Cardiovascular disease described

General precautions for each medication that has been used for smoking cessation are listed in the sections describing each medication. All FDA-approved first-line medications for smoking cessation have a relatively good safety profile. Consensus opinions on the safety of the various medications for persons with cardiovascular disease, other medical conditions, and pregnancy are beyond the scope of this chapter but can be found elsewhere (Society for Research on Nicotine and Tobacco 2003). 

Cardiovascular Effects. Chronic cardiovascular disease has not been reported in workers occupationally exposed to low levels of trichloroethylene (El Ghawabi et al. 1973), although deaths following acute high-level inhalation exposures to trichloroethylene have been attributed to cardiac arrhythmias. Case studies have described cardiac arrhythmias that in some instances led to death after occupational exposure (Bell 1951 Kleinfeld and Tabershaw 1954 Smith 1966), poisoning (Dhuner et al. 1957 Gutch et al. 1965), or... 

The drugs described in this chapter are used to treat a variety of disorders, ranging from severe cardiovascular and respiratory problems to symptoms of the common cold. Because these drugs are widely used in cardiovascular disease and other disorders, many patients seen in physical therapy and occupational... 

Although not commonly used in the U.S., danshen (the root of Salvia miltiorrhiza), also known as tan seng, is a very popular herb recommended in Chinese medicine for various cardiovascular diseases. The pharmacological effects of danshen have been described primarily in vitro and also in animals and include the following ... 

A different approach to measuring EC damage has been circulating ECs (CECs). CECs have been described in patients with cardiovascular disease namely, in myocardial infarction [72], in unstable angina [73, 74], and postangioplasty [75]. In addition, CECs have also been found to be elevated in Rickettsia Conorii infection [76] and hematological disorders such as sickle cell disease [77, 78], TTP [79], and systemic lupus erythematosus (SLE) [80],... 

The primary goal of therapy is the control of the hypercholesterolemia and prevention of atherosclerotic cardiovascular disease. Patients with heterozygous FH can usually be successfully treated with medications to lower the LDL cholesterol to acceptable levels (Table 14-2). They are generally responsive to treatment with statins, alone or in combination with other drugs, such as bile acid sequestrants (such as cholestyramine) or cholesterol absorption inhibitors (such as ezetimibe) that act additively to upregulate the expression of the functioning LDL receptor as described in the Biochemical Perspectives section. In a few cases, a more aggressive treatment with LDL apheresis (discussed in this section) may have to be considered in order to reach acceptable LDL cholesterol levels. 

The continued use of proteomics, as described in this review, should result in the discovery of new diagnostic and/or prognostic biomarkers, in addition to those already identified in the referenced studies in this chapter, facilitating the identification of potential drug targets for the development of new therapeutic approaches for combating heart and cardiovascular disease. 

The topic of lipoproteins is the most complicated issue presented in this chapter. Lipoproteins are complexes of specific proteins and lipids. Each lipoprotein contains different proportions of various lipids. The constant component of any one type of lipoprotein is the protein hence, the structure or function is described by first naming the protein. Lipoproteins are synthesized primarily in the intestines and liver and are secreted into the plasma, where their function is to transport various Lipids. Lipoproteins are water soluble because of their outside coat of proteins and the hydrophilic phosphate groups of their phospholipids. This water solubility enables lipoproteins to transport the triglycerides and cholesteryl esters that reside within their cores. An understanding of lipoproteins is useful to individuals interested in energy metabolism and essential to those concerned with cardiovascular disease. 

In contrast, published case reports and case series have provided more insight into the potential nephrotoxicity associated with COX-2-selective inhibitors. Taken together, these case reports suggest that COX-2 inhibitors, like non-selective NSAIDs, produce similar and consistent renal adverse effects in patients with one or more risk factors that induce prostaglandin-dependent renal function (that is patients with renal and cardiovascular disease and taking a number of culprit medications, such as diuretics and ACE inhibitors). Acute renal insufficiency, disturbances in volume status (edema, heart failure), metabolic acidosis, hyperkalemia, and hyponatremia have been commonly described. The duration of treatment with COX-2 inhibitors before the development of chnically recognized renal impairment ranged from a few days to 3-4 weeks. Withdrawal of COX-2 inhibitors and supportive therapy most often resulted in resolution of renal dysfunction, but in some patients hemodialysis was required (102,108-112). 

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