RESUMO
Despite the knowledge that a well-balanced diet provides most of the nutritional requirements, the use of supplemental vitamins is widespread among adults in the United States. Evidence from large randomized controlled trials over the last 2 decades does not support vitamin supplementation for the reduction of cardiovascular risk factors or clinical outcomes. Many of the vitamins used in common practice likely are safe when consumed in small doses, but long-term consumption of megadoses is not only expensive but has the potential to cause adverse effects. Therefore, a need exists to revisit this issue, reminding the public and healthcare providers about the data supporting the use of vitamins for cardiovascular disease, and the potential for harm and the expense associated with their unnecessary use. In this review, we highlight the scientific evidence from randomized controlled studies regarding the efficacy and safety of vitamin supplementation for primary and secondary prevention of cardiovascular diseases and outcomes. We also draw attention to issues related to widespread and indiscriminate use of vitamin supplements and the need to educate the public to curtail unnecessary consumption and expense by limiting their use based on strong scientific evidence.
Assuntos
Doenças Cardiovasculares/prevenção & controle , Vitaminas/uso terapêutico , Ácido Ascórbico/economia , Ácido Ascórbico/uso terapêutico , Doenças Cardiovasculares/tratamento farmacológico , Análise Custo-Benefício , Suplementos Nutricionais/economia , Medicina Baseada em Evidências , Humanos , Vitamina A/economia , Vitamina A/uso terapêutico , Complexo Vitamínico B/economia , Complexo Vitamínico B/uso terapêutico , Vitamina D/economia , Vitamina D/uso terapêutico , Vitamina E/economia , Vitamina E/uso terapêutico , Vitamina K/economia , Vitamina K/uso terapêutico , Vitaminas/economiaRESUMO
INTRODUCTION: The off-label use of chelation therapy (disodium edetate or EDTA) for prevention of cardiovascular disease (CVD) is widespread, despite the lack of convincing evidence for efficacy or approval from the Food and Drug Administration. After the publication of results from the National Institute of Health-sponsored Trial to Assess Chelation Therapy (TACT), a randomized controlled trial (RCT) in patients after myocardial infarction (MI), there is a renewed interest in clarifying the role of this treatment modality for patients with coronary artery disease. Areas covered: This narrative review highlights the evidence from observational studies and RCT in assessing the effect of chelation therapy on cardiovascular outcomes and potential for adverse effects or harm. Expert commentary: Although encouraging results were reported in TACT, the evidence is insufficient to recommend the routine use of chelation therapy even in the post-MI diabetic subgroup, which appeared to benefit. The ongoing TACT2 trial may clarify its use in post-MI diabetic patients. Unsubstantiated claims of chelation therapy as an effective treatment of atherosclerosis should be avoided and patients made aware of the inadequate evidence for efficacy and potential adverse effects, especially the harm that can occur if used as a substitute for proven therapies.
Assuntos
Doenças Cardiovasculares/tratamento farmacológico , Quelantes/uso terapêutico , Ácido Edético/uso terapêutico , Animais , Aterosclerose/tratamento farmacológico , Doenças Cardiovasculares/fisiopatologia , Quelantes/efeitos adversos , Terapia por Quelação/efeitos adversos , Terapia por Quelação/métodos , Doença da Artéria Coronariana/tratamento farmacológico , Ácido Edético/efeitos adversos , Humanos , Infarto do Miocárdio/tratamento farmacológico , Uso Off-Label , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do TratamentoRESUMO
Atrial fibrillation is a common arrhythmia encountered in clinical practice. The prevalence increases with age. A devastating complication of atrial fibrillation is cardioembolic stroke with central nervous system sequelae. Based on stroke risk scores (CHADS and CHA2DS2VASc) and bleeding risk (HAS-BLED), the optimal use of anticoagulation in atrial fibrillation is feasible. Warfarin is a proven medication for this specific indication but requires frequent monitoring and dose adjustments, and it has multiple food, drug, and disease-state interactions. In addition, management of anticoagulation during the perioperative period may be challenging. In this regard, novel oral anticoagulants (NOACs) have shown promise in the shift toward the "ideal" anticoagulant therapy, in that fixed dosing is the norm, drug interactions are few, food interactions are absent, onset is fairly immediate and offset predictable, and, in the majority of patients, therapeutic monitoring is not required. This article provides a review of recent published trials of the use of NOACs in atrial fibrillation. Practical points on indications, contraindications, mechanism of action, interactions, and perioperative management tips are discussed with a view toward the safe and effective use of these new medications. When patients are transitioned between different anticoagulant medications, the risks of thrombosis and bleeding need to be considered. When switching from warfarin to a NOAC, the NOAC can be started once the international normalized ratio is ≤2.0.