 to 0.47), depression (OR, 0.50; 95% CI, 0.45 to 0.55), GI disorders (OR, 0.59; 95% CI, 0.54 to 0.64), and osteoarthritis (OR, 0.63; 95% CI, 0.59 to 0.67) relative to those without these conditions. Reduced antihypertensive use was also associated with older age, female gender, white race, more severe other comorbidities, absence of some cardiovascular indications, hospitalizations, nursing home care, physician visits, and use of fewer other medications. Highly prevalent, noncardiovascular conditions appear to deter use of antihypertensives in elderly with hypertension.     

Pleiotropic effects of statins

Systematization of pleiotropic actions of statins is presented with special stress on effects important for prevention of atherosclerotic diseases, nonatherosclerotic cardiovascular diseases, and diseases of noncardiovascular origin. Dependence of pleiotropic effects of statins on dose and duration of administration is shown. The review contains data on novel studies of pleiotropic effects favorably affecting endothelial function, oxidative stress, arterial pressure, angiogenesis, heart failure, and disturbances of cardiac rhythm.     

Cardiorenal protection with SGLT2: Lessons from the cardiovascular outcome trials

Sodium glucose cotransporter 2 (SGLT2) inhibitors are a class of drugs that were primarily developed for the treatment of type 2 diabetes mellitus. However, these agents have shown to provide additional beneficial effects. We will discuss three main topics regarding the use of SGLT2 inhibitors: noncardiovascular effects, cardiovascular benefits, and novel clinical indications. Multiple clinical trials and preliminary studies across varying disciplines have shown that these agents exhibit cardiorenal‐protective benefits, retinoprotective benefits, and may aid in weight loss without causing marked hypoglycemia. Therefore, these agents represent an avenue in clinical practice to manage comorbid conditions in the hyperglycemic patient. Because of their multifaceted effects and robust action, SGLT2 inhibitors represent therapy options for providers that not only provide beneficial clinical results but also reduce total patient drug burden.     

Predictive value of clinic and ambulatory heart rate for mortality in elderly subjects with systolic hypertension

OBJECTIVE: To examine the association of clinic and ambulatory heart rate with total, cardiovascular, and noncardiovascular death in a cohort of elderly subjects with isolated systolic hypertension from the Systolic Hypertension in Europe Trial. METHODS: A total of 4682 patients participated, whose untreated blood pressure on conventional measurement at baseline was 160 to 219 mm Hg systolic and lower than 95 mm Hg diastolic. Clinic heart rate was the mean of 6 readings during 3 visits. Ambulatory heart rate was recorded with a portable intermittent technique in 807 subjects. RESULTS: Raised baseline clinic heart rate was positively associated with a worse prognosis for total, cardiovascular, and noncardiovascular mortality among the 2293 men and women taking placebo. Subjects with heart rates higher than 79 beats/min (bpm) (top quintile) had a 1.89 times greater risk of mortality than subjects with heart rate lower than or equal to 79 bpm (95% confidence interval, 1.33-2.68 bpm). In a Cox regression analysis, predictors of time to death were heart rate (P<.001), age (P<.001), serum creatinine level (P =.001), presence of diabetes (P =.002), previous cardiovascular disease (P =.01), triglyceride readings (P =.02), smoking (P =.04), and elevated systolic blood pressure (P =.05), while total cholesterol level was found to be nonsignificant in the model. In the ambulatory monitoring subgroup, clinic and ambulatory heart rates predicted noncardiovascular but not cardiovascular mortality. However, in a Cox regression analysis in which clinic and ambulatory heart rates were included, a significant association with noncardiovascular mortality was found only for clinic heart rate (P =.004). In the active treatment group, the weak predictive power of clinic heart rate for mortality disappeared after adjustment for confounders. CONCLUSIONS: In untreated older patients with isolated systolic hypertension, a clinic heart rate greater than 79 bpm was a significant predictor of all-cause, cardiovascular, and noncardiovascular mortality. Ambulatory heart rate did not add prognostic information to that provided by clinic heart rate.