Management Of Cardiovascular Complications Research Articles

A Survey of the Cardiology Care Delivered to Cancer Patients in Nigeria

BACKGROUND: The incidence of cardiovascular disease is on the rise and this is no less so amongst the population of individuals who are affected by cancer as improvement over the years in cancer treatment options have brought about improved outcomes in terms of overall patient survival and outcomes but has additionally also illuminated the side effects of these cancer treatment as patients live longer to manifest them thereby increasing morbidity and mortality. In Nigeria, there is paucity of data on cardio-oncology and this study will be the first documented study assessing the level of knowledge and the activity of cardiology care provided to oncology patients who develop cardiovascular disease in Nigeria and will therefore serve as a template towards the development of cardio-oncology services in Nigeria. METHODS: The survey was questionnaire-based involving cardiologist in Nigeria. They first part assessed the demographic characteristics of participants. The second part of the questionnaire assessed participants’ self-admitted expertise in the management of cardiovascular conditions complicating cancer treatment. RESULTS: There were more male (57.14%) than female (42.86%) respondents. More than two-thirds of respondents (71.4%, n=55) were aged 30-44 year. Cumulatively, the South-south and South-western regions accounted for over two-thirds of responses (72.43%, n=55). Over three-thirds of respondents (83.12%, n=) worked at teaching hospitals. Majority (89.5%, n=68) of ambulatory cancer patients in need of cardiology care received this service in a general cardiology clinic with only 10.5% (n=8) receiving care at a cardio-oncology centre. Majority of respondents (67.1%, n=51) dId not receive referrals from general practitioners or other specialists to evaluate cardiac problems in patients who had received cancer treatment. 80.5% of participants (n=62) said that they either did not know about the ESC position paper or knew about it but did not apply its suggestions to their practice. CONCLUSION: Most cancer patients requiring cardiovascular care are seen in the general cardiology clinic of Government owned hospitals in Nigeria. Although the knowledge of cardiologists in the management of cardiovascular complications of cancer patients is adequate, referral from General Practitioners is low. The ESC position paper on cardio-oncology is poorly known and utilized by cardiologist in the care of cancer patients with cardiovascular complications with the field of cardio-oncology generally regarded as a new topic in cardiology requiring more information on its dissemination and acceptance. This survey therefore makes obvious the dearth of knowledge regarding cardio-oncology that is prevalent in Nigeria. It is hoped that this will ignite a change in this aspect. There is therefore an urgent need to for all stakeholders to join force together towards the development of cardio-oncology skills and services in Nigeria.

Determination of Some Biochemical Parameters in Streptozotocin-Induced Diabetic Albino Rats Pre-Treated and Post-Treated with Vernonia amygdalina and Gongronema latifolium Extracts

The use of herbs in the management of diabetes mellitus and its complications have been reported. This study was thus aimed at determining the levels of some biochemical parameters in streptozotocin-induced diabetic albino rats pre-treated and post-treated with Vernonia amygdalina and Gongronema latifolium extracts. Fifty (50) albino rats weighing between 150 – 250 g were used for this study. 25 albino rats were used for each phase of the treatment. The pre-treatment phase involved the treatment of the rats with 400 mg/kg b.w (singly) and 200 mg/kg b.w (combined) extracts for 14 days, after which diabetes mellitus was induced using streptozotocin before the rats were sacrificed. The post-treatment phase involved the inducement of diabetes with streptozotocin after which the rats were treated with 400 mg/kg b.w (singly) and 200 mg/kg b.w (combined) extracts for 28 days before the animals were sacrificed. Blood was collected via cardiac puncture and plasma/serum was collected. Total cholesterol (TC), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), malondialdehyde (MDA), and total antioxidant capacity (TAC) were determined using standard procedures while glucose was measured with a glucometer. Cardiovascular risk ratios such as Castelli risk ratio I and II and atherogenic index of plasma were also calculated. Results showed that extracts of V. amygdalina (only), G. latifolium (only) and V.A+ GL (combined)significantly (p<0.05) reduced the TC, LDL-C , FBS, MDA and TAC levels while HDL-C level significantly (p<0.05) increased. The cardiac risk indices (CRI-I and CRI-II, and Atherogenic index of plasma (AIP) in both the pre-treated and post-treated rats were also reduced when compared to diabetic control. It is thus evident that these plants’ extracts possess hypoglycaemic, hypolipidaemic, and antioxidant properties and thus could be used to reduce cardiovascular risks. Therefore, the tradomedicinal use of these plants in the management of cardiovascular complications is highly recommended.

