Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 5.484
Filtrar
2.
Expert Opin Drug Saf ; 19(1): 59-67, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31795777

RESUMO

Introduction: The objective of this study was to review the current status of drug-induced hypomagnesemia and its adverse effects on cardiovascular disease (CVD) and hypertension. Since magnesium is a potent vasodilator, which modulates vasomotor tone, peripheral blood flow, and hypertension, its deficiency could have significant cardiovascular and blood pressure (BP) effects.Areas covered: Studies have shown that several factors can contribute to magnesium deficiency including age, diet, disease, and certain drugs such as diuretics and proton-pump inhibitors (PPIs). For an updated perspective of drug-induced hypomagnesemia, a Medline search of the English language literature was conducted between 2010 and 2019 using the terms diuretics, proton-pump inhibitors, hypomagnesemia, cardiovascular disease, hypertension, and 35 pertinent papers were retrieved.Expert opinion: The data showed that magnesium deficiency is difficult to occur since it is plentiful in green leafy vegetables, cereals, nuts, and the drinking water. However, magnesium deficiency can occur with the use of diuretics for the treatment of hypertension and heart failure, or the use of PPIs for the treatment of gastroesophageal reflux disease. Therefore, magnesium deficiency should be detected and treated to prevent the aggravation of hypertension and the onset of CVD and serious cardiac arrhythmias including torsades de points.


Assuntos
Diuréticos/efeitos adversos , Deficiência de Magnésio/induzido quimicamente , Inibidores da Bomba de Prótons/efeitos adversos , Animais , Arritmias Cardíacas/induzido quimicamente , Pressão Sanguínea/efeitos dos fármacos , Doenças Cardiovasculares/induzido quimicamente , Doenças Cardiovasculares/fisiopatologia , Diuréticos/administração & dosagem , Humanos , Hipertensão/etiologia , Deficiência de Magnésio/complicações , Deficiência de Magnésio/diagnóstico , Inibidores da Bomba de Prótons/administração & dosagem
3.
J Opioid Manag ; 15(5): 367-374, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31849028

RESUMO

OBJECTIVE: This study describes changes in weight and cardiovascular risk factors over time among individuals enrolled in methadone maintenance treatment for opioid use disorder. Demographic and clinical predictors of weight gain were also evaluated. DESIGN: This study was a retrospective chart review evaluating data over a period of 3 years. SETTING: Medical records of individuals enrolled in an academic research outpatient methadone maintenance treatment program were reviewed. PATIENTS: Seventy-four individuals who were admitted and retained in methadone maintenance treatment for at least 3 consecutive years were included. OUTCOME MEASURES: Annual weight was assessed by calculating body mass index (BMI). Changes over time in cardiovascular risk factors of hypertension, diabetes, and hypercholesterolemia were also assessed. RESULTS: The percentage of patients categorized as overweight, obese, or morbidly obese BMI increased from 42 percent (n = 31) at admission to 76 percent (n = 56), 82 percent (n = 61), and 88 percent (n = 65) at 1, 2, and 3 years post-admission, respectively. Hypertension, diabetes, and hypercholesterolemia also tended to increase following admission. BMI increases tended to be greater for those with a higher dose of methadone, as well as for females and Black/African American individuals. No other predictors of weight gain were identified. CONCLUSIONS: These data indicate that methadone maintenance treatment is associated with clinically meaningful weight gain and increases in cardiovascular risk factors. Given the importance of methadone maintenance for treatment of opioid use disorder, future research should examine additional predictors and potential mechanisms of weight gain among methadone patients and develop tailored interventions including nutritional knowledge and lifestyle recommendations.


Assuntos
Índice de Massa Corporal , Doenças Cardiovasculares , Metadona/efeitos adversos , Obesidade Mórbida , Analgésicos Opioides , Doenças Cardiovasculares/induzido quimicamente , Feminino , Humanos , Masculino , Obesidade Mórbida/induzido quimicamente , Estudos Retrospectivos , Fatores de Risco
4.
Lancet ; 394(10209): 1652-1667, 2019 11 02.
Artigo em Inglês | MEDLINE | ID: mdl-31668409

