Cardiovascular & hematological agents in medicinal chemistry最新文献

Background: Sympathomimetic nasal decongestants such as pseudoephedrine, phenylephrine, oxymetazoline, and xylometazoline are commonly used to relieve nasal blockage caused by allergic rhinitis, infections, or sinus inflammation. They work by activating α-adrenergic receptors, which promote vasoconstriction. However, overuse or inappropriate use of these medications has been linked to serious cardiovascular and cerebrovascular side effects.

Objective: The purpose of this review is to compile the available clinical evidence on the misuse and overuse of sympathomimetic nasal decongestants and their association with detrimental cardiovascular and cerebrovascular outcomes. It examines potential mechanisms, identifies risk factors, highlights diagnostic concerns, and outlines preventive measures.

Methods: A thorough literature search was conducted using databases such as Medline, Pub- Med, Scopus, Web of Science, and Google Scholar. The selection included case reports, observational studies, pharmacovigilance data, and clinical investigations published in English that evaluated the negative cardiovascular or cerebrovascular effects of sympathomimetic decongestants. Duplicate records were removed.

Results and discussion: Although rare, significant events such as myocardial infarction, stroke, hypertensive crises, and vasospasm have been documented with both oral and intranasal sympathomimetics, particularly when used excessively or in combination with other medications. Strong vasoconstriction, endothelial dysfunction, and elevated sympathetic activity are the primary mechanisms underlying these adverse effects. Nonspecific symptoms and underreporting of OTC drug use can delay diagnosis. Numerous reports suggest potentially serious or fatal outcomes, and most clinical evidence comes from case reports rather than high-level studies.

Conclusion: Sympathomimetic nasal decongestants are generally safe when used as directed. However, excessive or inappropriate use may lead to potentially fatal cerebrovascular and cardiovascular events. Healthcare professionals should thoroughly review patients' medication histories and provide clear instructions on proper use. Educating patients on the correct administration of sympathomimetic nasal decongestants and encouraging safer alternatives such as intranasal corticosteroids or saline sprays, when appropriate, is essential. Preventive measures, regulatory oversight, and interprofessional collaboration are crucial to ensuring safe use and reducing adverse outcomes.

Introduction: Heart failure (HF) is prevalent and debilitating, particularly among individuals with type 2 diabetes mellitus (T2DM). This study compared outcomes associated with sodium-glucose cotransporter-2 inhibitors (SGLT2i) versus the combination of furosemide and metformin in patients with HF and T2DM.

Methods: We used TriNetX, a global federated network of de-identified electronic health records from 98 healthcare organizations. Adults (≥18 years) with HF and T2DM were assigned to cohorts based on medication exposure. Propensity score matching (1:1) was performed to balance baseline characteristics. Outcomes were assessed using Cox models and Kaplan-Meier curves.

Results: Among 208,761 eligible patients (SGLT2i = 4,847; furosemide and metformin = 203,914), 4,824 patients per group remained after matching. In the matched cohorts, SGLT2i use was associated with lower all-cause mortality (hazard ratio [HR] = 4.077 for furosemide and metformin vs. SGLT2i; p < 0.001) and reduced hospitalization risk (e.g., HR/RR estimates summarized in Tables 2 and 4; see figure caption for Cox HRs). At the end of the observed follow- up (median follow-up detailed in Table 3), Kaplan-Meier survival probability remained higher in the SGLT2i group (82.84%) compared with the furosemide and metformin group (21.33%). Given the magnitude of this absolute difference relative to randomized trials, residual confounding is likely despite matching.

Conclusion: In this real-world analysis, SGLT2i use was associated with lower mortality and fewer hospitalizations compared with furosemide and metformin in patients with HF and T2DM. These findings should be interpreted as associations rather than causal effects due to the observational design and potential residual confounding. The results are hypothesis-generating and directionally consistent with prior randomized evidence.