Bringing Cardiovascular Comorbidities in Acromegaly to an Update. How Should We Diagnose and Manage Them?

Patients with acromegaly frequently develop cardiovascular comorbidities, which significantly affect their morbidity and contribute to an increased all-cause mortality. In this regard, the most frequent complications that these patients may encounter include hypertension, cardiomyopathy, heart valve disease, arrhythmias, atherosclerosis, and coronary artery disease. The specific underlying mechanisms involved in the pathophysiology of these comorbidities are not always fully understood, but uncontrolled GH/IGF-I excess, age, prolonged disease duration, and coexistence of other cardio-vascular risk factors have been identified as significant influencing predisposing factors. It is important that clinicians bear in mind the potential development of cardiovascular comorbidities in acromegalic patients, in order to promptly tackle them, and avoid the progression of cardiac abnormalities. In many cases, this approach may be performed using straightforward screening tools, which will guide us for further diagnosis and management of cardiovascular complications. This article focuses on those cardiovascular comorbidities that are most frequently encountered in acromegalic patients, describes their pathophysiology, and suggests some recommendations for an early and optimal diagnosis, management and treatment.

Management of cardiovascular complications in Klinefelter syndrome patients

ABSTRACTIntroduction: Klinefelter syndrome (KS), also known as 47, XXY, shows increased mortality when compared with mortality rates among the general population. Cardiovascular, hemostatic, metabolic diseases are implicated. Moreover, cardiac congenital anomalies in KS can contribute to the increase in mortality.Areas covered: In this study, we have systematically reviewed the relationships between KS and the cardiovascular system and the management of cardiovascular complication. In summary, patients with KS display increased cardiovascular risk profile, characterized by increased prevalence of metabolic alterations including dyslipidemia, diabetes mellitus (DM), and abnormalities in biomarkers of cardiovascular disease. KS subjects are characterized by subclinical abnormalities in endothelial function and in left ventricular (LV) systolic and diastolic function, which – when associated with chronotropic incompetence – may negatively influence cardiopulmonary performance. Moreover, KS patients appear to be at a higher risk for cardiovascular disease, due to thromboembolic events with high prevalence of recurrent venous ulcers, venous insufficiency, recurrent venous and arterial thromboembolism leading to deep venous thrombosis or pulmonary embolism.Expert opinion: Considering the unequivocal finding of increased mortality of KS patients, we suggest a periodic cardiovascular follow up in specialized centers with multidisciplinary care teams that comprise endocrinologists and cardiologists dedicated to KS syndrome.

Cardiovascular Complications of Proteasome Inhibitors Used in Multiple Myeloma.

The use of proteasome inhibitors (PI) as targeted chemotherapeutics have significantly improved survival in patients with multiple myeloma (MM). However, rare and serious cardiovascular complications have occurred as a result of their use, most commonly congestive heart failure, hypertension, and arrhythmias. MM occurs in an aged population with many concurrent cardiovascular risk factors. The primary disease process also contributes to cardiovascular complications. Furthermore, many MM patients have prior exposure to cardiotoxic chemotherapy such as anthracyclines. Because of these occurrences, the identification, prevention, and management of cardiovascular complications is made increasingly difficult. Various clinical studies and case reports have documented cardiotoxicity among all 3 of the currently approved PIs, bortezomib, carfilzomib, and ixazomib. Carfilzomib has shown the highest rates of cardiotoxicity, whereas there is conflicting evidence regarding bortezomib's role in producing cardiotoxicity. However, various case reports have documented the existence of adverse cardiac effects. Higher frequencies of complications have also been seen in "real-life" populations with cardiovascular co-morbidities who were originally excluded from clinical studies. Ixazomib, the most recently approved PI, has also been proposed to cause cardiotoxicity, elucidating a possible class effect. PIs are thought to cause cardiotoxicity through the unfolded protein response, leading to apoptosis in cardiac myocytes. Apremilast and rutin have been used in an animal model to reverse this signaling. Standardized guidelines identifying patients at greatest risk, to prevent and manage complications, have not yet been developed. Efforts have been made to prioritize patients older than 60 years with anthracycline exposure, cardiovascular risk factors, or amyloidosis. Withholding medication, using slower-infusion times, limiting fluids and providing supportive therapy have been successful. Screening echocardiograms have not been proven effective.

Management of cardiovascular complications in CML patients treated with tyrosine kinase inhibitors

Tyrosine kinase inhibitors (TKIs) have significantly improved the clinical outcomes of patients with chronic myeloid leukemia (CML). However, patients with CML need to receive TKI therapy for several years. Hence, the safety of long-term TKI treatment warrants utmost attention. Among various adverse events caused by TKI therapy, cardiovascular events (CVEs), such as acute myocardial infarction, cerebral infarction, and pulmonary hypertension, are the most serious with high mortality. TKIs inhibit various off-target molecules involved in the occurrence of CVEs such as c-Kit, platelet-derived growth factor receptor (PDGFR), vascular endothelial growth factor receptor (VEGFR), and Tie-2/Tec. At present, nilotinib, dasatinib, and ponatinib, but not bosutinib, have been demonstrated to increase the risk of CVEs in patients with CML compared with imatinib. Conversely, patients with CML have also been shown to have high CVE risks regardless of the TKI treatment compared with non-cancer population. Hence, further analyses are required to deduce the influence of TKI treatment on CVEs. Whatever the cause may be, to prevent CVEs in patients with CML, we need to appropriately screen and monitor CVE risks such as hypertension, serum glucose, lipid levels, ankle-brachial index (ABI), Electrocardiography (ECG), and echocardiography before and during TKI treatment.

Cardio-Onco-Hematología en la práctica clínica. Documento de consenso y recomendaciones

Improvements in early detection and treatment have markedly reduced cancer-related mortality. However, improving cancer prognosis not only depends on an effective cure, but also on the prevention, diagnosis, and treatment of cancer-related complications. Although cardiovascular toxicity is a widespread problem across many classes of therapeutic regimens, scientific evidence on the management of cardiovascular complications in onco-hematology patients is scarce because these pati ents have been systematically excluded from clinical trials and current recommendations are based on expert consensus. Multidisciplinary teams are mandatory to decrease morbidity and mortality from both cardiotoxicity and the cancer itself. Excessive concern for the occurrence of cardiovascular toxicity can hamper the use of potentially curative therapies, while underestimation of this risk increases the long-term mortality of cancer survivors. The objective of this consensus document, developed in collaboration with the Spanish Society of Cardiology, the Spanish Society of Medical Oncology, the Spanish Society of Radiation Oncology, and the Spanish Society of Hematology, is to update the necessary concepts and expertise on cardio-onco-hematology that enable its application in daily clinical practice and to promote the development of local multidisciplinary teams in order to improve the cardiovascular health of patients with cancer.Full English text available from: www.revespcardiol.org/en