RESUMO

We did a global review to synthesise data on the prevalence, harms, and interventions for stimulant use, focusing specifically on the use of cocaine and amphetamines. Modelling estimated the effect of cocaine and amphetamine use on mortality, suicidality, and blood borne virus incidence. The estimated global prevalence of cocaine use was 0·4% and amphetamine use was 0·7%, with dependence affecting 16% of people who used cocaine and 11% of those who used amphetamine. Stimulant use was associated with elevated mortality, increased incidence of HIV and hepatitis C infection, poor mental health (suicidality, psychosis, depression, and violence), and increased risk of cardiovascular events. No effective pharmacotherapies are available that reduce stimulant use, and the available psychosocial interventions (except for contingency management) had a weak overall effect. Generic approaches can address mental health and blood borne virus infection risk if better tailored to mitigate the harms associated with stimulant use. Substantial and sustained investment is needed to develop more effective interventions to reduce stimulant use.


Assuntos
Anfetaminas/efeitos adversos , Transtornos Relacionados ao Uso de Cocaína/mortalidade , Cocaína/efeitos adversos , Adolescente , Adulto , Anfetaminas/uso terapêutico , Doenças Cardiovasculares/induzido quimicamente , Doenças Cardiovasculares/mortalidade , Estimulantes do Sistema Nervoso Central/uso terapêutico , Transtornos Relacionados ao Uso de Cocaína/epidemiologia , Transtornos Relacionados ao Uso de Cocaína/prevenção & controle , Inibidores da Captação de Dopamina/efeitos adversos , Feminino , Infecções por HIV/induzido quimicamente , Infecções por HIV/mortalidade , Hepatite C/induzido quimicamente , Hepatite C/mortalidade , Humanos , Incidência , Masculino , Transtornos Mentais/induzido quimicamente , Transtornos Mentais/mortalidade , Pessoa de Meia-Idade , Prevalência , Viroses/sangue , Viroses/induzido quimicamente , Viroses/mortalidade , Adulto Jovem
5.
Methodist Debakey Cardiovasc J ; 15(3): 214-219, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31687101

RESUMO

Proton pump inhibitors (PPIs) are effective agents for the treatment of gastroesophageal reflux (GERD). However, these drugs have not been approved for long-term use. Now sold over the counter, these agents are being used chronically for GERD without medical supervision. The long-term use of PPIs may have significant adverse effects, in part mediated by their effect of accelerating vascular aging. Physicians should assist patients in tapering off their use of PPIs and replacing them with lifestyle modifications and/or other agents that have better long-term safety profiles.


Assuntos
Doenças Cardiovasculares/induzido quimicamente , Refluxo Gastroesofágico/tratamento farmacológico , Inibidores da Bomba de Prótons/efeitos adversos , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/epidemiologia , Esquema de Medicação , Refluxo Gastroesofágico/diagnóstico , Refluxo Gastroesofágico/epidemiologia , Humanos , Prognóstico , Inibidores da Bomba de Prótons/administração & dosagem , Medição de Risco , Fatores de Risco , Fatores de Tempo
6.
Presse Med ; 48(11 Pt 1): 1295-1300, 2019 Nov.
Artigo em Francês | MEDLINE | ID: mdl-31735524

RESUMO

Can menopausal hormone therapy (HT) be used in hypertensive women? The group of experts of the French Society of Hypertension has carried out a review of the recent literature in order to answer this question, based on the most recent scientific publications. If use of oral HT is associated with a discreet increase in blood pressure, the transdermal route seems to be safer. The first results of major randomized trials of HT had alerted to an increase in cardiovascular events and breast cancer with the use of oral HT, generally, tipping the benefit-risk balance of the deleterious side. Complementary analyzes have shown the importance of the window of intervention (less than 10 years after the menopause) and the age of the woman to start the HT. On the contrary, they have shown a significant decrease of the coronary events. For woman suffering from hypertension and important climacteric symptoms, it is important to evaluate the whole cardiovascular risk in order to decide the possibility of prescribing a HT. Thus, the group of experts proposes a prescription assistance algorithm based on the stratification of cardiovascular risk, always favoring, when it is authorized, HT by transdermal route of administration.


