OTHER CARDIAC RISK FACTORS

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. 

These data support an earlier study on the important predictive value of BNP (29). The BNP levels predicted the risk of death and nonfatal cardiac events across the spectrum of ACS. The BNP levels were supportive of other high risk factors age greater than 75 years Killip class two, three, or four ST-segment deviation greater than 1.0 mm new complete left bundle branch block troponin I, greater than 1.5 ng/mL (29). 

ED is common in patients with cardiovascular disease and should be routinely enquired about. The cardiac risk of sexual activity in patients with cardiovascular disease is minimal in properly assessed patients. The restoration of a sexual relationship is a possibility for the majority of patients with cardiovascular disease and ED using oral PDE5 inhibitors, which have an excellent safety profile (avoiding nitrate use). ED is a marker for cardiovascular disease as well as its consequence therefore, its identification (in the asymptomatic male) provides the opportunity to address other cardiovascular risk factors and detect silent but significant vascular pathology. 

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. 

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. ... 

Infective endocarditis (IE) is an uncommon infection usually occurring in persons with preexisting cardiac valvular abnormalities (e.g., prosthetic heart valves) or with other specific risk factors (e.g., intravenous drug abuse). 

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. 

Influenza vaccine. Influenza vaccine is recommended annually for children age > 6 months with certain risk factors (including but not limited to asthma, cardiac disease, sickle cell disease, HIV, diabetes see MMWR. 2001 50(RR-4) 1-44), and can be administered to all others wishing to obtain immunity. Children aged <12 years should receive vaccine in a dosage appropriate for their age (0.25 mL if age 6-35 months or 0.5 mL if age >3 years). Children aged <8 years who are receiving influenza vaccine for the first time should receive two doses separated by at least 4 weeks. 

Statins are helpful in decreasing morbidity and mortality in people with high cholesterol, as well as individuals who have normal cholesterol but other risk factors for cardiovascular disease.66 It is estimated that these drugs decrease the risk of a major cardiac event by approximately 30 to 35 percent, although the benefits depend on the extent that cholesterol is reduced and the influence of other risk factors.91,95,126 Nonetheless, statins are now regarded as a mainstay in treating cardiovascular disease, and efforts are underway to expand the use of these medications and to explore the... 

In a postmarketing study of the safety of cisapride during 1993-9,341 patients had cardiac effects, of whom 80 (23%) died, the deaths being directly or indirectly associated with a dysrhjdhmic event (17). The cardiac effects included QT interval prolongation, torsade de pointes, polymorphous ventricular tachycardia, ventricular fibrillation, ventricular tachycardia, cardiac arrest, unspecified serious dysrhythmias, and sudden death. In most instances the dysrhythmia occurred in the presence of risk factors such as other drugs or medical conditions. 

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