Rationale for setting up a cardio-oncology unit: our experience at Mayo Clinic

BackgroundThe diagnosis and management of cardiovascular complications have become a clinical concern for oncologists, cardiologists, surgeons, interventional radiologists, radiation therapy physicians, internists, nurses, pharmacists, administrators, and all the stakeholders involved in the care of cancer patients. Anticancer therapies have extended the lives of patients with cancer, but for some this benefit is attenuated by adverse cardiovascular effects.MethodsThis review article aims to provide an overview of the rationale of setting up a cardio-oncology unit and reflect on our own experience establishing this service, and conclude with some fundamental aspects of consideration for evaluation and management of patients with cancer and cardiovascular diseases.ResultsCardiotoxicity can lead to congestive heart failure and cardiac death. In fact, chemotherapy-related cardiac dysfunction may carry one of the worst prognoses of all types of cardiomyopathies, and has a profound impact on morbidity and mortality in oncology patients. Other complex clinical situations involve cancer patients who might benefit from a highly curative drug in terms of cancer survival but face limitations of its administration because of concomitant cardiovascular diseases. Indeed, the balance between the benefits and risks of the cancer therapy regimen in the context of the cardiovascular status of the individual patient can sometimes be extraordinarily challenging. A subspecialty with a multidisciplinary integrative approach between oncologists, hematologists, cardiologists, among others has thus emerged to address these issues, termed cardio-oncology. Cardio-oncology addresses the spectrum of prevention, detection, monitoring and treatment of cancer patients with cardiovascular diseases, or at risk for cardiotoxicity, in a multidisciplinary manner. In this field, cardiologists assist oncologists and hematologists with cardiovascular recommendations. This can be mediated through e-consultations or face-to-face evaluations.ConclusionCardio-oncology is a subspecialty that assists in the overall care of cancer patients with and without cardiovascular disease in an interdisciplinary fashion. We believe that this partnership of sharing responsibilities and experiences among health-care team members can potentially decrease cancer therapeutics-related cardiovascular complications and improve clinical outcomes.

Coronary artery disease in patients with chronic kidney disease: a brief literature review

Cardiovascular is the major cause of death in chronic kidney disease and end-stage renal disease. The cardiovascular mortality rate of patients with renal impairment is evaluated to be higher than general population. Coronary artery disease seems to be an important type of cardiovascular complication among patients with chronic kidney disease and end-stage renal disease before the renal replacement therapy. Due to the strong association between chronic kidney disease and the incidence of coronary artery disease, accurate screening, diagnosis, and management of cardiovascular complications would be essential in patients at different stages of renal dysfunction. Despite the need for the comprehensive knowledge about different aspects of coronary artery disease in patients with renal failure, there is not sufficient evidence regarding the pathophysiology, ideal diagnosis, and treatment strategies for coronary heart disease in population with chronic kidney disease. In this study, we briefly reviewed the existing literatures about the possible screening, diagnosis, and the treatment approaches of risk of coronary heart disease in patients with kidney dysfunction.

Variants in adiponectin signaling pathway genes show little association with subclinical CVD in the diabetes heart study

Understanding the interplay between adiposity, inflammation, and cardiovascular complications in type 2 diabetes mellitus (T2DM) remains a challenge. Signaling from adipocytes is considered important in this context. Adiponectin is the most abundant adipocytokine and has been associated with various measures of cardiovascular disease (CVD). This study examines the relationships between genetic variants in the adiponectin (ADIPOQ) and adiponectin-related signaling pathway genes and measures of subclinical CVD (vascular calcified plaque and carotid intima-media thickness), plasma lipids, and inflammation in T2DM. Single-nucleotide polymorphisms (SNPs) in ADIPOQ (n = 45), SNPs tagging ADIPOR1 (n = 6), APIPOR2 (n = 8), APPL1 (n = 6) and known rare coding variants in KNG1 (n = 3) and LYZL1 (n = 3) were genotyped in 1220 European Americans from the family-based Diabetes Heart Study. Associations between SNPs and phenotypes of interest were assessed using a variance components analysis with adjustment for age, sex, T2DM-affected status, and body mass index. There was minimal evidence of association between SNPs in the adiponectin signaling pathway genes and measures of calcified plaque; eight of the 71 SNPs showed evidence of association with subclinical CVD (P = 0.007-0.046) but not with other phenotypes examined. Nine additional SNPs were associated with at least one of the plasma lipid measures (P = 0.008-0.05). Findings from this study do not support a significant role for variants in the adiponectin signaling pathway genes in contributing to risk for vascular calcification in T2DM. However, further understanding the interplay between adiposity, plasma lipids, and inflammation may prove important in the prediction and management of cardiovascular complications in T2DM.