Assuntos
Neoplasias da Mama/induzido quimicamente , Doenças Cardiovasculares/induzido quimicamente , Terapia de Reposição de Estrogênios/métodos , Hipertensão , Menopausa , Administração Cutânea , Administração Oral , Fatores Etários , Algoritmos , Pressão Sanguínea/efeitos dos fármacos , Contraindicações de Medicamentos , Terapia de Reposição de Estrogênios/efeitos adversos , Feminino , Humanos , Pessoa de Meia-Idade , Ensaios Clínicos Controlados Aleatórios como Assunto , Medição de Risco , Fatores de Risco , Fatores de Tempo
8.
Toxicol Lett ; 317: 13-23, 2019 Dec 15.
Artigo em Inglês | MEDLINE | ID: mdl-31562912

RESUMO

Combination antiretroviral therapy (cART) has been hugely successful in reducing the mortality associated with human immunodeficiency virus (HIV) infection, resulting in a growing population of people living with HIV (PLWH). Since PLWH now have a longer life expectancy, chronic comorbidities have become the focus of the clinical management of HIV. For example, cardiovascular complications are now one of the most prevalent causes of death in PLWH. Numerous epidemiological studies show that antiretroviral treatment increases cardiovascular disease (CVD) risk and early onset of CVD in PLWH. Nucleoside reverse transcriptase inhibitors (NRTIs) are the backbone of cART, and two NRTIs are typically used in combination with one drug from another drug class, e.g., a fusion inhibitor. NRTIs are known to induce mitochondrial dysfunction, contributing to toxicity in numerous tissues, such as myopathy, lipoatrophy, neuropathy, and nephropathy. In in vitro studies, short-term NRTI treatment induces an endothelial dysfunction with an increased reactive oxygen species (ROS) production; long-term NRTI treatment decreases cell replication capacity, while increasing mtROS production and senescent cell accumulation. These findings suggest that a mitochondrial oxidative stress is involved in the pathogenesis of NRTI-induced endothelial dysfunction and premature senescence. Mitochondrial dysfunction, defined by a compromised mitochondrial quality control via biogenesis and mitophagy, has a causal role in premature endothelial senescence and can potentially initiate early cardiovascular disease (CVD) development in PLWH. In this review, we explore the hypothesis and present literature supporting that long-term NRTI treatment induces vascular dysfunction by interfering with endothelial mitochondrial homeostasis and provoking mitochondrial genomic instability, resulting in premature endothelial senescence.


Assuntos
Fármacos Anti-HIV/efeitos adversos , Doenças Cardiovasculares/induzido quimicamente , Senescência Celular/efeitos dos fármacos , Células Endoteliais/efeitos dos fármacos , Infecções por HIV/tratamento farmacológico , Mitocôndrias/efeitos dos fármacos , Animais , Fármacos Anti-HIV/administração & dosagem , Doenças Cardiovasculares/metabolismo , Doenças Cardiovasculares/patologia , Esquema de Medicação , Células Endoteliais/metabolismo , Células Endoteliais/patologia , Metabolismo Energético/efeitos dos fármacos , Infecções por HIV/metabolismo , Infecções por HIV/patologia , Humanos , Mitocôndrias/metabolismo , Mitocôndrias/patologia , Medição de Risco , Transdução de Sinais/efeitos dos fármacos , Fatores de Tempo
9.
Psychiatr Danub ; 31(Suppl 3): 585-590, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31488795

RESUMO

Ketamine is an anaesthetic and analgesic agent that demonstrates the antidepressive effect in major depression. Several administrations routes, dosing schemas and esketamine are investigated in basic and clinical research with particular focus on treatment-resistant depression (TRD) where drug demonstrates its efficacy where very limited alternatives are available. The majority of ketamine studies in TRD treatment reported no serious adverse events regardless the administration route or regimen. However, the most commonly observed adverse events following ketamine administration in antidepressive doses include general, psychotomimetic, dissociative and hemodynamic ones. The side effects are mild or moderate, well-tolerated and transient. This paper discusses the risks regarding cardiovascular safety in MDD patients in short-term ketamine administration with particular focus on the effect on blood pressure and adverse drug reactions mitigation measures. The increase in systolic (SBP) and diastolic (DBP) blood pressure is dose-dependent and begins shortly after administration peaking at around 30 to 50 minutes with SBP and DBP rise from 10% to 50% above predose values and resolving at approximately 2 to 4 hours after the dose administration. These changes generally are primarily asymptomatic. The elevations in SBP and DBP are observed on each dosing day with multiple administration schema. The treatment with ketamine and esketamine is contradicted in subjects at risk of an increase in blood pressure or intracranial pressure. The current evidence indicates the blood pressure should be assessed prior to dosing with ketamine and hypertensive individuals shall receive effective lifestyle/pharmacologic management prior to treatment. Blood pressure should be monitored after dose administration until blood pressure returns to acceptable levels. If blood pressure remains elevated acute blood pressure management shall be delivered. In patients experiencing symptoms of hypertensive crisis immediate emergency care must be provided. The unmet need for improved pharmacotherapies for TRD means the use of ketamine and esketamine is warranted therapeutic option in patients who fail to achieve a sustained remission of depressive symptoms with drugs with monoamine-based mechanisms of action. Adequate safety measures must be applied when using ketamine/esketamine in TRD subjects with particular focus on somatic comorbidities as the transient drug effect on cardiovascular system is demonstrated and of clinical significance.


