Current pharmaceutical design
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Caveolae are flask-like invaginations of the cell surface that have been identified as signaling epicenters. Within these microdomains, caveolins are structural proteins of caveolae, which are able to interact with numerous signaling molecules affecting temporal and spatial dimensions required in cardiac protection. ⋯ In this review we will outline a general overview of caveolae and caveolins and their role in protective signaling with a focus on the effects of volatile anesthetics. These recent developments have allowed us to better understand the mechanistic effect of volatile anesthetics and their potential in cardiac protection.
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Post cardiac surgery acute kidney injury (AKI) is common, poorly understood and associated with a significant increase in morbidity and mortality. ⋯ There is a paucity of effective renoprotective agents that can be used in adult cardiac surgical patients. There is an urgent need to develop novel renoprotective strategies.
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Review
Statin treatment non-adherence and discontinuation: clinical implications and potential solutions.
Statins are the most powerful lipid lowering drugs in clinical practice. However, the efficacy of statin therapy, as seen in randomized control trials, is undermined by the documented non-adherence observed in clinical practice. Understanding the clinical consequences of statin non-adherence is an important step in implementing successful interventions aimed at improving adherence. ⋯ Statin adherence, therefore, represents an important modifiable risk factor. Numerous interventions to improve adherence have shown promise, including copayment reduction, automatic reminders, mail-order pharmacies, counseling with a health professional, and fixed-dose combination therapy. Given the complexity of causes underlying statin non-adherence, successful strategies will likely need to be tailored to each patient.
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Aging is associated with arterial stiffening and subsequent acceleration of pulse wave movement. Traditional cardiovascular risk factors such as hypertension and dyslipidemia are associated with increased arterial stiffness, a 'premature' arterial aging. Antihypertensive drugs exhibit beneficial effects on arterial stiffness, both at the central and peripheral level, and these effects are mainly attributed to blood pressure reduction per se. ⋯ The effects of statins on arterial stiffness are not yet well established. Moreover, the effects of combining statins with antihypertensive drugs or other strategies to attenuate arterial aging are not adequately studied. The aim of the current review is to present the effects of available therapeutic strategies on arterial stiffness with special emphasis on hypolipidemic and antihypertensive drugs, critically evaluate available information and provide future perspectives in this field.
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General anesthesia-induced pharmacological protection of the central nervous system following injury has been under intense investigations during the past four decades. Indeed, if general anesthetics could provide therapeutic benefit in the event of hypoxia, ischemia or any other kinds of brain lesions, that would be of tremendous clinical importance. The potential for anesthesia-related brain protection, however, has been seriously challenged during the past 10 years. ⋯ The biological rational for anesthesia neurotoxicity will then be explored together with existing experimental and clinical evidence in favor of this possibility. Finally, insights into the increasing number of both experimental and clinical data suggesting that general anesthetics, especially ketamine, support the therapeutic value of these drugs in major depressive disorders. When taken together, these seemingly contradictory observations suggest the intriguing possibility that general anesthetics could stand as valuable context-dependent modulators of neural plasticity.