Newer Therapeutic Strategies to Alter High-Density Lipoprotein Level and Function
Measurements of low levels of high-density lipoprotein (HDL) cholesterol have been identified as a risk factor for premature coronary artery disease, however, to date, current pharmacologic approaches for raising HDL have provided little benefit, if at all, in reducing cardiovascular outcomes. It has been shown that HDL can modify many aspects of plaque pathogenesis. Its most established role is in reverse cholesterol transportation, but HDL can also affect oxidation, inflammation, cellular adhesion, and vasodilatation. Considering these potential benefits of HDL, newer treatments have been developed to modify HDL activity...
Source: Cardiology in Review - December 6, 2013 Category: Cardiology Tags: Review Article Source Type: research

Pathophysiology of Coronary Vascular Remodeling: Relationship With Traditional Risk Factors for Coronary Artery Disease
The relationship between cardiovascular risk factors and vascular remodeling is a relatively new area of investigation. We discuss the various mechanisms by which cardiovascular risk factors cause vascular remodeling. Endothelial dysfunction, lipoprotein alterations, inflammation, and platelet activation are the mechanisms by which remodeling occurs. Plaque composition also plays an important role in directing remodeling. Plaque with extensive calcification is more likely to undergo constrictive remodeling. Positive and negative remodeling is based on how these factors coordinate and determine the direction of remodeling. ...
Source: Cardiology in Review - December 6, 2013 Category: Cardiology Tags: Review Article Source Type: research

20-HETE and Blood Pressure Regulation: Clinical Implications
20-Hydroxy-5, 8, 11, 14-eicosatetraenoic acid (20-HETE) is a cytochrome P450 (CYP)–derived omega-hydroxylation metabolite of arachidonic acid. 20-HETE has been shown to play a complex role in blood pressure regulation. In the kidney tubules, 20-HETE inhibits sodium reabsorption and promotes natriuresis, thus, contributing to antihypertensive mechanisms. In contrast, in the microvasculature, 20-HETE has been shown to play a pressor role by sensitizing smooth muscle cells to constrictor stimuli and increasing myogenic tone, and by acting on the endothelium to further promote endothelial dysfunction and endothelial acti...
Source: Cardiology in Review - December 6, 2013 Category: Cardiology Tags: Review Article Source Type: research

Treatment Options for Patients With Poor Clopidogrel Response
A significant percentage of patients demonstrate a poor antiplatelet response to clopidogrel. With the emergence of testing for genetic variations in drug-metabolizing enzyme function and testing for platelet function, it is becoming more common to identify patients as poor responders to clopidogrel. This leaves the clinician in a difficult situation when confronted with a patient deemed to be a poor clopidogrel responder as there is no clear therapeutic strategy for treating these patients. In this situation, a number of alternatives to conventional dosing of clopidogrel have been investigated, including increasing the do...
Source: Cardiology in Review - November 1, 2013 Category: Cardiology Tags: Feature Curbside Consult Source Type: research

Subclinical Hyperthyroidism and Cardiovascular Risk: Recommendations for Treatment
Subclinical hyperthyroidism (SHy), the mildest form of hyperthyroidism, is diagnosed in patients having a persistently low or undetectable serum concentration of thyroid-stimulating hormone (TSH) with normal free T4 and T3 concentrations. Although overt hyperthyroidism is associated with an increased risk of adverse cardiovascular outcomes, the cardiovascular risk of SHy is controversial. Multiple studies have demonstrated an increased risk of atrial fibrillation, especially in older individuals with TSH levels (Source: Cardiology in Review)
Source: Cardiology in Review - November 1, 2013 Category: Cardiology Tags: Review Article Source Type: research

Statins and Venous Thromboembolic Disease Prophylaxis
Statins have dramatically improved the treatment of hyperlipidemia and cardiovascular disease through its inhibition of hydroxymethylglutaryl-coenzyme A reductase. Although its main effect has long been known, much is yet to be understood about the wide and varied pleiotropic properties of statins. Some studies have demonstrated that statins contain antiplatelet, antithrombotic, antiinflammatory, cardioprotective, and neuroprotective properties independent of their ability to lower plasma low-density lipoprotein cholesterol. More recently, statins have been used in novel ways in the treatment of Alzheimer disease, sepsis, ...
Source: Cardiology in Review - November 1, 2013 Category: Cardiology Tags: Review Article Source Type: research

Temporal Evolution and Implications of Ventricular Arrhythmias Associated With Acute Myocardial Infarction
It is important that clinicians have a clear understanding of the significance of ventricular arrhythmias (VAs) that occur in the context of acute myocardial infarction depending on the type of VA and timing in relation to the myocardial injury. This will greatly assist in evaluating prognostic implications and tailoring optimal strategies for management. This review presents an update on the current understanding of the pathogenesis, incidence, and clinical features of postinfarction VAs, and outcomes and potential therapeutic options. (Source: Cardiology in Review)
Source: Cardiology in Review - November 1, 2013 Category: Cardiology Tags: Review Article Source Type: research