Importance of Prandial Glucose Regulation in the Management of Cardiovascular Complications in Type 2 Diabetes Mellitus

AbstractThere is a worldwide epidemic increase in the number of type 2 diabetes (T2DM)patients who frequently associate with cardiovascular disease (CVD). There are datasuggesting that glycemic control does not substantially reduce CVD risk buthyperglycemia increases the risk of CVD. This apparent paradox could be explainedby the role of post-prandial hyperglycemia in the pathogenesis of cardiovascularcomplications in T2DM. There is numerous evidences, both experimental andclinical, for this association but controversies on this topic persist. The aim of thispaper was to review the current literature regarding the role of postprandial glucosein the genesis of CVD in T2DM.

Interplay between statins and PPARs in improving cardiovascular outcomes: a double‐edged sword?

Statins are best-selling medications in the management of high cholesterol and associated cardiovascular complications. They inhibit 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA)-reductase in order to prevent disproportionate cholesterol synthesis. Statins slow the progression of atherosclerosis, prevent the secondary cardiovascular events and improve the cardiovascular outcomes in patients with elevated cholesterol levels. The underlying mechanisms pertaining to the cardioprotective role of statins are linked with numerous pleiotropic actions including inhibition of inflammatory events and improvement of endothelial function, besides an effective cholesterol-lowering ability. Intriguingly, recent studies suggest possible interplay between statins and nuclear transcription factors like PPARs, which should also be taken into consideration while analysing the potential of statins in the management of cardiovascular complications. It could be suggested that statins have two major roles: (i) a well-established cholesterol-lowering effect through inhibition of HMG-CoA-reductase; (ii) a newly explored PPAR-activating property, which could mediate most of cardiovascular protective pleiotropic effects of statins including anti-inflammatory, antioxidant and anti-fibrotic properties. The present review addressed the underlying principles pertaining to the modulatory role of statins on PPARs.

Cardiovascular Complications of Breast Cancer Therapy in Older Adults

Older adults frequently have pre-existing and cancer-related risk factors for cardiovascular toxicity from cancer treatment. In this review, we discuss the risk factors and strategies for prevention and management of cardiovascular complications in older women with breast cancer.

Influences of diabetes on the development and progression of cardiovascular disease

Introduction The prevalence of type 2 diabetes mellitus is increasing rapidly worldwide, and by 2030 this insidious condition may well affect 438 million individuals, though this may still be an underestimate. Diabetes mellitus is also a considerable public health concern and more aggressive management of the condition and its complications, particularly cardiovascular disease, is warranted. This dramatic situation requires a more profound understanding of pathophysiological conditions preceding vascular damage in diabetes, the identification and adaptation of new and innovative diagnostic strategies in selecting diabetic patients at high cardiovascular risk and last but not least of course the development and availability of effective and safe drugs for blood glucose control and for the reduction of vascular risk. The March/April 2010 issue of our journal focuses on all three aspects and discusses the management of cardiovascular complications in diabetes. This provides me with the opportunity to introduce myself as a new member of the editorial team of the British Journal of Diabetes & Vascular Disease with primary responsibility for cardiovascular topics.

Management of cardiovascular complications in systemic lupus erythematosus

Cardiovascular disease (CVD) is a major cause of morbidity and mortality in patients with systemic lupus erythematosus (SLE). Patients with SLE have an excess risk compared with the general population; this is particularly pronounced in younger women with SLE who have an excess risk of over 50-fold compared with population controls. There is a higher prevalence of subclinical atherosclerosis in patients with SLE compared with controls, as demonstrated by a variety of imaging modalities discussed in this review. The causality of the excess risk of CVD and subclinical atherosclerosis is multifactorial in patients with SLE. While traditional risk factors play a role, after controlling for the traditional Framingham risk factors, the excess risk is still 7.5-fold greater than the general population. This review will also cover novel cardiovascular risk factors and some SLE-specific variables that contribute to CVD risk. This review discusses the risk factor modification and the evidence available for treatment of these risk factors in SLE. There have not yet been any published randomized, controlled trials in patients with SLE with respect to CVD risk factor modifications. Thus, the treatment and management recommendations are based largely on published guidelines for other populations at high risk for CVD.

