Cardiac risk factors

Cushman M, Costantino JP, Tracy RP, Song K, Buckley L, Roberts JD, Krag DN (2001) Tamoxifen and cardiac risk factors in healthy women suggestion of an antiinflammatory effect. Arterioscler Thromb Vase Biol 21 255-261... 

Myocardial toxicity, manifested in its most severe form by potentially fatal CHF, may occur either during therapy with mitoxantrone or months to years after termination of therapy. Mitoxantrone use has been associated with cardiotoxicity this risk increases with cumulative dose. In cancer patients, the risk of symptomatic CHF was estimated to be 2.6% for patients receiving up to a cumulative dose of 140 mg/m. For this reason, monitor patients for evidence of cardiac toxicity and question them about symptoms of heart failure prior to initiation of treatment. Monitor patients with multiple sclerosis (MS) who reach a cumulative dose of 100 mg/m for evidence of cardiac toxicity prior to each subsequent dose. Ordinarily, patients with MS should not receive a cumulative dose greater than 140 mg/m. Active or dormant cardiovascular disease, prior or concomitant radiotherapy to the mediastinal/pericardial area, previous therapy with other anthracyclines or anthracenediones, or concomitant use of other cardiotoxic drugs may increase the risk of cardiac toxicity. Cardiac toxicity with mitoxantrone may occur at lower cumulative doses whether or not cardiac risk factors are present (see Warnings and Administration.and.Dosage). 

Other potential adverse events are rash, fever, nausea, vomiting, diarrhea, headache, dyspnea, fatigue, and pancreatitis (rare). Abacavir should be used cautiously in patients with existing cardiac risk factors due to a possible increased risk of myocardial events. 

Sulprostone should be used with care, particularly in patients with cardiac risk factors, and only in settings equipped to manage complications. 

Straznicky NE, Lambert EA, Lambert GW, Masuo K, Esler MD, Nestle PJ. Effects of dietary weight loss on sympathetic activity and cardiac risk factors associated with the metabolic syndrome. J. Clin. Endocrinol. Metab. 2005 90 5998-6005. 

Post-MI management calls for strict adherence to a program of secondary prevention. Cardiac risk factors have to be excluded or modified, for instance, by reduction of overweight, cessation of smoking, optimal control of diabetes mellitus, and physical exercise (a dog that loves to run is an ideal training partner). Supportive pharmacother-apeutic measures include administration of platelet aggregation inhibitors, p-blockers, and ACE inhibitors. 

B. N. Becker, J. Himmelfarb, W. L. Henrich and R. M. Hakim, Reassessing the Cardiac Risk Profile in Chronic Hemodialysis Patients A Hypothesis on the Role of Oxidant Stress and Other Non-Traditional Cardiac Risk Factors, Journal ofAmerican Society of Nephrology 8 (1997) 475-486. 

Continuous cardiac monitoring is recommended for patients with serious conduction abnormalities however, routine cardiac monitoring is considered unnecessary in patients without a history of cardiac conduction abnormalities (7). Further studies are needed to determine the risk in patients treated with paclitaxel with predisposing cardiac risk factors. 

The Advisory Committee on Immunization Practices (ACIP) has recommended that people who have underlying heart disease, with or without symptoms, or who have three or more known major cardiac risk factors (that is hypertension, diabetes, hypercholesterolemia, heart disease at age 50 years in a first-degree relative, and smoking) should be excluded from the pre-event smallpox vaccination program (27). 

Mortality secondary to cardiovascular disease is 10 to 30 times greater in dialysis patients than in the general population. In addition to traditional cardiac risk factors such as diabetes, hypertension, hyperlipidemia, tobacco use, and physical inactivity, patients with kidney disease have other unique risk factors. Among these are hyper-homocysteinemia, elevated levels of C-reactive protein, increased oxidant stress, and hemodynamic overload. Complications previously discussed such as anemia and metabolic disorders of CKD are also contributory. In particular, arterial vascular disease (i.e., atherosclerosis) and cardiomyopathy are the primary types of cardiovascular disorders present in the CKD population. These disorders lead to development of ischemic heart disease and its manifestations including myocardial infarction. As a predominant comorbidity, cardiovascular disorders and their sequela are the leading cause of death in the ESKD population. ... 

Strom BL, Abrutyne E, Berlin JA, et al. Dental and cardiac risk factors for infective endocarditis A population-based, case-control study. Ann Intern Med 1998 129 761-769. 

It was thus possible to demonstrate that Hypericum extract, even at high doses, does not adversely influence depolarization in a patient sample with pre-existing pathological alterations of heart electrical activity. The drug therefore appears suitable for patients with cardiac risk factors. 

Drug delivery systems have been developed for doxorubicin [51] (a drug used to treat leukemia but which has cardiac risk factors), and for flavors such as decanoic acid [52]. In both cases, the encapsulation efficiency as given by load, recovery speed and recovered quantity was assessed. In addition, the stabihty (shelf life) of such gel matrices in terms of stabihty of the pharmaceutically active ingredient was increased compared to their free form. Similar appHcations for coatings for the controlled release of biocides [53] and other pharmaceuticals such as vitamins [54] have also been made. Clearly, gel porosity, pore size distribution, temperature, pH all influence the release, and these parameters must be optimized. 

Shaw LJ, Raggi P et al. (2003) Prognostic value of cardiac risk factors and coronary artery calcium screening for all-cause mortality. Radiology 228 826-833... 

A 25-year-old male veteran developed PTSD after deployment in Iraq and was given prazosin 1 mg at night for sleep disturbance. After only a few doses he developed acute, intermittent, left-sided chest pain. No alternative cause could be found for the pain and he had minimal cardiac risk factors. The pain resolved completely within 1 week after drug withdrawal. 

Further studies are needed to determine the risks in patienb with predbposing cardiac risk factors who are being treated with paclitaxel. A retrospective review of patienb with major cardiac risk factors who were treated with paclitaxel (either monotherapy or in combination with cbplatin or carbo-platin) did not find any evidence of reduced cardiac function after treatment with paclitaxel. However the series only consbted of 15 patients [36 ]. 

Markman M, Kennedy A, Webster K, Kulp B, Peterson G, Belinson J. Paclitaxel administration to gynecologic cancer patients with major cardiac risk factors. J Clin Oncol 1998 16(11) 3483-5. 

Cardiac risk factors cannot predict how disease will progress, and as these important chemical changes occur at an asymptomatic phase, there is a need to delineate underlying chemical structure at this early stage, thus allowing optimal planning of treatment. At present the majority of patients present after a clinical vascular event, such as a myocardial infarction (MI, heart attack ) or cerebrovascular accident (CVA, stroke ). At this stage, permanent morbidity... 

Landy DC, Miller TL, Lipsitz SR, Lopez-Mitnik G, Hinkle AS, Constine LS, et al. Cranial irradiation as an additional risk factor for anthra-cycUne cardiotoxicity in childhood cancer survivors an analysis from the cardiac risk factors in childhood cancer survivors study. Pediatr Cardiol 2013 34(4) 826-34. 

Schmitt CJ, EHetrich S, Ho AD, Witzens-Harig M. Replacement of conventional doxorubicin by pegylated liposomal doxorubicin is a safe and effective alternative in the treatment of non-Hodgkin s lymphoma patients with cardiac risk factors. Ann Hematol 2012 91(3) 391-7. 

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