Hypertension, a prevalent cardiovascular condition, increases the risk of strokes and myocardial infarctions by inducing elevated blood pressure. Its prevalence has risen, particularly in low- and middle-income nations. The incidence of hypertension in adults is higher in low- and middle-income countries compared to high-income nations. One significant class of antihypertensive drugs is α1-adrenoceptor antagonists, which inhibit α1-adrenergic receptors and promote vasodilation. Terazosin, doxazosin, tamsulosin, and alfuzosin are examples of α1-adrenoceptor antagonists that have antihypertensive properties; however, they are linked to considerable side effects, including headaches, dizziness, reproductive problems, and postural hypotension. In the last several years, a number of novel α1-adrenergic antagonists have been synthesised by modifications of various pharmacophores such as Isochroman-4-one, Quinazolines, Piperazine, and Quinazoline-triazole, etc. The present review highlights recently synthesized α1-adrenoceptor antagonists for the management of hypertension, and emphasizes their structure-activity relationship and subtype selectivity.

Background: Pulmonary Hypertension (PH) is a significant contributor to cardiac mortality in Dilated Cardiomyopathy (DCM) patients. Inflammatory processes and oxidative stress play pivotal roles in the advancement of Pulmonary Hypertension (PH). The Monocyte-to-High-- Density-Lipoprotein Cholesterol Ratio (MHR), a newly identified biomarker indicative of inflammatory and oxidative stress, has not been extensively researched in the context of pulmonary hypertension, especially within the scope of dilated cardiomyopathy.

Objective: Given the reason mentioned above, our research explores the correlation between the MHR and the severity of PH in patients suffering from DCM.

Methods: In this study, we conducted a retrospective review of medical data from 107 individuals diagnosed with non-ischemic DCM, evaluating their clinical profiles, biochemical indicators, MHR, and echocardiographic parameters. We analyzed the relationships between Pulmonary Arterial Systolic Pressure (PASP) and the Ejection Fraction of the Left Ventricle (LVEF). Utilizing logistic regression analysis, we determined the predictors of PH.

Results: Findings indicated that the DCM-PH group exhibited a significantly larger male population and elevated New York Heart Association (NYHA) classification scores (both with p-values <0.001 and 0.01, respectively) compared to the DCM-only group. A positive association was observed between the PASP and parameters, such as the Dimensions of the Left Atrium (LAD) and Left Ventricle in Systole (LVDs), Monocyte (M) levels, Direct Bilirubin (DB), and MHR. Conversely, an inverse relationship was noted with serum lipid profiles, including Total Cholesterol (TC), HDL Cholesterol (HDL-c), and apolipoprotein A1. LVEF demonstrated positive linkage with the same lipid profiles and the Left Ventricular Posterior Wall Thickness (LVPWT) yet showed negative correlations with the NYHA classification, Red Blood Cell Distribution Width Standard Deviation (RDW-SD), Total Bilirubin (TB), Direct Bilirubin (DB), and dimensions of the left ventricle in diastole and systole, as well as MHR. Through logistic regression analysis, several factors were recognized as significant predictors for the severity of PH within the DCM cohort, with weight (OR1.20, CI 1.022-1.409, p=0.026), RDW-SD (OR1.988, CI 1.015-3.895, p=0.045), LVPW (OR3.577, CI 1.307-9.792, p=0.013), LVDd (OR1.333, CI 1.058-1.680, p=0.015), MHR (OR3.575, CI 1.502-8.506, p=0.032), and TB (OR1.416, CI 1.014-1.979, p=0.041) showing positive associations, while apoB (OR0.001 CI0.001-0.824, p=0.045) exhibiting negative associations, all with p-values <0.05.

Conclusion: Higher MHR and LVD correlate with increased PASP and reduced LVEF in DCMPH patients. MHR and LVPW are independent predictors of PH severity, indicating their potential as novel severity markers in DCM-related PH.

Introduction: Hypertension is associated with oxidative disturbances and often coexists with metabolic disorders like hyperlipidemia. Some antihypertensive drugs, particularly angiotensin- converting enzyme (ACE) inhibitors, offer benefits beyond lowering blood pressure by addressing related conditions. This study aimed to investigate the effects of ACE inhibitors on oxidative stress and dyslipidemia induced by L-NAME hypertension in rats.

Methods: Fifteen male Wistar rats (150-170 g) were divided into three groups. Group 1 received 10 mL/kg distilled water (control), while Groups 2 and 3 were orally administered 60 mg/kg of L-NAME (L-NAME60) for eight weeks to induce hypertension. After this period, Group 2 continued to receive L-NAME60 plus distilled water (HYP), and Group 3 received L-NAME60 plus ramipril (10 mg/kg) (RMHYP) for an additional five weeks. Blood pressure was measured using the tail-cuff method. Serum oxidative stress markers and lipid profiles were analyzed by spectrophotometry.

Results: The blood pressure significantly decreased in RMHYP compared to HYP. Malondialdehyde concentration significantly decreased, and antioxidant enzyme levels significantly increased in RMHYP compared to HYP. Serum lipid profiles showed a significant decrease in total cholesterol and triglycerides, as well as atherogenic indices, but a significant increase in highdensity lipoprotein cholesterol levels in RMHYP compared to HYP.

Discussion: This research shows that ramipril not only lowers blood pressure but also significantly reduces oxidative stress and dyslipidemia in L-NAME hypertensive rats, indicating its potential as an effective treatment for metabolic syndrome.

Conclusion: The findings of this study demonstrate that angiotensin-converting enzyme inhibitors (ramipril) have the ability to act as both an antioxidant and an anti-dyslipidemic agent in hypertensive conditions.

Introduction: Coriandrum sativum (C. sativum), widely known as coriander, is a herb of global significance, valued for its flavor and therapeutic properties. Originating from the Mediterranean, it has acclimatized to various continents, including Europe, Africa, and Asia.

Method: This review article was compiled from the data obtained from Google Scholar, Pub- Med/Medline, ScienceDirect, Hinari, and EBSCO.

Results: The herb thrives in areas with favorable agricultural climates, such as India, China, and parts of Europe. The plant's phytochemical spectrum is notably rich, featuring essential oils, flavonoids, phenolic compounds, and fatty acids. The seed oil is predominantly composed of linalool, complemented by γ-terpinene, decanal, and geranyl acetate. Both leaves and seeds are rich in nutrients, including tocopherols, carotenoids, chlorophylls, sugars, ascorbic acid, phenolics, and anthocyanins. C. sativum has shown beneficial effects in easing anxiety, depression, and convulsions, protecting neural health, combating bacteria and fungi, repelling insects, and supporting cardiovascular and diabetic health.

Discussion: These benefits are mainly due to the combined action of its phytochemicals. The toxicity study of this plant revealed that it is safe when administered in single or multiple doses. The essential oils of the herb have also been explored for their repellent and fumigant capabilities. Various clinical trials have been conducted to evaluate its different pharmacological safety profiles and assess its therapeutic potential.

Conclusion: This review aimed to discuss the botanical features, chemical constituents, pharmacological properties, toxicity studies, and clinical trials. Further study is needed related to embryonic and other toxicities.

Cardiovascular disease remains a leading global cause of mortality, with dyslipidemia as a major risk factor. While conventional lipid-lowering therapies are effective, they may have adverse effects, highlighting the need for alternative approaches. With its rich biodiversity and long-standing traditional medicine practices, Sri Lanka offers a natural alternative through medicinal plants with antilipidemic properties. Many of these plants are commonly used in Sri Lankan cuisine, not only enhancing flavor but also providing bioactive compounds that regulate lipid levels. This review explores the role of Murraya koenigii, Garcinia quesita, Garcinia zeylanica, Moringa oleifera, Tamarindus indica, Piper nigrum, and Trigonella foenum-graecum in managing dyslipidemia. These plants have demonstrated lipid-lowering effects by reducing total cholesterol, LDL cholesterol, and triglycerides while increasing HDL cholesterol, enhancing fat metabolism, and exerting antioxidant and anti-inflammatory properties. The review also promotes the integration of these herbs into daily meals for cardiovascular disease management, offering a natural remedy and prevention method. By integrating traditional knowledge with scientific research, Sri Lanka can enhance its healthcare system and improve cardiovascular health outcomes.