Vascular Extracellular Matrix in Atherosclerosis
The extracellular matrix (ECM) is an essential component of the human body that is responsible for the proper function of various organs. Changes in the ECM have been implicated in the pathogenesis of several cardiovascular conditions including atherosclerosis, restenosis, and heart failure. Matrix components, such as collagens and noncollagenous proteins, influence the function and activity of vascular cells, particularly vascular smooth muscle cells and macrophages. Matrix proteins have been shown to be implicated in the development of atherosclerotic complications, such as plaque rupture, aneurysm formation, and calcifi...
Source: Cardiology in Review - November 1, 2013 Category: Cardiology Tags: Review Article Source Type: research

Brown Adipose Tissue Thermogenesis: [beta]3-Adrenoreceptors as a Potential Target for the Treatment of Obesity in Humans
It has been shown in rodents and newborn babies that brown adipose tissue (BAT) plays an important role in the generation of heat for maintenance of core body temperature. BAT is responsible for the process of adaptive thermogenesis, which involves heat generation in response to a drop in the environment’s temperature or to high energy intake from diet. In rodents, the process of BAT thermogenesis is controlled by activation of the β3-adrenergic receptor (β3-AR), which has a protective effect against development of obesity. Previously, it was generally thought that in humans, BAT dissipated after childhood ...
Source: Cardiology in Review - November 1, 2013 Category: Cardiology Tags: Review Article Source Type: research

When Lithium Hurts: A Look at Ebstein Anomaly
Ebstein anomaly (EA) is a congenital defect of the tricuspid valve (TV) and the right ventricle (RV) in which the attachments of the septal and posterior valve leaflets are apically displaced. The latter creates 3 morphologic components inside the right heart, namely the right atrium proper, the atrialized RV, and the functional RV. This rare anomaly accounts for (Source: Cardiology in Review)
Source: Cardiology in Review - August 7, 2013 Category: Cardiology Tags: Review Article Source Type: research

Endothelin in Coronary Artery Disease and Myocardial Infarction
Coronary artery disease remains a major cause of morbidity and mortality. Experimental and clinical data have indicated an important role of endothelin-1 at various subclinical and clinical stages of the disease. Endothelin-1 causes endothelial dysfunction and inflammation and may contribute to atherosclerotic plaque formation. During acute myocardial infarction, endothelin-1 enhances myocardial necrosis and arrhythmogenesis, but seems to exert a favorable effect on subsequent infarct healing and early ventricular remodeling. In the chronic postinfarction phase, endothelin-1 increases left ventricular afterload and partici...
Source: Cardiology in Review - August 7, 2013 Category: Cardiology Tags: Review Article Source Type: research

Ambulatory Electrocardiology
This article reviews the state of the art of these techniques from both clinical and technical approaches, covering a historic perspective up to today, and discusses current applications, challenges, and future directions. (Source: Cardiology in Review)
Source: Cardiology in Review - August 7, 2013 Category: Cardiology Tags: Review Article Source Type: research

Arrhythmias in Athletes: Evidence-Based Strategies and Challenges for Diagnosis, Management, and Sports Eligibility
Assessment and management of cardiac rhythm disorders in athletes is particularly challenging. An accurate diagnosis and optimal risk-stratification are often limited because of substantial phenotypic overlap between pathological entities and adaptive cardiovascular responses that normally occur in athletes. An accurate diagnosis, however, is particularly important in this population, as 2 competing risks need to be cautiously balanced: the risk of under-diagnosis of an arrhythmogenic substrate that may trigger life-threatening events versus the risk of over-diagnosis that may result in an athlete’s improper disquali...
Source: Cardiology in Review - August 7, 2013 Category: Cardiology Tags: Review Article Source Type: research

Medico-Legal Issues in Cardiology
The aim of this article is to educate physicians about the current litigation climate in cardiology and cardiac surgery, with a focus on the most frequently litigated areas of practice, including failure to diagnose and treat myocardial infarction, coronary artery bypass graft surgery, percutaneous coronary intervention, and the use of tissue plasminogen activator. Empirical research on cardiology malpractice is presented, along with a sampling of up-to-date cases designed to illustrate common issues and important themes. The principles for reducing legal liability are also discussed, including the informed consent process...
Source: Cardiology in Review - August 7, 2013 Category: Cardiology Tags: Review Article Source Type: research

An Office-Based Approach to Emotional and Behavioral Risk Factor Reduction for Cardiovascular Disease
There are many psychological risk factors for cardiovascular disease, and the ability to reduce mortality depends on an ability to integrate care of these risk factors with traditional Framingham cardiovascular risk and use them both in routine practice. The aim of this article is to provide an update of all the major emotional and behavioral cardiovascular risk factors along with a practical treatment model for implementation. First, we provide a review of major emotional and behavioral cardiovascular risk factors, the associated primary effect, and proposed mechanism of action. Second, we provide an office-based approach...
Source: Cardiology in Review - August 7, 2013 Category: Cardiology Tags: Review Article Source Type: research

Apixaban: A New Factor Xa Inhibitor for Stroke Prevention in Patients With Nonvalvular Atrial Fibrillation
Atrial fibrillation (AF) is an independent risk factor for ischemic stroke occurrence, severity, recurrence, and mortality. Anticoagulation therapy for the prevention of thromboembolism is critical in patients with AF who are at risk of stroke. