Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 11.941
Filtrar
1.
Vopr Virusol ; 66(1): 40-46, 2021 03 07.
Artigo em Russo | MEDLINE | ID: mdl-33683064

RESUMO

INTRODUCTION: Analysis of the pathogenesis of coronavirus infection caused SARS-CoV-2 indicates a significant impact of hemorheological disorders on its course and outcomes. It is known that chronic cardiovascular diseases are associated with the risk of severe course and lethal outcomes both in COVID-19 and other infectious diseases. Therefore, in each case it is necessary to study the interaction and mutual influence of different components of the treatment program prescribed to such patients.The purpose of this work was to evaluate the effect of coagulation activity on the course of a novel coronavirus infection (COVID-19) and to justify the management of comorbid patients having been received novel oral anticoagulants (NOACs) in previously selected doses according to indications in concomitant somatic diseases. MATERIAL AND METHODS: Total 76 cases of confirmed coronavirus infection in patients who had been received initial therapy on an outpatient basis were analyzed. 26 patients who received NOACs (rivaroxaban, apixaban, dabigatran) made up the main group and 50 - the comparison (control) group in which patients had not been administered any drugs that affect blood clotting until the episode of COVID-19. All patients have been prescribed therapy following the Provisional guidelines «Prevention, diagnosis and treatment of coronavirus infection (COVID-19)¼ (https://static-0.minzdrav.gov.ru/system/attachments/attaches/). RESULTS AND DISCUSSION: The number of hospitalizations was significantly fewer in the group of patients who had been received NOACs (19 vs. 66% in the control group). No deaths or cases of severe respiratory and/or renal failure were observed in the main group, while adverse outcomes were noted in 14% of patients who had not been administered these drugs. CONCLUSION: Taking NOACs reduces the probability of severe course and adverse outcomes in the development of coronavirus infection caused by SARS-CoV-2, which indicates a significant contribution of coagulation mechanisms to the pathogenesis in COVID-19. There were no indications for drug replacement and correction of anticoagulant therapy regimens in patients who received adequate therapy with oral anticoagulants for treating a non-severe form of coronavirus infection in ambulatory patient settings.


Assuntos
Anticoagulantes/uso terapêutico , Fibrilação Atrial/tratamento farmacológico , Doença das Coronárias/tratamento farmacológico , Coagulação Intravascular Disseminada/tratamento farmacológico , Hipertensão/tratamento farmacológico , Arteriosclerose Intracraniana/tratamento farmacológico , Acetilcisteína/uso terapêutico , Idoso , Idoso de 80 Anos ou mais , Antivirais/uso terapêutico , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/mortalidade , Fibrilação Atrial/virologia , Azitromicina/uso terapêutico , /patologia , Estudos de Coortes , Comorbidade , Doença das Coronárias/diagnóstico , Doença das Coronárias/mortalidade , Doença das Coronárias/virologia , Dabigatrana/uso terapêutico , Coagulação Intravascular Disseminada/diagnóstico , Coagulação Intravascular Disseminada/mortalidade , Coagulação Intravascular Disseminada/virologia , Feminino , Humanos , Hipertensão/diagnóstico , Hipertensão/mortalidade , Hipertensão/virologia , Indóis/uso terapêutico , Interferon alfa-2/uso terapêutico , Arteriosclerose Intracraniana/diagnóstico , Arteriosclerose Intracraniana/mortalidade , Arteriosclerose Intracraniana/virologia , Masculino , Pessoa de Meia-Idade , Pirazóis/uso terapêutico , Piridonas/uso terapêutico , Rivaroxabana/uso terapêutico , /patogenicidade , Índice de Gravidade de Doença , Análise de Sobrevida
3.
Zhongguo Zhong Yao Za Zhi ; 46(1): 237-246, 2021 Jan.
Artigo em Chinês | MEDLINE | ID: mdl-33645075

RESUMO

To systematically evaluate the clinical efficacy and safety of Danhong Injection combined with conventional therapy in improving diabetes mellitus complicated with coronary heart disease. Based on the online literature database(CNKI, Wanfang, VIP, PubMed, Web of Science, Cochran Library), the Chinese and English papers about the randomized controlled trial(RCT) of Danhong Injection in the treatment of diabetes mellitus complicated with coronary heart disease were searched comprehensively from the establishment of the databases to January 1, 2020. The papers were screened strictly according to the inclusion and exclusion criteria. Based on Jadad scale, the risk assessment of literature was carried out, and Meta-analysis was performed by STATA 12.0 software. Seventeen RCTs were included, involving 1 453 patients. The results of Meta-analysis showed that the combination of Danhong Injection and conventio-nal treatment could improve the clinical comprehensive effective rate(RR=1.47, 95%CI[1.38, 1.58], P<0.000 1), electrocardiogram(ECG) efficiency(RR=1.30, 95%CI[1.16, 1.46], P<0.000 1), efficiency of the angina pectoris(RR=1.41, 95%CI[1.25, 1.58], P<0.000 1), cholesterol level(SMD=-1.05, 95%CI[-1.95,-0.16], P=0.02), low-density lipoprotein(LDL) level(SMD=-0.50, 95%CI[-0.79,-0.21], P<0.000 1), coronary angina attack frequency(SMD=-3.71, 95%CI[-4.05,-3.36], P<0.000 1) and duration of angina pectoris(SMD=-2.96, 95%CI[-3.25,-2.66], P<0.000 1), with statistically significant differences. But the differences in fasting plasma glucose(FPG)(SMD=-0.19, 95%CI[-0.45, 0.08], P=0.16), plasma glucose of two hours after meal(2 hPG)(SMD=0.19, 95%CI[-0.11, 0.49], P=0.22), and high-density lipoprotein(HDL) level(SMD=0.10, 95%CI[-0.30, 0.49], P=0.62) after treatment were not statistically significant. Compared with the control group, there was no significant difference in adverse reactions(SMD=-2.96, 95%CI[-3.25,-2.66], P=0.75). The existing evidence shows that the combination of Western medicine and Danhong Injection can improve the clinical effect for diabetes mellitus complicated with coronary heart disease and has no obvious adverse reactions. However, due to the low level of overall literature evidence, high risk and some kind of publication bias, it still needs more high-quality randomized controlled trials and low-bias studies for further verification.


Assuntos
Doença das Coronárias , Diabetes Mellitus , Medicamentos de Ervas Chinesas , Angina Pectoris , Doença das Coronárias/complicações , Doença das Coronárias/tratamento farmacológico , Humanos
5.
Medicine (Baltimore) ; 100(3): e24113, 2021 Jan 22.
Artigo em Inglês | MEDLINE | ID: mdl-33546020

RESUMO

BACKGROUND: Coronary heart disease (CHD) is an important cause of chronic heart failure, and chronic heart failure is also a serious complication in the end stage of coronary heart disease. At present, there is no specific treatment plan. Shenfu injection has advantages in the treatment of heart failure in patients with coronary heart disease, but there is a lack of standard clinical study to verify this. Therefore, the purpose of this randomized controlled trial is to evaluate the efficacy and safety of Shenfu injection combined with furosemide in the treatment of chronic heart failure in patients with coronary heart disease. METHODS: This is a prospective randomized controlled trial to study the efficacy and safety of Shenfu injection combined with furosemide in the treatment of coronary heart disease and chronic heart failure. This study will be approved by the clinical research ethics committee of our hospital. The patients will be randomly divided into two groups according to 1:1:(a) Shenfu injection combined with furosemide group and (b) simple furosemide group. Standard treatment for 7 days followed up for 30 days at the same time, pay attention to its efficacy and safety indicators. The total effective rate of cardiac function improvement, left ventricular ejection fraction (LVEF), N-terminal pro-brain natriuretic peptide (NT-pro BNP), 6-minute walk test (6-MWTD), and adverse reactions will be observed. Data will be analyzed using the statistical software package SPSS version 25.0 (Chicago, IL). DISCUSSION: This study will evaluate the efficacy and safety of Shenfu injection combined with furosemide in the treatment of coronary heart disease with chronic heart failure. The results of this experiment will provide a clinical basis for Shenfu injection combined with furosemide in the treatment of coronary heart disease and chronic heart failure. OSF REGISTRATION NUMBER: doi: 10.17605/OSF.IO/27FPM.


Assuntos
Doença das Coronárias/tratamento farmacológico , Diuréticos/uso terapêutico , Medicamentos de Ervas Chinesas/uso terapêutico , Furosemida/uso terapêutico , Insuficiência Cardíaca/tratamento farmacológico , Doença Crônica/tratamento farmacológico , Doença das Coronárias/complicações , Quimioterapia Combinada , Insuficiência Cardíaca/complicações , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto
6.
Z Evid Fortbild Qual Gesundhwes ; 160: 48-54, 2021 Feb.
Artigo em Alemão | MEDLINE | ID: mdl-33451924

RESUMO

INTRODUCTION: Little is known about social inequalities in outpatient long-term care of coronary heart disease (CHD) in Germany. METHODS: Regression analyses are based on the responses of women and men who participated in the national cross-sectional study "German Health update" (GEDA) 2014/2015 and had self-reported CHD (N=920). Outpatient healthcare of CHD was analysed on the basis of the self-reported administration of antihypertensive and cholesterol-lowering drugs, and the frequency of general practitioner (GP) contacts. RESULTS: On average, respondents visited their GP 7.5 times a year (mean). 46 % did not receive guideline-consistent treatment, i. e. both antihypertensive and cholesterol-lowering drugs. Respondents of lower social status consulted their GP more frequently (approx. two visits per year) than those of higher social status (AME: 1.94; 95% CI 0.56 to 3.31). Regarding treatment with antihypertensive and cholesterol-lowering drugs, there were no significant differences for either gender or social status. Nevertheless, the probability that respondents with increased levels of blood lipids or cholesterol took only one or none of the two medications recommended for long-term treatment of CHD was reduced by 54 percentage points (AME: -0,54; 95% CI -0,61 to -0,48). DISCUSSION: There are no social inequalities in the treatment of CHD patients with antihypertensive and cholesterol-lowering drugs, but inequalities exist in the frequency of visits to the GP who is more often consulted by the more socially disadvantaged patients. CONCLUSION: With about 7.5 consultations per year, CHD patients visit their general practitioner more often than average, but in about half of these patients the medication supply is less than optimal. This may indicate a deficit in the medical treatment of CHD that cannot be explained by social inequalities. A possible starting point for improving healthcare, especially for patients without other risk factors, is to focus more strongly on a guideline-based approach to prescribing medication for CHD patients.


Assuntos
Doença das Coronárias , Disparidades em Assistência à Saúde , Doença das Coronárias/tratamento farmacológico , Estudos Transversais , Assistência à Saúde , Feminino , Alemanha , Humanos , Masculino , Fatores de Risco , Fatores Socioeconômicos
7.
Am Heart J ; 233: 92-101, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33400910

RESUMO

BACKGROUND: In patients with coronary heart disease (CHD), atrial fibrillation (AF) is associated with increased morbidity and mortality. We investigated the associations between clinical risk factors and biomarkers with incident AF in patients with CHD. METHODS AND RESULTS: Around 13,153 patients with optimally treated CHD included in the STabilization of Atherosclerotic plaque By Initiation of darapLadIb TherapY (STABILITY) trial with plasma samples obtained at randomization. Mean follow-up time was 3.5 years. The association between clinical risk factors and biomarkers with incident AF was estimated with Cox-regression models. Validation was performed in 1,894 patients with non-ST-elevation acute coronary syndrome included in the FRISC-II trial. The median (min-max) age was 64 years (range 26-92) and 2,514 (19.1%) were women. A total of 541 patients, annual incidence rate of 1.2%, developed AF during follow-up. In multivariable models, older age, higher levels of NT-proBNP, higher body mass index (BMI), male sex, geographic regions, low physical activity, and heart failure were independently associated with increased risk of incident AF with hazard ratios ranging from 1.04 to 1.79 (P ≤ .05). NT-proBNP improved the C-index from 0.70 to 0.71. In the validation cohort, age, BMI, and NT-proBNP were associated with increased risk of incident AF with similar hazard ratios. CONCLUSIONS: In patients with optimally treated CHD, the incidence of new AF was 1.2% per year. Age, NT-proBNP as a marker of impaired cardiac function, and BMI were the strongest factors, independently and consistently associated with incident AF. Male sex and low physical activity may also contribute to the risk of AF in patients with CHD.


Assuntos
Fibrilação Atrial/sangue , Doença das Coronárias/sangue , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Índice de Massa Corporal , Doença das Coronárias/tratamento farmacológico , Método Duplo-Cego , Feminino , Seguimentos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Comportamento Sedentário , Fatores Sexuais
8.
Gene ; 771: 145354, 2021 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-33333215

RESUMO

BACKGROUND: Puerarin shows inhibitory effects on inflammation in chronic heart failure (CHF), but its efficacy in coronary heart disease (CHD) remained vague. METHODS: Rat CHD model was constructed, and serum parameters were determined using a blood liquid biochemical analyzer. Also, contents of creatine kinase (CK), creatine kinase MB isoenzyme (CK-MB), lactate dehydrogenase (LDH) and cardiac troponin (cTnT) were measured using colorimetry. Histological examination was conducted with Hematoxylin-Eosin (H&E) staining, and cardiac function was assessed by Echocardiography. Cell apoptosis was detected using Terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling (TUNEL) assay. Relative expressions were measured using quantitative real-time polymerase chain reaction (qRT-PCR) and Western blot as needed. RESULTS: In CHD rats, the levels of TC, LDL and TG and the expressions of matrix metalloproteinase-9 (MMP-9), CD40 ligand (CD40L), tumor necrosis factor-α (TNF-α) and C-reactive protein (CRP) were increased while HDL level was decreased, accompanied with inflammatory cell infiltration and cardiac malfunction. Also, the contents of CK, CK-MB, LDH and cTnT, the percentage of apoptotic cells, the expressions of Bcl-2 associated X protein (Bax), cleaved Caspase-3, TNF-α, Interleukin-ß (IL-ß), IL-6 and Lipoprotein-associated Phospholipase A2 (Lp-PLA2) expressions and the levels of oxidized-(ox-)LDL and malondialdehyde (MDA) were upregulated, while the level of super oxidase dismutase (SOD) and the expressions of B cell lymphoma-2 (Bcl-2) and vascular endothelial growth factor (VEGF) were downregulated. However, Puerarin ameliorated the effects of CHD model construction, suppressed nuclear factor-(NF-)κB expression, and enhanced the expressions of Farnesoid X Receptor (FXR), phosphorylated-AKT (p-AKT) and phosphorylated-signal transducer and activator of transcription 3 (p-STAT3). CONCLUSION: Puerarin alleviated CHD in rats via inhibiting inflammation, providing possible method for CHD treatment.


Assuntos
Anti-Inflamatórios/administração & dosagem , Doença das Coronárias/tratamento farmacológico , Redes Reguladoras de Genes/efeitos dos fármacos , Isoflavonas/administração & dosagem , Animais , Anti-Inflamatórios/farmacologia , Doença das Coronárias/genética , Creatina Quinase/sangue , Modelos Animais de Doenças , Regulação da Expressão Gênica/efeitos dos fármacos , Isoflavonas/farmacologia , L-Lactato Desidrogenase/sangue , Masculino , Ratos , Troponina C/sangue
9.
Biomed Pharmacother ; 134: 111165, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33370633

RESUMO

High platelet reactivity and gastric mucosal injury after aspirin (ASA) treatment are associated with poor compliance and an increased risk of cardiovascular events. Panax notoginseng saponins (PNS) have been widely used for the treatment of coronary heart disease (CHD) in addition to antiplatelet drugs in China; however, the joint effect and possible mechanism of PNS in addition to ASA on platelet activation and gastric injury remain unclear. This study was designed to investigate the combinational effects of PNS with ASA, and to explore the underlying mechanism via arachidonic acid (AA) metabolism pathway using lipidomic analysis. In a randomized, assessor-blinded trial, 42 patients with stable coronary heart disease (SCHD) and chronic gastritis were randomly assigned to receive ASA (n = 21) or PNS + ASA (n = 21) for 2 months. Compared with ASA alone, PNS + ASA further inhibited CD62p expression, GPIIb-IIIa activation and platelet aggregation and led to increased platelet inhibition rate. PNS + ASA suppressed the activity of platelet cyclooxygenase (COX)-1, and decreased the production of TXB2, PGD2, PGE2, 11-HETE, the downstream oxylipids of AA/COX-1 pathway in platelets, compared with ASA alone. The severity of dyspepsia assessment (SODA) results showed that patients in PNS + ASA group exhibited relieved dyspeptic symptoms as compared with those in ASA group, which might be associated with enhanced secretion of gastrin and motilin. In vivo study of myocardial infarction rats demonstrated that PNS attenuated ASA-induced gastric mucosal injury, which was related to markedly boosted gastric level of 6,15-diketo-13,14-dihydro-prostaglandin (PG)F1α, 13,14-dihydro-15-keto-PGE2 and PGE2 from AA/PG pathway in response to PNS + ASA compared with ASA alone. In summary, our study demonstrated that the combination of PNS and ASA potentiated the antiplatelet effect of ASA via AA/COX-1/TXB2 pathway in platelets, and mitigated ASA-related gastric injury via AA/PG pathway in gastric mucosa.


Assuntos
Ácido Araquidônico/metabolismo , Aspirina/uso terapêutico , Plaquetas/efeitos dos fármacos , Doença das Coronárias/tratamento farmacológico , Mucosa Gástrica/efeitos dos fármacos , Gastrite/tratamento farmacológico , Fármacos Gastrointestinais/uso terapêutico , Panax notoginseng , Extratos Vegetais/uso terapêutico , Ativação Plaquetária/efeitos dos fármacos , Inibidores da Agregação de Plaquetas/uso terapêutico , Saponinas/uso terapêutico , Adulto , Idoso , Animais , Aspirina/efeitos adversos , Pequim , Plaquetas/metabolismo , Doença Crônica , Doença das Coronárias/diagnóstico , Doença das Coronárias/metabolismo , Citoproteção , Sinergismo Farmacológico , Feminino , Mucosa Gástrica/metabolismo , Mucosa Gástrica/patologia , Gastrite/diagnóstico , Gastrite/metabolismo , Fármacos Gastrointestinais/efeitos adversos , Fármacos Gastrointestinais/isolamento & purificação , Humanos , Lipidômica , Masculino , Pessoa de Meia-Idade , Panax notoginseng/química , Extratos Vegetais/efeitos adversos , Extratos Vegetais/isolamento & purificação , Inibidores da Agregação de Plaquetas/efeitos adversos , Ratos Wistar , Saponinas/efeitos adversos , Saponinas/isolamento & purificação , Fatores de Tempo , Resultado do Tratamento
10.
Medicine (Baltimore) ; 99(51): e23573, 2020 Dec 18.
Artigo em Inglês | MEDLINE | ID: mdl-33371087

RESUMO

ABSTRACT: To Investigate the recent effects of small dose of folic acid on lipoprotein-associated phospholipase A2 (LP-PLA2) and systolic blood pressure variability in coronary heart disease (CHD) patients with hyperhomocysteinemia.In this prospective cohort study, a total of 167 CHD patients with hyperhomocysteinemia were consecutively enrolled, and they were divided into Group A (without folic acid intervention, n = 99), Group B (with 0.4 mg of folic acid intervention, n = 34), Group C (0.8 mg of folic acid intervention, n = 34). General information, fasting blood glucose, and blood lipid, folic acid, homocysteine, Lp-PLA2, and blood pressure variability were compared among 3 groups. The above indicators were reviewed after 3 months of treatment.There were no statistically significant differences of age, gender, blood pressure, incidence of type 2 diabetes mellitus, fasting blood glucose, folic acid, homocysteine, Lp-PLA2, total cholesterol, 3 acyl glycerin, apolipoprotein B, lipoprotein (a), high density lipoprotein cholesterol, and low density lipoprotein cholesterol were found among 3 groups (P > .05); however, after being treated for 3 months, there was statistically significant difference in folic acid among 3 groups (P < .05), there was statistically significant difference in apolipoprotein A between Group A and Group B (t = 0.505, P = .039), and also between Group A and Group C (t = 0.052, P = .017). There were statistically significant differences in Lp-PLA2 (t = 24.320, P = .016) and systolic blood pressure variability (t = 0.154, P = .018) between Group A and Group C.For CHD patients with hyperhomocysteinemia, the higher dose (0.8 mg) of folic acid supplement was beneficial for increasing the apolipoprotein A, reducing the Lp-PLA2, and improving the systolic blood pressure variation, which might help to improve the prognosis in these patients.


Assuntos
Doença das Coronárias/tratamento farmacológico , Doença das Coronárias/epidemiologia , Ácido Fólico/farmacologia , Ácido Fólico/uso terapêutico , Hiper-Homocisteinemia/epidemiologia , 1-Alquil-2-acetilglicerofosfocolina Esterase/efeitos dos fármacos , Fatores Etários , Idoso , Apolipoproteínas A/efeitos dos fármacos , Pressão Sanguínea/efeitos dos fármacos , Relação Dose-Resposta a Droga , Feminino , Ácido Fólico/administração & dosagem , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores Sexuais
11.
Zhongguo Zhong Yao Za Zhi ; 45(19): 4756-4765, 2020 Oct.
Artigo em Chinês | MEDLINE | ID: mdl-33164443

RESUMO

To systematically evaluate the efficacy and safety of Xinmailong Injection in the treatment of coronary heart disease complicated with heart failure. Seven databases,namely CNKI, VIP,WanFang,SinoMed,PubMed,EMbase,Cochrane Library, were retrieved by computer for collecting the randomized controlled trials about Xinmailong Injection in the treatment of coronary heart disease complicated with heart failure. The literatures were screened out, data was extracted, and the methodological quality evaluation was conducted by 2 researchers independently according to inclusion and exclusion criteria. RevMan 5.3 software was used for Meta-analysis and corresponding description analysis. A total of 19 studies involving 1 922 patients were included, including 967 cases in the trial group and 955 cases in the control group. All the clinical studies showed a low quality. Meta-analysis results showed that Xinmailong Injection combined with conventional treatment could better reduce the BNP level(SMD=-3.34, 95%CI[-4.06,-2.63]) in patients of coronary heart disease complicated with heart failure or NT-proBNP level, improve the cardiac function(RR=1.23,95%CI[1.18,1.29]) and LVEF(MD=6.85,95%CI[4.93,8.76]),increase 6 MWT(MD=24.34, 95%CI[16.05, 32.64]) and VEGF(MD=26.39,95%CI[24.30,28.49]),and decreased LVEDD(MD=-4.06, 95%CI[-6.33,-1.80]). And subgroup analysis suggested that the course of treatment may be related to the increase of LVEF. This study found that Xinmailong Injection for coronary heart disease complicated with heart failure can further alleviate clinical symptoms and relevant indicators, with no serious adverse reaction. However, it still needs the support of well-designed multicenter, double-blind and high-quality clinical trials.


Assuntos
Doença das Coronárias , Medicamentos de Ervas Chinesas , Insuficiência Cardíaca , Doença das Coronárias/complicações , Doença das Coronárias/tratamento farmacológico , Medicamentos de Ervas Chinesas/uso terapêutico , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/tratamento farmacológico , Humanos , Injeções
12.
Medicine (Baltimore) ; 99(45): e22600, 2020 Nov 06.
Artigo em Inglês | MEDLINE | ID: mdl-33157917

RESUMO

BACKGROUND: This study will assess the efficacy and safety of ticagrelor in the treatment of patients with stable coronary heart disease (SCHD). METHODS: We will search the following databases for relevant potential studies in Cochrane Library, MEDLINE, EMBASE, Web of Science, Google Scholar, Chinese Biomedical Literature Database, and China National Knowledge Infrastructure. We will search all literature sources from inception to the present without limitations of language and publication status. We will only consider randomized controlled trials on exploring the efficacy and safety of ticagrelor for the treatment of SCHD. Investigators will separately examine studies, collect data and appraise study quality. Data synthesis and analysis will be performed using RevMan 5.3 software. RESULTS: This study will summarize high quality synthesis of present evidence of ticagrelor for the treatment of SCHD. CONCLUSION: The findings of this study will provide evidence to appraise whether ticagrelor is effective for the treatment of patients with SCHD. OSF REGISTRATION NUMBER:: osf.io/fq69u.


Assuntos
Doença das Coronárias/tratamento farmacológico , Inibidores da Agregação de Plaquetas/uso terapêutico , Projetos de Pesquisa , Ticagrelor/uso terapêutico , Humanos , Revisões Sistemáticas como Assunto
13.
Wiad Lek ; 73(8): 1707-1711, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33055338

RESUMO

OBJECTIVE: The aim: To assess the metabolic by-products of nitric oxide in peripheral blood before and after the medicamentous management in patients suffering from community-acquired pneumonia associated with coronary heart disease. PATIENTS AND METHODS: Materials and methods: We have examined 102 patients with community-acquired pneumonia aged from 50 to 65 years, of which 58 patients were diagnosed with coronary heart disease (CHD). The complex treatment of patients with coronary heart disease was supplemented by the additional use of tivortin aspartate, which was taken orally with food at the dose of 5 ml (1g) 3 times a day for 15 days. The NO content in blood plasma was assessed by the concentration of the amount of final NO metabolites (NO3 + NO2), identified by means of the photocalorimetric method. RESULTS: Results: The content of (NO3 + NO2) in peripheral blood of patients with CAP was slightly higher (6.83 ± 0.29) µmol/l as compared to the group of apparently healthy individuals (5.19 ± 0.14) µmol/l, while in patients with CAP associated with CHD it has markedly increased to (12.74 ± 1.09) µmol/l. Against the background of administered treatment, the index of (NO3 + NO2) in patients with coronary heart disease has decreased to (5.76 ± 0.33) µmol/l, while in the group of patients who were not given tivortin aspartate additionally, this index has even slightly increased (7.01 ± 0.40) µmol/l. CONCLUSION: Conclusions: Marked increase of (NO3 + NO2) levels in blood pointed to destabilization of the course of coronary heart disease with CAP, which was eliminated by the involvement of tivortin aspartate (15 days) to the main course of treatment.


Assuntos
Infecções Comunitárias Adquiridas , Doença das Coronárias , Pneumonia , Idoso , Infecções Comunitárias Adquiridas/complicações , Infecções Comunitárias Adquiridas/tratamento farmacológico , Doença das Coronárias/complicações , Doença das Coronárias/tratamento farmacológico , Humanos , Pessoa de Meia-Idade , Óxido Nítrico , Nitritos , Pneumonia/complicações , Pneumonia/tratamento farmacológico
14.
Medicine (Baltimore) ; 99(36): e21991, 2020 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-32899044

RESUMO

OBJECTIVE: To assess the clinical efficacy and safety of Zhibitai, as a kind of natural lipid-lowering Chinese medicine, in treating coronary heart disease patients with hyperlipemia METHODS: : A systematic literature search for articles up to July 2020 will be performed in following electronic databases: PubMed, Embase, the Cochrane Library, China National Knowledge Infrastructure, Chinese Scientific Journals Database Database, Chinese Biomedical Database, Chinese Biomedical Literature Service System, and Wanfang Database. Inclusion criteria are randomized controlled trials of Zhibitai applied on coronary heart disease patients with hyperlipemia. The primary outcome measures will be serum lipid levels (including total cholesterol, triglyceride, low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol) and acute cardiovascular events. The secondary outcome measures will be inflammatory factors (high sensitive C-reactive protein, interleukin-6, etc), safety index (liver function, renal function, etc), and adverse events. RevMan 5.3 software will be used for data synthesis, sensitivity analysis, meta-regression, subgroup analysis, and risk of bias assessment. A funnel plot will be developed to evaluate reporting bias and Egger tests will be used to assess funnel plot symmetries. We will use the grading of recommendations assessment, development, and evaluation system to assess the quality of evidence.Trial registration number PROSPERO CRD42018103341.


Assuntos
Doença das Coronárias/tratamento farmacológico , Medicamentos de Ervas Chinesas/uso terapêutico , Hiperlipidemias/tratamento farmacológico , Doença das Coronárias/complicações , Humanos , Hiperlipidemias/complicações , Metanálise como Assunto , Fitoterapia , Revisões Sistemáticas como Assunto
15.
Am Heart J ; 228: 17-26, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32745732

RESUMO

BACKGROUND: Secondary preventive therapies play a key role in the prevention of adverse events after coronary artery bypass grafting (CABG). However, adherence to secondary preventive drugs after CABG is often poor. With the increasing penetration of smartphones, health-related smartphone applications might provide an opportunity to improve medication adherence. We aimed to evaluate the effectiveness and feasibility of using a smartphone-based application to improve medication adherence in patients after CABG. METHODS: The Measurement and Improvement Studies of Surgical coronary revascularizatION: medication adherence (MISSION-2) study is a multicenter randomized controlled trial that planned to enroll over 1000 patients who underwent isolated CABG at one of four large teaching hospitals in China; all enrolled participants had access to a smartphone and were able to operate at least three smartphone applications. The investigators randomly assigned the participants to one of two groups: (1) the intervention group with an advanced smartphone application for 6 months which was designed specifically for this trial and did not exist before. Participants could receive medication reminders and cardiac health education by the smartphone application or (2) the control group with usual care. The primary outcome was CABG secondary preventive medication adherence as measured by the translated Chinese version of the 8-item Morisky Medication Adherence Scale (MMAS-8) at 6 months after randomization. The secondary outcomes were mortality, major adverse cardiovascular and cerebrovascular events (MACCE), cardiovascular rehospitalization, self-reported secondary preventive medication use after 6 months of follow-up, blood pressure (BP), body mass index (BMI), and self-reported smoking status. All analyses were conducted using the intention-to-treat principle. RESULTS: A total of 1000 patients (mean age, 57.28 [SD, 9.09] years; 85.5% male) with coronary heart disease after CABG were enrolled between September 2015 and September 2016 and were randomly assigned to the intervention (n = 501) or control group (n = 499). At 6 months, the proportion of low-adherence participants, categorized by MMAS-8 scores, was 11.8% in the intervention group and 11.7% in the control group (RR = 1.005, 95% CI 0.682 to 1.480, P = 1.000). Similar results were found in sensitivity analyses that considered participants who withdrew from the study, or were lost to follow-up as nonadherent. There were no significant differences in the secondary clinical outcome measures, and there were no significant differences in the primary outcome across the subgroups tested. In the intervention group, the proportion of participants who used and operated the application during the first month after CABG was 88.1%; however, the use rate decreased sharply from 42.5% in the second month to 9.2% by the end of the study (6 months). CONCLUSIONS: A smartphone-based application supporting secondary prevention among patients after CABG did not lead to a greater adherence to secondary preventive medications. The limited room for improvement in medication adherence and the low participants' engagement with the smartphone applications might account for these non-significant outcomes.


Assuntos
Fármacos Cardiovasculares/uso terapêutico , Ponte de Artéria Coronária/efeitos adversos , Doença das Coronárias , Educação em Saúde/métodos , Adesão à Medicação/estatística & dados numéricos , Complicações Pós-Operatórias , Smartphone , Software , Ponte de Artéria Coronária/métodos , Doença das Coronárias/tratamento farmacológico , Doença das Coronárias/psicologia , Doença das Coronárias/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Sistemas de Alerta/instrumentação , Prevenção Secundária/métodos
16.
Medicine (Baltimore) ; 99(32): e21589, 2020 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-32769912

RESUMO

BACKGROUND: Coronary heart disease (CHD) is the leading cause of morbidity and mortality worldwide. Guipi Decoction (GPD) is a classical traditional Chinese medication used to treat CHD. However, systematic review and meta-analysis regarding its efficacy and safety has not been systematically evaluated. The objective of this protocol is to determine the efficacy and safety of GPD in the treatment of CHD. METHODS: Randomized controlled trials evaluating the effectiveness and safety of GPD in the treatment of CHD will be retrieved from 8 electronic databases, including PubMed, EMBASE, Cochrane Library, Web of science, China National Knowledge Infrastructure Database, VIP Database, Wanfang Database and China Biology Medicine Database. Study selection, data collection, risk of bias assessment, and evaluation of the quality of evidence will be performed in order. Data will be analyzed by RevMan V.5.3.5 software. RESULTS: This study will evaluate the efficacy and safety of GPD in the treatment of CHD. CONCLUSION: This systematic review will provide evidence for determining whether or not GPD is an effective and safe intervention for CHD. PROSPERO REGISTRATION NUMBER: PROSPERO CRD 42020156420.


Assuntos
Protocolos Clínicos , Doença das Coronárias/tratamento farmacológico , Medicamentos de Ervas Chinesas/uso terapêutico , Medicamentos de Ervas Chinesas/normas , Humanos , Metanálise como Assunto , Revisões Sistemáticas como Assunto , Resultado do Tratamento
17.
Lancet ; 395(10235): 1487-1495, 2020 05 09.
Artigo em Inglês | MEDLINE | ID: mdl-32386592

RESUMO

BACKGROUND: Antiplatelet therapy is recommended among patients with established atherosclerosis. We compared monotherapy with a P2Y12 inhibitor versus aspirin for secondary prevention. METHODS: In this systematic review and meta-analysis, all randomised trials comparing P2Y12 inhibitor with aspirin monotherapy for secondary prevention in patients with cerebrovascular, coronary, or peripheral artery disease were evaluated for inclusion. On Dec 18, 2019, we searched PubMed, Embase, BioMedCentral, Google Scholar, and the Cochrane Central Register of Controlled Trials. Additionally, we reviewed references from identified articles and searched abstracts from 2017 to 2019 presented at relevant scientific meetings. Data about year of publication, inclusion and exclusion criteria, sample size, baseline patients' features including the baseline condition determining study inclusion (ie, cerebrovascular, coronary, or peripheral artery disease), P2Y12 inhibitor type and dosage, aspirin dosage, endpoint definitions, effect estimates, follow-up duration, and percentage of patients lost to follow-up were collected. Odds ratios (ORs) and 95% CIs were used as metric of choice for treatment effects with random-effects models. Co-primary endpoints were myocardial infarction and stroke. Key secondary endpoints were all-cause death and vascular death. Heterogeneity was assessed with the I2 index. This study is registered with PROSPERO (CRD42018115037). FINDINGS: A total of nine randomised trials were identified and included in this study, and 42 108 patients randomly allocated to a P2Y12 inhibitor (n=21 043) or aspirin (n=21 065) were included in our analyses. Patients who received a P2Y12 inhibitor had a borderline reduction for the risk of myocardial infarction compared with those who received aspirin (OR 0·81 [95% CI 0·66-0·99]; I2=10·9%). Risks of stroke (OR 0·93 [0·82-1·06]; I2=34·5%), all-cause death (OR 0·98 [0·89-1·08]; I2=0%), and vascular death (OR 0·97 [0·86-1·09]; I2=0%) did not differ between patients who received a P2Y12 inhibitor and those who received aspirin. Similarly, the risk of major bleeding (OR 0·90 [0·74-1·10]; I2=3·9%) did not differ between patients who received a P2Y12 inhibitor and those who received aspirin. The number needed to treat to prevent one myocardial infarction with P2Y12 inhibitor monotherapy was 244 patients. Findings were consistent regardless of the type of P2Y12 inhibitor used. INTERPRETATION: Compared with aspirin monotherapy, P2Y12 inhibitor monotherapy is associated with a risk reduction for myocardial infarction and a comparable risk of stroke in the setting of secondary prevention. The benefit of P2Y12 inhibitor monotherapy is of debatable clinical relevance, in view of the high number needed to treat to prevent a myocardial infarction and the absence of any effect on all-cause and vascular mortality. FUNDING: Italian Ministry of Education.


Assuntos
Aspirina/uso terapêutico , Aterosclerose/tratamento farmacológico , Clopidogrel/uso terapêutico , Inibidores da Agregação de Plaquetas/uso terapêutico , Antagonistas do Receptor Purinérgico P2Y/uso terapêutico , Ticagrelor/uso terapêutico , Ticlopidina/uso terapêutico , Idoso , Aterosclerose/complicações , Transtornos Cerebrovasculares/tratamento farmacológico , Doença das Coronárias/tratamento farmacológico , Feminino , Hemorragia/induzido quimicamente , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/prevenção & controle , Doença Arterial Periférica/tratamento farmacológico , Ensaios Clínicos Controlados Aleatórios como Assunto , Medição de Risco , Prevenção Secundária/métodos , Acidente Vascular Cerebral/prevenção & controle
18.
Am J Ophthalmol ; 218: 54-58, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32413410

RESUMO

PURPOSE: To determine whether an association exists between dry eye disease (DED) and statin use and/or dyslipidemia. DESIGN: Retrospective, case-control study. METHODS: Setting: University of North Carolina (UNC)-affiliated healthcare facilities. STUDY POPULATION: 72,931 patients seen at UNC ophthalmology clinics over a 10-year period. MAIN OUTCOME MEASURES: Odds ratios (ORs) calculated between DED and a history of low, moderate, or high-intensity statin use; and ORs calculated between DED and abnormal lipid panel values. RESULTS: Total of 39,336 individuals (53.9% female) were analyzed after exclusion of individuals with confounding risk factors for DED. Of these, 3,399 patients (8.6%) carried a diagnosis of DED. Low-, moderate-, and high-intensity statin regimens were used by 751 subjects (1.9%), 2,655 subjects (6.8%), and 1,036 subjects (2.6%). Lipid abnormalities were identified as total cholesterol >200 mg/dL, 4,558 subjects (11.6%); high-density lipoprotein (HDL) <40 mg/dL, 2,078 subjects (5.3%); low-density lipoprotein (LDL) >130 mg/dL, 2,756 subjects (7.0%); and triglycerides (TGs) >150 mg/dL, 2,881 subjects (7.3%). The odds ratios (OR) of carrying a diagnosis of DED given the presence of low-, moderate-, and high-intensity statin use were 1.39 (95% confidence interval [CI]: 1.13-1.72); OR 1.47 (95% CI: 1.30-1.65), and OR 1.46 (95% CI: 1.21-1.75), respectively. The OR of carrying a diagnosis of DED given the presence of total cholesterol >200 mg/dL, HDL <40 mg/dL, LDL >130 mg/dL, and TGs >150 mg/dL were 1.66 (95% CI: 1.52-1.82), 1.45 (95% CI: 1.26-1.67), 1.55 (95% CI: 1.39-1.74), and 1.43 (95% CI: 1.27-1.61), respectively. CONCLUSIONS: A history of statin use or dyslipidemia is associated with an increased odds of having a DED diagnosis. Further studies are needed to determine whether statin use and/or dyslipidemia increases the risk of DED.


Assuntos
Síndromes do Olho Seco/diagnóstico , Dislipidemias/tratamento farmacológico , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Adolescente , Adulto , Idoso , Estudos de Casos e Controles , Colesterol/sangue , HDL-Colesterol/sangue , LDL-Colesterol/sangue , Doença das Coronárias/sangue , Doença das Coronárias/tratamento farmacológico , Síndromes do Olho Seco/sangue , Síndromes do Olho Seco/fisiopatologia , Dislipidemias/sangue , Dislipidemias/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Estudos Retrospectivos , Medição de Risco , Triglicerídeos/sangue , Adulto Jovem
19.
Orv Hetil ; 161(16): 611-622, 2020 04 01.
Artigo em Húngaro | MEDLINE | ID: mdl-32323965

RESUMO

Introduction: Trimetazidine is a metabolic agent of proven efficacy in the management of chronic coronary syndromes. According to guidelines, trimetazidine should be considered as a second-line treatment to reduce angina frequency and improve exercise tolerance in subjects whose symptoms are not adequately controlled by beta-blockers, calcium channel blockers and/or long-acting nitrates. Aim: This meta-analysis aimed to evaluate the efficacy of different doses (3 × 20 mg, 2 × 35 mg, 1 × 80 mg) of trimetazidine formulations in stable angina pectoris. Primary outcomes consisted of clinical parameters: numbers of weekly angina attacks and nitroglycerin usage. Method: Articles were collected from PubMed, Cochrane Library and Cochrane Central Register of Controlled Trials databases for the period from 1967 to 30 September 2019. Statistical analysis was performed by standard meta-analysis methods. Results: A total of 31 randomized controlled and observational trials, consisting of 9856 participants (mean age: 59.6 years, men: 61.6%) were included. Trimetazidine treatment, compared to placebo, reduced the number of weekly angina attacks (mean difference: ­1.84, 95% CI: ­2.39 to ­1.30; p<0.0001) and reduced weekly nitroglycerin consumption (­1.65, 95% CI: ­2.17 to ­1.14; p<0.0001) in randomized trials. Trimetazidine treatment reduced the number of weekly angina attacks (­3.73, 95% CI: ­4.53 to ­2.92; p<0.0001) and nitroglycerin consumption (­3.23, 95% CI: ­4.23 to ­2.24; p<0.0001) in observational studies. No difference in angina reduction and nitroglycerin intake was observed between the three treatment doses (p = 0.57 and p = 0.48, respectively). Further results: the two primary variables decreased from visit to visit, higher enrollment angina rates and lower doses of trimetazidine were observed in shorter studies. Patients in shorter trials were younger than subjects in the longer ones. In shorter studies, the initial needs for nitroglycerin consumption and the following reduction were greater than those with longer duration. Conclusions: Regardless of dosage, trimetazidine has a favorable clinical effect in stable angina. New finding is that younger patients with more severe conditions show the most clinical benefit from treatment with trimetazidine. Orv Hetil. 2020; 161(16): 611­622.


Assuntos
Angina Estável/tratamento farmacológico , Doença das Coronárias/tratamento farmacológico , Trimetazidina/uso terapêutico , Angina Estável/complicações , Doença Crônica , Doença das Coronárias/complicações , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
20.
Medicine (Baltimore) ; 99(14): e19672, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32243401

RESUMO

BACKGROUND: Coronary heart disease (CHD) has become the primary cause of heart failure (HF). Wenyang Huoxue method can significantly improve cardiac function in patients with CHD complicated with HF, but it has not been systematically evaluated for efficacy and safety. METHODS: We will search China National Knowledge Infrastructure Database, Wanfang database, China Biomedical Literature Database, China Science Journal Database PubMed, Excerpt Medica Database, and Cochrane library. Clinical trial registrations, potential grey literature, related conference abstracts, and reference lists of identified studies will also be retrieved. The electronic database will be searched for literatures published from January 2000 to September 2019. Based on the heterogeneity test, data integration is performed using a fixed effect model or a random effects model. Changes in total effective rate in cardiac function will be assessed as primary outcome. 6-minute walk test, left ventricular ejection fraction, and plasma brain natriuretic peptide will be assessed as secondary outcomes. RevMan 5.3.5 will be used for meta-analysis. RESULTS: This study will provide a high-quality comprehensive evaluation of the efficacy and safety of Wenyang Huoxue method for treating patients with CHD complicated with HF. CONCLUSIONS: This systematic review will determine whether Wenyang Huoxue method provides evidence for effective intervention in patients with CHD complicated with HF. ETHICS AND DISSEMINATION: This systematic review and meta-analysis of randomized controlled trials does not require ethical recognition, and the results of this paper will be published in an open access, internationally influential academic journal. TRIAL REGISTRATION NUMBER: CRD42016025957.


Assuntos
Fenômenos Fisiológicos Cardiovasculares/efeitos dos fármacos , Doença das Coronárias/tratamento farmacológico , Medicamentos de Ervas Chinesas/farmacologia , Insuficiência Cardíaca/tratamento farmacológico , Doença das Coronárias/complicações , Doença das Coronárias/fisiopatologia , Insuficiência Cardíaca/etiologia , Insuficiência Cardíaca/fisiopatologia , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Projetos de Pesquisa , Revisões Sistemáticas como Assunto , Resultado do Tratamento
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...