Introduction: The consumption of tea and coffee as beverages is prevalent worldwide, with each having potential health implications. The study investigated the effect of black tea (BT), green tea (GT), and coffee on blood pressure (BP), heart rate (HR), and blood glucose level (BGL) in healthy females.

Methods: Forty (40) participants aged 18 to 26 were randomly assigned to four groups: control (250 mL warm water), GT (2 g GT dissolved in 250 mL of hot water), coffee (2 g coffee dissolved in 250 mL of hot water), and BT (2 g BT dissolved in 250 mL of hot water) groups with 10 subjects each. Each group was given its designated drink once a day for three consecutive days. Baseline measurements of BP, HR, and BGL were taken after a 15-minute rest before the consumption of the beverages. Follow-up measurements were taken at 15, 30, 45, and 60 minutes after consumption for cardiovascular indices, and 30 and 60 minutes for BGL. This procedure was repeated for three days.

Results: The results showed no significant changes in BP, HR, and BGL in all the experimental groups compared to the control group.

Discussion: Coffee and tea are popular beverages enjoyed worldwide, recognized for their numerous health benefits largely due to their bioactive compounds, particularly polyphenols and caffeine. The different concentrations of polyphenols and caffeine in these drinks can affect various physiological functions in distinct ways. The results of the present study showed no significant changes in blood pressure, heart rate, or blood glucose level among healthy young female participants who consumed green tea, coffee, and black tea, respectively. Although some previous studies have indicated that these beverages can significantly impact these health metrics, other research has shown no notable changes. The lack of significant findings in this study may be attributed to its short duration; a more extended study could potentially uncover significant changes.

Conclusion: The findings of this study revealed that green tea, black tea, and coffee have no acute effect on blood pressure, heart rate, and blood glucose levels in healthy female individuals. It can therefore be concluded that green tea, black tea, and coffee have a neutral effect on these physiological parameters, but a more elaborate study is highly recommended.

Background: Chronic renal failure (CRF) triggers chronic systemic inflammation and causes vascular calcification, a prominent contributor to the progression of cardiovascular disease. Adropin and spexin peptides regulate energy balance; also, these peptides trigger anti-inflammatory pathways.

Objective: Our present study aimed to clarify the potentially protective impact of spexin and adropin peptides on cardiovascular inflammation in an adenine-induced chronic renal failure model.

Methods: The CRF model in Sprague-Dawley rats was established by the administration of adenine hemisulfate for ten days. Then, rats were treated with saline or adropin, or/and spexin for four weeks. CRP, CK, and CK-MB levels in serum were measured by autoanalyzer. Aortic contraction- relaxation responses were determined by the organ bath system. H&E, PAS, and Masson's trichrome stainings evaluated histopathological alterations in both aorta and cardiac tissue. Gene expression levels of ILs (IL1β, IL10, IL17A, IL18, IL21, and IL33), MMPs (MMP1, MMP2, MMP3, MMP9, MMP13, and MMP14), NGAL, TGFβ1, TIMP1, and TNFα in cardiac tissue were evaluated by real-time PCR.

Results: We found increased CK and CK-MB levels by CRF induction. In addition, IL1β, IL17A, IL18, IL21, MMP1, MMP3, MMP13, and MMP14 increased after CRF progression. While adropin has effects on CK levels, spexin decreases CK-MB levels. Also, adropin and spexin had a nitric oxide-dependent impact on vascular reactivity. Besides, spexin downregulated IL1β, IL10, IL17A, TGFβ1, MMP1, MMP3, MMP9, MMP13, MMP14 and NGAL; however, the adropin peptide had a limited effect.

Conclusion: These results suggest that adropin and spexin have potential preventive roles on vascular damage in CRF progression via modulation of MMPs and inflammatory genes.