Cardiology in Review最新文献

The adverse effects of environmental noise on human health have been recognized for more than a century. In particular, during the last decades, the vast majority of studies have focused on the detrimental role of noise in the induction of cardiovascular diseases. In this study, we aim to conduct a literature review on chronic stress responses induced by environmental noise, the risk of cardiovascular disease, and the underlying pathophysiological mechanisms. We retrieved the publications from the PubMed database by searching for "noise AND cardiovascular." By reviewing these publications in this study, we will first describe the epidemiologic research on cardiovascular risk factors and diseases induced by environmental noise, then discuss the mechanism(s) underlying these noise-induced cardiovascular impairments based on clinical and experimental studies, and finally evaluate the strategies to mitigate the effects of noise on cardiovascular health. We also evaluate the studies that describe the effects of noise level and noise intermittency, such as train noise, on cardiovascular health. We discuss whether environmental noise should be part of a risk factor profile for cardiovascular disease and how we should manage it, and assess the strategy that can be used to mitigate the noise-induced physiopathological changes. Furthermore, we briefly describe the effects of air pollution and heavy metals on cardiovascular health and discuss the relevance of these environmental stressors in the noise-induced cardiovascular disease. Our studies suggest that future studies are warranted to investigate new strategies that can mitigate the adverse effects of environmental noise on cardiovascular health.

Coronary artery disease (CAD) is responsible for 690,000 deaths a year, a leading cause of mortality worldwide. CAD results from cholesterol plaque buildup in arteries. Chelation therapy, which uses ethylenediaminetetraacetic acid to remove toxic metals from the bloodstream, has been explored as an alternative treatment for atherosclerotic CAD. While the 2013 Trial to Assess Chelation Therapy (TACT) trial showed modest cardiovascular benefits, particularly in patients with diabetes, subsequent studies such as TACT2 did not confirm its efficacy in reducing cardiovascular events in patients with diabetes. Adverse effects of chelation therapy could include renal dysfunction, electrolyte imbalances, and potential complications from heavy metal mobilization that could be fatal. Still, none of these were seen in TACT or TACT2.

Aldosterone plays a critical role in maintaining volume and blood pressure control. It also plays a highly negative role in vascular diseases such as systemic hypertension, congestive heart failure, and cardiorenal syndrome due to the critical role that the renin-angiotensin-aldosterone system plays in these diseases from oxidative stress, vasoconstriction, and vascular remodeling caused by angiotensin II. Controlling aldosterone involves drugs such as angiotensin-converting enzyme inhibitor/angiotensin receptor blockers and mineralocorticoid receptor antagonists (MRAs). Recent guidelines suggest that the MRAs were more beneficial than angiotensin-converting enzyme inhibitor/angiotensin receptor blockers and diuretics in resistant hypertension. It is also essential to understand the role of both mineralocorticoid receptors (MRs) and glucocorticoid receptors (GRs) because they are present in many of the same tissues, and the balance of these 2 receptors is critical for homeostasis. Glucocorticoids activate MRs at basal levels and GRs at stress levels. During oxidative stress, MR activation can negatively affect the balance of MRs/GRs interactions, cognition, and memory. The older drugs in this category were less effective than MRAs in controlling blood pressure. A new class of drugs to consider are the aldosterone synthase inhibitors, which inhibit salt and water reabsorption and decrease sympathetic stimulation. The ideal candidate drug must be capable of inhibiting the MR while sparing the glucocorticoid receptor, a challenge given the 95% homology of these receptors.

Sickle cell trait was once considered to benign hereditary condition, besides the association of renal medullary carcinoma, affecting red blood cells. The inherited disorder creates several health issues under various conditions, such as dehydration, hypoxia, or extreme physical exertion. Healthcare professionals and patients with the disorder should understand the importance of vascular complications in sickle cell traits. This article emphasizes the pathophysiology, epidemiology, and molecular basis of the sickle cell trait, which involves virtually every organ system and involves vascular endothelial dysfunction, cerebral vasculopathy, renal complications, cardiopulmonary manifestations, and splenic issues. Techniques of prevention and management strategies for quality-of-life improvement in the case of sickle cell trait are presented.

Trimetazidine is an antianginal medication approved in numerous countries for use in the symptomatic treatment of stable coronary artery disease and angina pectoris. Its main mechanism of action revolves around the inhibition of β-oxidation of free fatty acids in the myocardium, in addition to its antioxidant properties and inhibition of cardiac fibrosis. Based on current evidence, trimetazidine is classified by European guidelines as a second-line antianginal agent and as an add-on for the symptomatic treatment of stable angina in patients not adequately controlled with first-line antianginal therapies such as beta-blockers. However, its role in the treatment of cardiovascular disease extends past coronary artery disease, as numerous studies have demonstrated its potential benefit in heart failure patients as well. Unfortunately, trimetazidine's role in the treatment of heart failure is still not clearly identified, since most studies on this topic were underpowered and unable to reach a decisive conclusion regarding any potential mortality benefits in heart failure. Current European guidelines have categorized trimetazidine as a class IIb recommendation in patients with heart failure with reduced ejection fraction and angina because of its additive effects of improved left ventricular function and anginal symptom relief in patients already on beta-blockers. Additionally, trimetazidine's use in coronary interventions (ie, percutaneous coronary intervention and coronary artery bypass grafting) showed a reduction in the frequency of anginal attacks and myocardial damage, but the studies were also underpowered and therefore unable to conclusively determine whether trimetazidine should be incorporated in guideline-directed therapy for coronary interventions.

There has been ongoing debate about whether to continue or withhold angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) in patients undergoing noncardiac surgery. With over 200 million surgeries performed annually worldwide and millions of patients on ACE inhibitors and ARBs, it is crucial to elucidate the best management strategy for patients undergoing noncardiac surgery while on these medications. Several large randomized controlled trials, the Stop-or-Not and the Perioperative Ischemic Evaluation-3 trials, were conducted to investigate this important issue. Both clinical trials demonstrated no difference in cardiovascular adverse events, including vascular death, myocardial injury, stroke, and cardiac arrest, with continuation versus discontinuation of ACE inhibitors or ARBs in patients undergoing noncardiac surgery. However, these clinical trials showed a higher incidence of intraoperative hypotension in patients who continued taking their ACE inhibitor or ARB through the surgery. Based on this evidence, the American College of Cardiology 2024 Perioperative Guidelines recommend that patients undergoing elevated-risk surgery should have their ACE inhibitor or ARB withheld 24 hours before the surgery; however, patients with heart failure with reduced ejection fraction undergoing noncardiac surgery should continue their regimen. Currently, while the evidence indicates no difference in adverse outcomes between continuing and discontinuing ACE inhibitors and ARBs in patients undergoing noncardiac surgery, the decision to continue or withhold these medications remains individualized. Clinicians must consider various patient and clinical factors when making this decision, including the type of surgery, the risk for intraoperative blood loss and hypotension, and the specific indication of the ACE inhibitor or ARB.

Sodium-glucose cotransporter-2 (SGLT2) inhibitors were originally approved for use in type 2 diabetes, but in recent years, these medications were found to also have significant cardiovascular benefits in patients with heart failure with reduced and preserved ejection fraction and chronic kidney disease. Part of the cardiovascular benefits of SGLT2 inhibitors likely comes from their antihypertensive effect in addition to other unknown effects, but the mechanism by which these medications reduce blood pressure has not been identified yet. Multiple mechanisms have been proposed to describe SGLT2 inhibitors' antihypertensive effect, including their associated weight loss and diuretic effect. However, studies have shown that these indirect mechanisms alone do not account for the antihypertensive effect seen with this medication, with more recent studies identifying a new potential mechanism by which SGLT2 inhibitors may derive their direct antihypertensive and cardiovascular benefits. In animal models, SGLT2 receptors were identified in parts of the brain responsible for regulating the sympathetic nervous system and adjusting blood pressure. In these studies, SGLT2 inhibitors suppressed the neuronal activity in these brain regions, reducing the sympathetic nervous system activity and blood pressure of the animals. Further investigation is needed to identify whether there are SGLT2 receptors in the central nervous system of humans and whether SGLT2 inhibitors can suppress neuronal activity in these brain regions. This information could be significant in learning more about the susceptibility and severity of primary hypertension in certain patient populations, as well as identifying whether SGLT2 inhibitors can be considered as a primary antihypertensive agent.

Syphilis is a disease caused by the spirochete bacterium Treponema pallidum, progressing in 4 stages: primary, secondary, latent, and tertiary syphilis. In the tertiary stage, patients may develop cardiovascular syphilis, which includes syphilitic aortitis, aortic aneurysm, aortic regurgitation, and coronary artery involvement. These cardiovascular manifestations increase morbidity and mortality during this late stage of syphilis. A recent large-scale, population-wide study has built on our knowledge of cardiovascular syphilis by identifying an increased risk for the development of acute myocardial infarction, heart failure, atrial fibrillation, ischemic stroke, hemorrhagic stroke, venous thromboembolism, and cardiovascular death in syphilis patients. This review discusses the incidence and pathophysiology of these various manifestations of cardiovascular syphilis, while also detailing the latest treatment options and the prognosis of these conditions. The clinical significance of this topic stems from the fact that the incidence of syphilis has spiked in recent years after previously reaching an all-time low in 1999. According to the Centers for Disease Control in the United States, from 2018 to 2022, the reported cases of syphilis increased by 80%. However, the incidence of cardiovascular syphilis has remained the same during this period, likely due to the efficacy of penicillin use early in the infection, preventing the progression of the disease to the tertiary stage. As a result, cardiovascular syphilis mostly remains a disease of the past, with only a few sporadic cases being reported in the literature in recent years.

Hypopituitarism is a rare condition that presents significant diagnostic challenges, particularly in elderly patients (over 65 years of age). It often manifests with a range of symptoms affecting multiple organ systems, with cardiovascular involvement being uncommon. As a result, the underlying diagnosis may be easily overlooked. Physicians must maintain a high level of awareness about hypopituitarism to establish an accurate diagnosis and initiate appropriate treatment. This study reviews recent advances in understanding the cardiovascular manifestations of hypopituitarism.