Assuntos
Doenças Cardiovasculares/prevenção & controle , Sistema Cardiovascular/efeitos dos fármacos , Transtorno Depressivo Resistente a Tratamento/tratamento farmacológico , Ketamina/administração & dosagem , Ketamina/uso terapêutico , Antidepressivos/administração & dosagem , Antidepressivos/uso terapêutico , Doenças Cardiovasculares/induzido quimicamente , Depressão/tratamento farmacológico , Humanos , Ketamina/efeitos adversos
10.
Int J Mol Sci ; 20(17)2019 Aug 30.
Artigo em Inglês | MEDLINE | ID: mdl-31480335

RESUMO

Cyclo-oxygenase (COX) inhibitors are among the most commonly used drugs in the western world for their anti-inflammatory and analgesic effects. However, they are also well-known to increase the risk of coronary events. This area is of renewed significance given alarming new evidence suggesting this effect can occur even with acute usage. This contrasts with the well-established usage of aspirin as a mainstay for cardiovascular prophylaxis, as well as overwhelming evidence that COX inhibition induces vasodilation and is protective for vascular function. Here, we present an updated review of the preclinical and clinical literature regarding the cardiotoxicity of COX inhibitors. While studies to date have focussed on the role of COX in influencing renal and vascular function, we suggest an interaction between prostanoids and T cells may be a novel factor, mediating elevated cardiovascular disease risk with NSAID use.


Assuntos
Anti-Inflamatórios não Esteroides/efeitos adversos , Doenças Cardiovasculares/induzido quimicamente , Inibidores de Ciclo-Oxigenase/efeitos adversos , Animais , Doenças Cardiovasculares/imunologia , Doenças Cardiovasculares/fisiopatologia , Humanos , Prostaglandinas/metabolismo , Fatores de Risco , Linfócitos T/efeitos dos fármacos
11.
Vasc Health Risk Manag ; 15: 159-174, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31417268

RESUMO

While tobacco cigarette (TC) smoking has continued to drop to all-time lows, the use of electronic cigarettes (ECs), introduced in the US in 2007, has been rising dramatically, especially among youth. In EC emissions, nicotine is the major biologically active element, while levels of carcinogens and harmful combustion products that typify TC smoke are very low or even undetectable. TCs cause cardiovascular harm by activation of inflammatory pathways and oxidative damage, leading to atherogenesis and thrombosis, as well as through sympathetic activation triggering ischemia and arrhythmia. While ECs are generally believed to be safer than TCs, there remain many uncertainties regarding the overall cardiovascular health effects of EC usage. In this review, we discuss the various components of EC smoke and review the potential mechanisms of cardiovascular injury caused by EC use. We also discuss the controversy regarding the increasing epidemic of youth EC use weighed against the use of ECs as a smoking-cessation aid.


Assuntos
Doenças Cardiovasculares/induzido quimicamente , Sistemas Eletrônicos de Liberação de Nicotina , Nicotina/administração & dosagem , Agonistas Nicotínicos/administração & dosagem , Abandono do Hábito de Fumar/métodos , Fumar/efeitos adversos , Vaping , Administração por Inalação , Fatores Etários , Animais , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/epidemiologia , Humanos , Nicotina/efeitos adversos , Agonistas Nicotínicos/efeitos adversos , Medição de Risco , Fatores de Risco , Fumar/epidemiologia , Resultado do Tratamento , Vaping/efeitos adversos
13.
Res Nurs Health ; 42(5): 324-333, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31389621

RESUMO

Androgen deprivation therapy (ADT) is a treatment used across the prostate cancer disease spectrum and works by suppressing testicular androgen production to castrate levels. Although ADT can provide survival benefits, it is also associated with increased risk for cardiovascular disease, metabolic syndrome, increased visceral fat mass, dyslipidemia, decreased arterial compliance, and diminished health-related quality of life. The Staying Strong And Healthy protocol is a telephone-delivered intervention led by a nurse coordinator to minimize the increased cardiovascular and metabolic risks associated with ADT. This study will evaluate the feasibility of the protocol and provides the foundation for future behavioral interventions across diverse populations of men on ADT.