The Heart And HIV/ AIDS

HIV/AIDS is one of the leading health problems in the world, especially in sub-saharan Africa, where it is the single greatest health challenge facing the continent. Cardiac involvement impacts on the natural history and prognosis of the disease, however, evidence of cardiac involvement may be clinically quiescent initially. With improved management of opportunistic infections, and the advent of Highly Active AntiRetroviral Therapy (HAART), more organ related manifestations of the disease including heart diseases are emerging. The extra cardiovascular burden will be enormous in view of the increasing prevalence of HIV infection globally.This demands an awareness by clinicians of its cardiovascular manifestations for a complete and rational diagnosis and management. This article presents a concise review of the clinical manifestations, pathophysiolgy/ pathogenesis and management of Cardiovascular complications in HIV/AIDS.

Venous air embolism during laparoscopic cholecystectomy

Vascular air embolism is a rare and potentially life-threatening event. In this study, a case of venous air embolism during laparoscopic cholecystectomy due to an injured inferior vena cava is presented. Anesthesiologists and surgeons must be aware of this dangerous complication. Emphasis is given to the prevention and prompt recognition of this event and to the use of all available tools in the management of cardiovascular complications.

Suspected venous air embolism in a Finnhorse

SummaryVascular air embolism (VAE) is the entrainment of air from the operative field or other communication with the environment into the venous or arterial vasculature, producing systemic effects. The horse described in this report, after having been discovered to have dislodged the extension set from the jugular vein catheter, demonstrated clinical signs considered most likely to have resulted from a VAE, and represents a case of primarily neurological signs resolving spontaneously. Emphasis is given to the prevention and prompt recognition of this event and to the use of all available tools in the management of cardiovascular complications.

Cardiovascular complications associated with biological therapies for breast cancer

Background: With increasing number of breast cancer survivors, treatment-associated toxicities are gaining importance because they may decrease quality of life and shorten expected survival. Biological treatment strategies are less toxic than conventional chemotherapy. However, practically all biological therapies for breast cancer induce cardiovascular complications. In the case of targeted therapies mechanisms of cardiotoxicity and strategies to manage cardiovascular disorders have not been completely defined. Methods: Articles were found by searching PubMed and abstract databases of several oncological meetings. This review summarizes the risks and mechanisms of cardiovascular complications associated with biological agents used in treatment of breast cancer. Results/conclusion: Introduction of biological therapies has resulted in reduction of morbidity and mortality of breast cancer patients in recent years. However, all biological strategies bring a risk of cardiotoxicity and despite progress in the knowledge and management of cardiovascular complications there are still many unaswered questions.

The influence of yoga-based programs on risk profiles in adults with type 2 diabetes mellitus: a systematic review.

There is growing evidence that yoga may offer a safe and cost-effective intervention for Type 2 Diabetes mellitus (DM 2). However, systematic reviews are lacking. This article critically reviews the published literature regarding the effects of yoga-based programs on physiologic and anthropometric risk profiles and related clinical outcomes in adults with DM 2. We performed a comprehensive literature search using four computerized English and Indian scientific databases. The search was restricted to original studies (1970–2006) that evaluated the metabolic and clinical effects of yoga in adults with DM 2. Studies targeting clinical populations with cardiovascular disorders that included adults with comorbid DM were also evaluated. Data were extracted regarding study design, setting, target population, intervention, comparison group or condition, outcome assessment, data analysis and presentation, follow-up, and key results, and the quality of each study was evaluated according to specific predetermined criteria. We identified 25 eligible studies, including 15 uncontrolled trials, 6 non-randomized controlled trials and 4 randomized controlled trials (RCTs). Overall, these studies suggest beneficial changes in several risk indices, including glucose tolerance and insulin sensitivity, lipid profiles, anthropometric characteristics, blood pressure, oxidative stress, coagulation profiles, sympathetic activation and pulmonary function, as well as improvement in specific clinical outcomes. Yoga may improve risk profiles in adults with DM 2, and may have promise for the prevention and management of cardiovascular complications in this population. However, the limitations characterizing most studies preclude drawing firm conclusions. Additional high-quality RCTs are needed to confirm and further elucidate the effects of standardized yoga programs in populations with DM 2.