ASSESSMENT OF ADVERSE DRUG REACTIONS AS CARDIOVASCULAR RISK FACTORS.

UNLABELLED: A wide range of pharmaceutical substances can induce side-effects expressed as cardiovascular changes or events, adding to other risk factors or worsening preexisting cardiovascular diseases. AIM: Continuous study focused on iatrogenic conditions representing cardiovascular risk factors. METHODS: We developed a descriptive study of patients admitted to the Iasi Vth Internal Medicine and Geriatrics-Gerontology Clinic between 1998-2013, focusing on iatrogenic conditions representing cardiovascular risk factors. RESULTS: We have diagnosed 81 cases of drug-induced hypertension, and 43 patients with hypertensive crises; 72 cases of iatrogenic hyperglycemia; 36 cases of drug-induced hyperuricemia; 50 cases of drug-induced dyslipidemias; and 17 cases of iatrogenic obesity. These iatrogenic diseases were more common in women and the elderly. Twenty-eight patients have developed simultaneous adverse drug reactions induced by the same drug and manifest as different cardiovascular risk factors. CONCLUSIONS: Cardiovascular risk factors can be induced to a significant extent by chronic drug administration. Some medications (e.g., NSAIDs, corticoids, beta-blockers, diuretics, contraceptives) can act on the same patient by multiple pathogenic links. The adverse drug reactions can be cardiovascular risk factors that persist in time, or can be removed (by discontinuing the administration of the implicated drug). The highest importance of their acknowledgment relies on the possibility of their prevention through carefully balancing the benefits and the risk of each new medication.

Correlations between the presence of sigmoid interventricular septum and increased relapse risk of stroke in hypertensive patients.

OBJECTIVES: Comparison between cerebrovascular accident (CVA) relapse in hypertensive patients with sigmoid interventricular septum (SIS) and CVA relapse in hypertensive patients without SIS. MATERIALS AND METHODS: We selected 36 hypertensive patients, all of them complicated with previous CVA; 18 patients had SIS (Group A) and 18 patients didn't have SIS (Group B). The utilized methods were the following: clinical examination, electrocardiogram, transthoracic echocardiogram, biochemical findings and complete blood count, performed every 3 months, during 2 years of observation. Another method, addressed for CVA relapse patients, were cerebral computed tomography or magnetic resonance imaging .The recommended treatment was administered according to the European therapeutic guidelines. RESULTS: 6 (out of 18) patients with SIS presented a CVA relapse and only 1 (out of 18) patient without SIS revealed a CVA relapse. CONCLUSIONS: Our results support recent conclusions from another publications: patients with SIS (an apparently benign condition, which is a part of the cardiac modifications usually discovered in elderly people) have a higher cardiovascular risk for acute events, than the patients without SIS.

Long-term prognosis of polyvascular patients with associated chronic obstructive pulmonary disease.

OBJECTIVE: To evaluate by various tools the prognosis of the polyvascular patients (defined as the presence of more than one affected vascular bed), who also associate chronic obstructive pulmonary disease. MATERIAL AND METHODS: Fifty-eight patients discharged after an episode of acute cardiorespiratory failure were examined at 3 month-intervals for 1, 2 and 3 years (2010-2012). The following were performed: physical examination, biochemical and hematological tests, spirometry, electrocardiography, transthoracic echocardiography, brain computer tomography or magnetic resonance imaging. All patients in our study were smokers with chronic pulmonary obstructive disease. Treatment relied on the European recommendations for cardiac pathology and associated medical conditions. RESULTS: A favorable clinical course was noticed in compliant patients. Patients with metabolic syndrome and/or old stroke, and peripheral arterial disease have a poor prognosis. A strong link seems to exist between systolic function of the right ventricle and cardiovascular mortality. The association of this condition to ischemic heart disease modifies the right ventricle hemodynamics. CONCLUSIONS: Polyvascular patients in acute cardiorespiratory failure have a mortality of 36% in the first 3 weeks. After 3 years, 86% of the patients survive. The modern methods of diagnosis and treatment allow improving the quality of life and increasing its duration.

[Depression and cardiovascular diseases in the elderly]. / Depresia si bolile cardiovasculare la pacientii vârstnici.

UNLABELLED: The aim of this study was to reveal if there are connections between depression and cardiovascular disease. MATERIAL AND METHOD: We have studied 413 patients from Jorasti, Jud Galati on a two-years period (2008-2010). On these patients there was performed a careful history taking and they were physically examined (height, weight, body mass index, waist, blood pressure, heart rate). There was also performed an ECG (electrocardiogram), there were measured the levels of cholesterolemia, HDL-cholesterolemia, trygliceridemia and creatininemia. We used the Geriatric Depression Scale (GDS) in order to evaluate depression. RESULTS: in these patients there was noticed a higher prevalence of dyslipidemias, obesity and depression in women. Out of the 46 women with mild and severe depression 32 are overweight, 7 have obesity, 29 a high cholesterol, 23 a high LDL-cholesterol; all of them had a high risk or the presence of cardiovascular disease. CONCLUSIONS: Depression is an independent risk factor for producing a cardiovascular event; the level of cholesterol and of the blood preessure was higher in patients with severe depression, proving that the level of the cardiovascular risk factors increased with the severity of the depression. Treating the elderly, which often associate depression, makes necessary a careful evaluation of all comorbidities and risks, in order to establish perfect individualized strategies of improving the quality of life.

[Dislypidemia as a risk factor for cardiovascular disease]. / Dislipidemia--factor determinant al cardiopatiei ischemice.

UNLABELLED: The aim of the study was to evaluate dislypidemias as risk factor in the countryside. MATERIAL AND METHOD: There have been evaluated 413 patients from the countryside (Jorasti, Galati County), in the period 2008-2010. There was performed history taking, physical examination, an ECG and biological findings (glycemia, colesterolemia, HDL-colesterolemia, trygliceridemia, creatinenemia). RESULTS: In these patients there was noticed a higher prevalence of the dislypidemias in women (65.7%) than in men (50.29%). Both dislypidemias and hypertension were more frequent in patients with cardiovascular disease or in those with high risk of cardiovascular disease than in those with a small or absent risk both in men and in women. In 208 cases there have been present all the elements of the metabolic syndrome. CONCLUSIONS: The modifiable risk factors have a very important part in the development of cardiovascular diseases in the countryside. Using proper programmes of prophylaxis there can be hope for a decrease of the morbidity and mortality of cardiovascular disease.

[Clinical epidemiologic study of 277 patients with gallstones, treated at the Gastroenterology Unit of the Emergency Hospital of Bacau County, in 2006-2008]. / Cercetari clinico-epidemiologice privind evolutia unui lot de 277 bolnavi cu litiaza a veziculei biliare, asistati in serviciul de gastroenterologie din Spitalul Judetean de Urgenta Bacau, in perioada 2006-2008.

A sample of 277 cases admitted for gallstones was studied between September 2006 and August 2008. The purpose of the study was the investigation of gallstones with or without other pathologies, which have a connection with gallbladder diseases. Paraclinical investigations were necessary to monitor the diagnosis and complications.

[Protective effects of vegetable polyphenols on the dynamic metabolism of lipids]. / Efectele protectoare ale polifenolilor vegetali asupra dinamicii metabolismului lipidic.

Epidemiological studies generally showed a strong inverse association between red wine consumption and mortality for coronary heart disease (CHD). Antiatherogenic alteration in plasma lipoproteins, particularly increase in high-density lipoprotein (HDL) cholesterol, is considered as the most plausible mechanism of the protective effect of alcohol consumption on CHD. The aim of our study was to investigate the in vivo effects of regular consumption of 300 ml red wine/day, for three weeks, on human serum lipid profile. Thirty healthy volunteers on no medication, abstained from alcohol for 21 days prior the study, were included in our study, and blood samples were taken for serum lipids at base line and after 21 days of wine consumption. This study confirmed that moderate consumption of red wine exerts cardioprotective effects through beneficial changes in lipid profile.

[Cardio-thoracic index: marker of the clinical course of alcoholic dilated cardiomyopathy]. / Indicele cardiotoracic--marker al evolutiei cardiomiopatiei dilatative alcoolice.

Alcoholic cardiomyopathy (ACM), a principal form of secondary dilated cardiomyopathy, can ensue from heavy consumption of alcohol over a long period of time. In harmful consumption, alcohol and its metabolites has a toxic effect on heart muscle cells. The clinical features include dilatation of the left ventricle, poor myocardial contractility and symptoms of heart failure. The heart and lung X-ray examination is required in all disease stages. The information gathered from this cheap and noninvasive investigation method, are very important in the diagnosis algorithm. In the ACM stages beginning, before the installation of the heart failure symptoms, it is possible to found normal dimensions of the heart, which is compatible with the alcoholic cardiomyopathy diagnosis. Specific for dilated alcoholic cardiomyopathy is the reversible character of cardiomegaly, objectified through the reduction of the cardio-thoracic index in conditions of alcohol abstinence and adequate treatment of the heart failure.

[Treatment with angiotensin conversion enzyme inhibitors in heart failure]. / Tratamentul cu inhibitori ai enzimei de conversie a angiotensinei în insuficienta cardiaca.

The appearance of the Angiotensine Conversion Enzyme Inhibitors represents one of the most important events in cardio-vascular therapy, being much utilized in the last few years. The present study had as a main aim the evaluation of the benefit of the treatment with ACE Inhibitors in heart failure. Analyzing the results obtained, we can appreciate that ACE Inhibitors have a real benefit in patients with heart failure, improving the performance of physical effort and the life quality.

[The implications of thromboembolism in chronic heart failure]. / Implicatiile tromboembolismului în insuficienta cardiaca cronica (ICC).

The goal of investigation was to determine whether long-term anticoagulant therapy influences the mortality rate in CHF. The method consisted in the calculation of the annual death rate of the patients with CHF class III-IV NYHA: group A (controls)--who did not receive anticoagulant or antiplatelet therapy; group B--treated with Acenocumarol or Aspirin. The results show in group A, which included 150 patients, during the 5-year interval under study 30 deaths, representing an annual death rate of 4%. In group B, which included 325 patients of which 75 treated with Acenocumarol and 250 patients with aspirin, 20 deaths were recorded during the same 5-year interval, representing an annual death rate of 1.2%. Thus, the mortality risk proved to be 70% lower in group B than in the control group. It came out that the main mechanism of death in CHF is thrombembolism and in this circumstance anticoagulant or antiplatelet therapy would be essential.