Assuntos
Antagonistas de Androgênios/efeitos adversos , Antagonistas de Androgênios/uso terapêutico , Doenças Cardiovasculares/induzido quimicamente , Doenças Cardiovasculares/prevenção & controle , Neoplasias da Próstata/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Terapia Comportamental/métodos , Terapia por Exercício/métodos , Estudos de Viabilidade , Estilo de Vida Saudável , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Qualidade de Vida , Telemedicina/métodos , Estados Unidos
15.
Artigo em Inglês | MEDLINE | ID: mdl-31323774

RESUMO

Approximately 2150 adults die every day in the U.S. from Cardiovascular Diseases (CVD) and another 115 deaths are attributed to opioid-related causes. Studies have found conflicting results on the relationship between opioid therapy and the development of cardiovascular diseases. This study examined whether an association exists between the use of prescription opioid medicines and cardiovascular diseases, using secondary data from the National Hospital Ambulatory Medical Care Survey (NAMCS) 2015 survey. Of the 1829 patients, 1147 (63%) were male, 1762 (98%) above 45 years of age, and 54% were overweight. The rate of cardiovascular diseases was higher among women [(p < 0.001), 95% CI: 0.40-0.51]. The covariates were age, race/ethnicity, sex, diabetes mellitus, hyperlipidemia, and hypertension; and were adjusted. Diabetes mellitus, hyperlipidemia, and hypertension were significant predictors of CVD [(p < 0.001, 95% CI: 0.57-0.78); (p < 0.001, 95% CI: 0.34-0.44); (p < 0.001, 95% CI: 0.49-0.59)]. There was no significant association between prescription opioid medication use and coronary artery disease [first opioid group p = 0.34, Prevalence Odds Ratio (POR): 1.39, 95% CI: 0.71-2.75; second opioid group: p = 0.59, POR: 1.20, 95% CI: 0.61-2.37, and third opioid group: p = 0.62, POR: 0.85, 95% CI: 0.45-1.6]. The results of this study further accentuate the conflicting results in literature. Further research is recommended, with a focus on those geographical areas where high prevalence of cardiovascular diseases exists.


Assuntos
Analgésicos Opioides/efeitos adversos , Doenças Cardiovasculares/induzido quimicamente , Adolescente , Adulto , Idoso , Doenças Cardiovasculares/epidemiologia , Comorbidade , Doença da Artéria Coronariana/induzido quimicamente , Doença da Artéria Coronariana/epidemiologia , Estudos Transversais , Diabetes Mellitus/epidemiologia , Feminino , Humanos , Hiperlipidemias/complicações , Hiperlipidemias/epidemiologia , Hipertensão/induzido quimicamente , Hipertensão/epidemiologia , Masculino , Pessoa de Meia-Idade , Razão de Chances , Prevalência , Fatores de Risco , Estados Unidos/epidemiologia , Adulto Jovem
16.
Kardiologiia ; 59(7): 76-83, 2019 Jul 19.
Artigo em Russo | MEDLINE | ID: mdl-31322093

RESUMO

In 2008 the Food and Drug Administration has revised approval process for new antidiabetic agents and introduced a requirement to demonstrate the cardiovascular safety in an international multicenter trial. Currently cardiovascular outcome trials of dipeptidyl peptidase-4 (DPP-4) inhibitors (SAVOR-TIMI53, EXAMINE and TECOS), sodium-glucose cotransporter 2 inhibitors (EMPAREG, CANVAS), glucagon-like peptide-1 receptor agonists (ELIXA, EXSCEL LEADER and SUSTAIN-6), ultralong-acting and insulin (DEVOTE) have been completed. The trials confirmed cardiovascular safety of these glucose-lowering medications, and in addition, EMPA-REG OUTCOME (empagliflozin), CANVAS (canagliflozin) and LEADER (liraglutide) have also demonstrated cardioprotective effect of sodium-glucose cotransporter 2 inhibitors and glucagon-like peptide-1 receptor agonists. These data led to the changes of clinical guidelines for the management of type 2 diabetes.


