Angiotensin Receptor Antagonists ; therapeutic use ; Betacoronavirus ; Cardiovascular Diseases ; complications ; drug therapy ; Coronavirus Infections ; complications ; Humans ; Pandemics ; Pneumonia, Viral ; complications ; Renin-Angiotensin System ; drug effects

Antiviral Agents/adverse effects* ; Betacoronavirus ; COVID-19 ; Cardiovascular System/drug effects* ; Coronavirus Infections/drug therapy* ; Humans ; Pandemics ; Pneumonia, Viral/drug therapy* ; SARS-CoV-2

Cardiovascular diseases are life-threatening illnesses with high morbidity and mortality. Suppressed vagal (parasympathetic) activity and increased sympathetic activity are involved in these diseases. Currently, pharmacological interventions primarily aim to inhibit over-excitation of sympathetic nerves, while vagal modulation has been largely neglected. Many studies have demonstrated that increased vagal activity reduces cardiovascular risk factors in both animal models and human patients. Therefore, the improvement of vagal activity may be an alternate approach for the treatment of cardiovascular diseases. However, drugs used for vagus nerve activation in cardiovascular diseases are limited in the clinic. In this review, we provide an overview of the potential drug targets for modulating vagal nerve activation, including muscarinic, and β-adrenergic receptors. In addition, vagomimetic drugs (such as choline, acetylcholine, and pyridostigmine) and the mechanism underlying their cardiovascular protective effects are also discussed.
Acetylcholine ; pharmacology ; Animals ; Cardiovascular Diseases ; drug therapy ; Cholinergic Agents ; therapeutic use ; Humans ; Receptors, Muscarinic ; drug effects ; Sympathetic Nervous System ; drug effects ; physiopathology ; Vagus Nerve ; drug effects ; physiopathology

Local anesthetic systemic toxicity (LAST) refers to the complication affecting the central nervous system (CNS) and cardiovascular system (CVS) due to the overdose of local anesthesia. Its reported prevalence is 0.27/1000, and the representative symptoms range from dizziness to unconsciousness in the CNS and from arrhythmias to cardiac arrest in the CVS. Predisposing factors of LAST include extremes of age, pregnancy, renal disease, cardiac disease, hepatic dysfunction, and drug-associated factors. To prevent the LAST, it is necessary to recognize the risk factors for each patient, choose a safe drug and dose of local anesthesia, use vasoconstrictor , confirm aspiration and use incremental injection techniques. According to the treatment guidelines for LAST, immediate application of lipid emulsion plays an important role. Although lipid emulsion is commonly used for parenteral nutrition, it has recently been widely used as a non-specific antidote for various types of drug toxicity, such as LAST treatment. According to the recently published guidelines, 20% lipid emulsion is to be intravenously injected at 1.5 mL/kg. After bolus injection, 15 mL/kg/h of lipid emulsion is to be continuously injected for LAST. However, caution must be observed for >1000 mL of injection, which is the maximum dose. We reviewed the incidence, mechanism, prevention, and treatment guidelines, and a serious complication of LAST occurring due to dental anesthesia. Furthermore, we introduced lipid emulsion that has recently been in the spotlight as the therapeutic strategy for LAST.
Anesthesia, Dental ; Anesthesia, Local ; Arrhythmias, Cardiac ; Cardiovascular System ; Causality ; Central Nervous System ; Dizziness ; Drug-Related Side Effects and Adverse Reactions ; Heart Arrest ; Heart Diseases ; Humans ; Incidence ; Parenteral Nutrition ; Pregnancy ; Prevalence ; Risk Factors ; Unconsciousness

Androgen deprivation therapy (ADT) is one of the dominant treatment options for advanced prostate cancer, which has been certified to significantly improve the overall survival of prostate cancer patients. However, it sometimes can also produce severe adverse effects on body metabolism. This review summarizes the adverse effects of ADT on body composition, the levels of cholesterol and blood glucose, and the cardiovascular system, and the intervention management of these metabolic complications as well.
Androgen Antagonists ; adverse effects ; Blood Glucose ; drug effects ; Body Composition ; drug effects ; Cardiovascular System ; drug effects ; Cholesterol ; blood ; Humans ; Male ; Prostatic Neoplasms ; blood ; drug therapy

ObjectiveHydrogen sulfide (HS), a gaseous signal molecule, plays a crucial role in many pathophysiologic processes in the cardiovascular system. Autophagy has been shown to participate in the occurrence of many cardiac diseases. Increasing evidences indicated that HS regulates myocardial structure and function in association with the altered autophagy and plays a "switcher" role in the autophagy of myocardial diseases. The aim of this review was to summarize these insights and provide the experimental evidence that HS targets cardiomyocyte autophagy to regulate cardiovascular function.

Data SourcesThis review was based on data in articles published in the PubMed databases up to October 30, 2017, with the following keywords: "hydrogen sulfide," "autophagy," and "cardiovascular diseases."

Study SelectionOriginal articles and critical reviews on HS and autophagy were selected for this review.

ResultsWhen autophagy plays an adaptive role in the pathogenesis of diseases, HS restores autophagy; otherwise, when autophagy plays a detrimental role, HS downregulates autophagy to exert a cardioprotective function. For example, HS has beneficial effects by regulating autophagy in myocardial ischemia/reperfusion and plays a protective role by inhibiting autophagy during the operation of cardioplegia and cardiopulmonary bypass. HS postpones cardiac aging associated with the upregulation of autophagy but improves the left ventricular function of smoking rats by lowering autophagy.

