Heart disease drug-related

Sudden death has occurred in patients with preexisting heart disease on antidepressant therapy. It may be difficult, however, to separate a causally related drug effect from a cardiovascular incident precipitated by other factors and only by chance coincident with drug therapy. Furthermore, Roose ( 418), who has summarized the literature, noted that major depressive disorder occurs frequently after a myocardial infarct and may adversely affect the recovery process. 

After heart disease and cancer, alcohol-related disorders are considered the third most important health problem in the United States, estimated to account for at least one fourth of all hospitalizations in this country. Almost 50% of those who suffer from alcohol dependence also abuse other legal and illicit drugs (see Appendix D). Alcohol is involved in 25% to 35% of all suicides and 50% to 70% of all homicides it also figures prominently in accidental deaths and domestic violence (388, 389). Furthermore, causes of death resulting from excessive alcohol use include the following ... 

Antiarrhythmic therapy carries with it a number of risks. In some cases, the risk of an adverse reaction is clearly related to high dosages or plasma concentrations. Examples include lidocaine-induced tremor or quinidine-induced cinchonism. In other cases, adverse reactions are unrelated to high plasma concentrations (eg, procainamide-induced agranulocytosis). For many serious adverse reactions to antiarrhythmic drugs, the combination of drug therapy and the underlying heart disease appears important. 

Sibutramine (Meridia), a weight-loss drug introduced in 1998, inhibits the reuptake of the brain chemicals norepinephrine, dopamine, and serotonin, but does not promote monoamine release like the amphetamines. Yet the drug has been linked to serious side effects, including rapid heart rate, increased blood pressure, heart disease, stroke, seizure, and mental impairments. In March 2002, Italy s Health Ministry announced that it was immediately withdrawing all sibutramine products from the market due to health-related problems. Also, Meridia was the subject of a class action lawsuit filed in the United States. 

Insomnia is a common complaint in the elderly. As people age they require less sleep, and a variety of physical ailments to which the elderly are subject can cause a change in the sleep pattern (e.g. cerebral atherosclerosis, heart disease, decreased pulmonary function), as can depression. Providing sedative hypnotics are warranted, the judicious use of short half-life benzodiazepines such as temazepam, triazolam, oxazepam and alprazolam for a period not exceeding 1-2 months may be appropriate. Because of their side effects, there would appear to be little merit in using chloral hydrate or related drugs in the treatment of insomnia in the elderly. It should be noted that even benzodiazepines which have a relatively short half-life are likely to cause excessive day-time sedation. The side effects and dependence potential of the anxiolytics and sedative hypnotics have been covered elsewhere in this volume (Chapter 9). 

Synthetic statins are important lipid regulating drugs for the treatment of atherosclerosis and other diseases related to hyperlipidaemia, especially coronary heart disease. As the pharmacophore, all synthetic statins contain a saturated or partially unsaturated syn-3,5-dihydroxy C7-carboxylate. An important building block for the synthesis of the side chain is represented by 4-chloro-3-hydroxybutanoate esters (CHBE). Both enantiomers can be obtained by enzyme-catalyzed reduction of the (1-keto ester. The group of Kataoka and Shimizu found that an aldehyde reductase of Sporobolomyces salmonicolor [161] and a carbonyl reductase of Candida... 

Food and drugs have traditionally been considered separate categories in the legislative process. Until relatively recently, health claims on foods were prohibited in many countries. However, in recent years consumers have been deluged with health information relating to their foods. Some of this information has been negative, such as information about the effect of fat on the incidence of heart disease other information has been positive as for instance the beneficial effect of dietary fiber. 

Food and Drug Administration (FDA) health claims" show that a relationship between a nutrient(s) or other substances and a disease or health-related condition, i.e., foods with soy protein, soluble fiber, and plant sterols, helps lower the risk of coronary heart disease (Table 8.5). These claims help individuals to select foods as either part of following recommended dietary guidelines, such as the TLC and Heart Healthy diets, or part of a self-treatment in response to You need to eat less fat and cholesterol and more fiber. ... 

More recently, it has been shown that hypokalemia and other dose-related adverse metabolic effects of thiazide diuretics increase the risk of sudden death and negate the cardiovascular benefit of blood pressure lowering when high doses these drugs are prescribed (21). Hence, another explanation for the apparent inability of antihypertensive therapy to lower mortality in patients with coronary heart disease is that high thiazide doses were used in many of the trials that were analyzed. As pointed out by Temple (2), this explanation is supported by the results of a trial of antihypertensive therapy in elderly patients with isolated systolic hypertension (22). In this study, only low doses of a thiazide diuretic were prescribed and a 4-mm Hg average decrease in diastolic blood pressure was associated with a 36% reduction in the... 

Peroxides can play a physiological role in the cell but also mediate processes leading to heart disease and carcinogenesis. Fatty acid peroxidation may also be related to free radical-mediated metabolic activation of carcinogens or drugs, which lead to the initiation of carcinogenesis or cytotoxicity. Modification of membrane function as a consequence of lipid peroxidation includes imcoupling of oxidative phosphorylation... 

As a recreational substance, alcohol is second only to caffeine in worldwide use and second only to tobacco in health costs from abuse. In recent years, the American public has received a mixed message on alcohol s health benefits and deficits. Wine is said to help protect moderate drinkers from heart disease, but at the same time, alcoholism is responsible for more substance-related deaths than all other psychoactive drugs combined, with the exception of tobacco. Although there are few pharmacotherapies for alcoholism and alcohol abuse, a multimillion dollar project has been funded at the University of California at San Francisco by Gallo Wine and the state of... 

Sorkin EM, Clissold SP, Brogden RN. Nifedipine. A review of its pharmacodynamic and pharmacokinetic properties, and therapeutic efficacy, in ischaemic heart disease, hypertension and related cardiovascular disorders. Drugs 1985 30(3) 182-274. 

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