Cardiology in review
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Cardiology in review · Jan 2015
ReviewPulmonary arterial hypertension: a review in pharmacotherapy.
Pulmonary arterial hypertension (PAH) is a progressive disease that remains incurable. The past 2 decades have witnessed many advances in PAH-directed therapies. More recently, 3 new oral agents have become available in the United States within the past 2 years. ⋯ Riociguat is the first soluble guanylate cyclase stimulator that has been approved for use in the United States. This article reviews the clinical efficacy and safety of these 3 agents and the roles they play in the management of PAH. Additionally, we review the limitations of using surrogate markers such as change in 6-minute walk distance to assess disease progression.
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Cardiology in review · Jan 2014
ReviewNew antiobesity agents: lorcaserin (Belviq) and phentermine/topiramate ER (Qsymia).
Obesity is a risk factor for a wide range of conditions, including cardiovascular disease. Although lifestyle modifications remain the cornerstone for the management of obesity, pharmacologic agents may be a helpful addition to patients who have comorbidities and do not respond adequately to diet and exercise. ⋯ This article reviews the pharmacology and clinical efficacy and safety of each of these agents. The differences among the three available agents for long-term management of obesity will also be examined.
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Cardiology in review · Jul 2013
ReviewIncreased cardiovascular risk in patients with chronic obstructive pulmonary disease and the potential mechanisms linking the two conditions: a review.
Cardiovascular diseases, especially coronary artery disease (CAD), are the leading causes of death in patients with chronic obstructive pulmonary disease (COPD). There is a high prevalence of common risk factors in the COPD/CAD patient population including smoking, sedentary lifestyle and low socio-economic status. ⋯ Statins and inhaled corticosteroids have been investigated as potential therapeutic interventions in COPD that may lower cardiovascular risk. The goals of this review are to examine the evidence for increased cardiovascular risk in COPD patients, the possible mechanisms linking these two chronic conditions, to discuss possible predictors or markers of poor outcomes among patients diagnosed with both COPD and CAD, and the therapeutic options aimed at reducing cardiovascular risks associated with COPD.
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The presence of pulmonary arterial hypertension (PAH) in pregnancy is rare and signifies a high-risk pregnancy. Although the majority of mothers have knowledge of their condition before pregnancy, approximately one-third of patients are diagnosed during pregnancy. Termination of pregnancy should be discussed, and is often advised; however, a significant proportion of patients will choose to proceed with the pregnancy despite increased maternal and fetal mortality. ⋯ The time of greatest maternal risk is in the first month after delivery. Transplantation of these patients in the nonpregnant state may be considered when those with idiopathic pulmonary hypertension have poor functional status despite optimal therapy and their projected 2-year survival is less than 50%. For patients with Eisenmenger syndrome, severe symptoms and an unacceptable quality of life may lead to transplantation.
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Heart failure (HF) poses a significant economic burden on our health-care resources with very high readmission rates. Remote monitoring has a substantial potential to improve the management and outcome of patients with HF. ⋯ Current data examining the efficacy of remote monitoring technologies in improving outcomes have shown inconsistent results. Various medicolegal and financial issues need to be addressed before widespread implementation of this exciting technology can take place.