ConclusionsHS exerts cardiovascular protection by regulating autophagy. Cardiovascular autophagy would likely become a potential target of HS therapy for cardiovascular diseases.

Animals ; Autophagy ; drug effects ; Cardiovascular Diseases ; prevention & control ; Cardiovascular System ; cytology ; drug effects ; Humans ; Hydrogen Sulfide ; therapeutic use ; Myocytes, Cardiac ; cytology ; drug effects

Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly used in various clinical situations, with excellent analgesic, anti-pyretic and anti-inflammatory effects. In addition to gastrointestinal bleeding, which was the first adverse effect to be reported, myriad adverse effects from the digestive system, cardiovascular system, renal system and hematology have been also reported. In early 2000s, a few new cyclooxygenase (COX)-2 selective inhibitors were developed with the expectation of better gastrointestinal safety profile, most of them were withdrawn from the market due to various adverse effects, and interest in safety of NSAIDs has been increased again. Over the past two decades, research on the safety and adverse effects of NSAIDs has accumulated. In brief, celecoxib is associated with fewer gastrointestinal adverse events compared to non-selective NSAIDs. In patients receiving aspirin, the use of non-selective NSAIDs should be avoided, and if an anti-inflammatory drug is required, a COX-2 selective inhibitor should be considered. Celecoxib has been shown to have similar or better safety profile than other non-selective COX inhibitors. Additionally, the new COX-2 selective inhibitors of etorixocib and polmacoxib have been approved. Many factors should be considered when prescribing NSAIDs, as the safety profile of indivisual NSAIDs vary, and NSAIDs have a high risk of duplicate prescription because of the variety of indications and over-the-counter products. Physicians should comprehend the updated guidelines and the results of new clinical studies, and the risk factors for each individual patient should also be reviewed. Physicians should therefore contemplate new prescription strategies.
Anti-Inflammatory Agents, Non-Steroidal ; Aspirin ; Cardiovascular System ; Celecoxib ; Digestive System ; Drug-Related Side Effects and Adverse Reactions ; Hematology ; Hemorrhage ; Humans ; Medication Therapy Management ; Prescriptions ; Prostaglandin-Endoperoxide Synthases ; Risk Factors

BACKGROUND/AIMS: Several factors contribute to the greater propensity for adverse drug reactions (ADRs) in the elderly, including the use of multiple drugs and pharmacokinetic and pharmacodynamic alterations due to aging. We evaluated the characteristics of ADRs in elderly versus younger adults. METHODS: ADRs were collected from a spontaneous reporting system at Seoul National University Hospital from February 2010 to September 2013. We analyzed causative drugs, clinical manifestations, and the severity of ADRs. RESULTS: In total, 15,541 ADRs were reported in patients 18 years of age or older. Common causative drug categories included nervous system, anti-neoplastics, and anti-infectives. The prevalence of ADRs due to respiratory drugs and cardiovascular drugs was higher in the elderly group (≥ 60 years) than in other groups. The most common clinical types were gastrointestinal and skin and appendage issues. The elderly group had a tendency to show a higher proportion of psychiatric, cardiovascular, hematological, and genitourinary symptoms. The proportions of severe ADRs were higher in the elderly groups and in male patients. CONCLUSIONS: Elderly patients were susceptible to ADRs related to respiratory and cardiovascular drugs. Psychiatric, cardiovascular, hematological, and genitourinary disorders account for a higher proportion of ADR symptoms in the elderly than in other age groups. Further efforts to understand, manage, and prevent ADRs in the elderly are required.
Adult ; Aged* ; Aging ; Cardiovascular Agents ; Drug-Related Side Effects and Adverse Reactions* ; Humans ; Male ; Nervous System ; Pharmacovigilance ; Prevalence ; Seoul ; Skin ; Tertiary Care Centers*

Cardiovascular System ; drug effects ; Humans ; Hydrocarbons, Brominated ; toxicity ; Occupational Exposure ; adverse effects

Notoginseng Radix et Rhizoma (Sanqi), the underground part of Panax notoginseng (Burk.) F. H. Chen (Araliaceae) is commonly used in Chinese medicine for treatment of haemorrhage, haemostasis, swelling, etc. The aerial part including leaves, flowers and fruits are also applied for similar functions. Triterpenoid saponins are considered to be responsible for the biological activities of Sanqi. Up to date, more than 100 saponins have been isolated from theroots, rhizomes, leaves, flowers and fruits of P. notoginseng. The reported saponins can be classified into protopanaxadiol (PPD), protopanaxatriol (PPT), C17 side-chain varied and other types, according to the skeletons of the aglycons. The present review summarizes the saponins isolated from P. notoginseng and their distribution in different medicinal organs, as well as the pharmacological actions on cardiovascular system.
Animals ; Cardiovascular System ; drug effects ; Drugs, Chinese Herbal ; chemistry ; pharmacology ; Humans ; Molecular Structure ; Panax notoginseng ; chemistry ; Plant Roots ; chemistry ; Saponins ; chemistry ; pharmacology