Assuntos
Doenças Cardiovasculares , Diabetes Mellitus Tipo 2 , Hipoglicemiantes/efeitos adversos , Cardiotoxicidade , Doenças Cardiovasculares/induzido quimicamente , Glucose , Humanos , Inibidores do Transportador 2 de Sódio-Glicose
17.
Cardiol Young ; 29(6): 808-812, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31280730

RESUMO

BACKGROUND: Cardiovascular disease is a leading cause of morbidity and mortality in childhood cancer survivors. Cardiologists must be aware of risk factors and long-term follow-up guidelines, which have historically been the purview of oncologists. Little is known about paediatric cardiologists' knowledge regarding the cardiotoxicity of cancer treatment and how to improve this knowledge. METHODS: A total of 58 paediatric cardiologists anonymously completed a 21-question, web-based survey focused on four cardio-oncology themes: cancer treatment-related risk factors (n = 6), patient-related risk factors (n = 6), recommended surveillance (n = 3), and cardiac-specific considerations (n = 6). Following the baseline survey, a multi-disciplinary team of paediatric cardiologists and cancer survivor providers developed an in-person and web-based educational intervention. A post-intervention survey was conducted 5 months later. RESULTS: The response rate was 41/58 (70.7%) pre-intervention and 30/58 (51.7%) post-intervention. On the baseline survey, the percentage of correct answers was 68.8 ± 10.3%, which improved to 79.2 ± 16.2% after the intervention (p = 0.009). The theme with the most profound knowledge deficit was surveillance; however, it also had the greatest improvement after the intervention (49.6 ± 26.7 versus 66.7 ± 27.7% correct, p = 0.025). Individual questions with the largest per cent improvement pertained to risk of cardiac dysfunction with time since treatment (52.4 versus 93.1%, p = 0.002) and the role of dexrazoxane (48.8 versus 82.8%, p = 0.020). CONCLUSION: Specific knowledge deficits about the care of paediatric cancer survivors were identified amongst cardiologists using a web-based survey. Knowledge of surveillance was initially lowest but improved the most after an educational intervention. This highlights the need for cardio-oncology-based educational initiatives among paediatric cardiologists.


Assuntos
Antineoplásicos/efeitos adversos , Atitude do Pessoal de Saúde , Sobreviventes de Câncer , Cardiologistas/normas , Doenças Cardiovasculares/psicologia , Conhecimentos, Atitudes e Prática em Saúde , Neoplasias/tratamento farmacológico , Antineoplásicos/uso terapêutico , Cardiologistas/educação , Doenças Cardiovasculares/induzido quimicamente , Doenças Cardiovasculares/epidemiologia , Criança , Seguimentos , Humanos , Incidência , Neoplasias/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida/tendências , Fatores de Tempo , Estados Unidos/epidemiologia
18.
Environ Pollut ; 252(Pt B): 1412-1422, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31260941

RESUMO

Concerning PM2.5 concentrations, rapid industrialization, along with increase in cardiovascular disease (CVD) were recorded in Pakistan, especially in urban areas. The degree to which air pollution contributes to the increase in the burden of CVD in Pakistan has not been assessed due to lack of data. This study aims to describe the characteristics of PM2.5 constituents and investigate the impact of individual PM2.5 constituent on cardiovascular morbidity in Karachi, a mega city in Pakistan. Daily levels of twenty-one constituents of PM2.5 were analyzed using samples collected at two sites from fall 2008 to summer 2009 in Karachi. Hospital admission and emergency room visits due to CVD were collected from two large hospitals. Negative Binominal Regression was used to estimate associations between pollutants and the risk of CVD. All PM2.5 constituents were assessed in single-pollutant models and selected constituents were assessed in multi-pollutant models adjusting for PM2.5 mass and gaseous pollutants. The most common CVD subtypes among our participants were ischemic heart disease, hypertension, heart failure, and cardiomyopathy. Extremely high levels of PM2.5 constituents from fossil-fuels combustion and industrial emissions were observed, with notable peaks in winter. The most consistent associations were found between exposure to nickel (5-14% increase per interquartile range) and cardiovascular hospital admissions. Suggestive evidence was also observed for associations between cardiovascular hospital admissions and Al, Fe, Ti, and nitrate. Our findings suggested that PM2.5 generated from fossil-fuels combustion and road dust resuspension were associated with the increased risk of CVD in Pakistan.


Assuntos
Poluentes Atmosféricos/análise , Poluição do Ar/análise , Doenças Cardiovasculares/induzido quimicamente , Doenças Cardiovasculares/epidemiologia , Material Particulado/análise , Adulto , Cardiomiopatias/epidemiologia , Cidades/epidemiologia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Insuficiência Cardíaca/epidemiologia , Hospitalização/estatística & dados numéricos , Humanos , Hipertensão/epidemiologia , Indústrias/estatística & dados numéricos , Isquemia Miocárdica/epidemiologia , Níquel/toxicidade , Paquistão/epidemiologia , Estações do Ano
19.
Artigo em Inglês | MEDLINE | ID: mdl-31261612

RESUMO

Exposure to ambient NO2 and benzene, toluene ethyl-benzene and m+p- and o-xylenes (BTEX) is associated with adverse cardiovascular effects, but limited information is available on the effects of personal exposure to these compounds in South African populations. This 6-month follow-up study aims to determine 7-day personal ambient NO2 and BTEX exposure levels via compact passive diffusion samplers in female participants from Cape Town, and investigate whether exposure levels are associated with cardiovascular risk markers. Overall, the measured air pollutant exposure levels were lower compared to international standards. NO2 was positively associated with systolic and diastolic blood pressure (SBP and DBP), and inversely associated with the central retinal venular equivalent (CRVE) and mean baseline brachial artery diameter. o-xylene was associated with DBP and benzene was strongly associated with carotid intima media thickness (cIMT). Our findings showed that personal air pollution exposure, even at relatively low levels, was associated with several markers of cardiovascular risk in women residing in the Cape Town region.


Assuntos
Doenças Cardiovasculares/induzido quimicamente , Exposição Ambiental , Dióxido de Nitrogênio/toxicidade , Compostos Orgânicos Voláteis/toxicidade , Adulto , Poluentes Atmosféricos/análise , Doenças Cardiovasculares/epidemiologia , Feminino , Seguimentos , Humanos , Fatores de Risco , África do Sul/epidemiologia , Compostos Orgânicos Voláteis/análise
20.
Inflammopharmacology ; 27(5): 903-910, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31359235

RESUMO

Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly used to treat pain and inflammatory conditions such as arthritis. However, both arthritis and many NSAIDs increase cardiovascular (CV) risks. The dose-dependency of the elevated CV risks of NSAIDs has not been well-studied. We tested the hypothesis that low but still effective doses of these drugs are void of CV side effects. As the model drug, we chose diclofenac because of its known high CV toxicity, as markers of CV risks, we assessed concentrations of cytochrome P450-mediated metabolites of arachidonic acid (ArA), and we used adjuvant arthritis as an experimental model of arthritis. Following 7 daily doses (2.5-15 mg/kg), the effective dosage range of diclofenac was identified (> 5 mg/kg/day). While 7 consecutive days of low therapeutic doses did not alter the CYP-mediated ArA metabolism, the highest dose of 15 mg/kg/day caused imbalances in ArA metabolic profiles toward cardiotoxicity by increasing the ratio of cardiotoxic 20-hydroxyeicosatetraenoic acid over cardioprotective epoxyeicosatrienoic acids. This is suggestive of dose-dependency of NSAID cardiotoxicity, and that low therapeutic doses may be void of CV side effects. Human studies are needed to examine the safety of low but effective doses of NSAIDs.


Assuntos
Anti-Inflamatórios não Esteroides/administração & dosagem , Anti-Inflamatórios não Esteroides/efeitos adversos , Artrite Experimental/tratamento farmacológico , Doenças Cardiovasculares/induzido quimicamente , Animais , Ácido Araquidônico/metabolismo , Artrite Experimental/metabolismo , Diclofenaco/administração & dosagem , Diclofenaco/efeitos adversos , Ácidos Hidroxieicosatetraenoicos/metabolismo , Masculino , Ratos , Ratos Sprague-Dawley , Fatores de Risco
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA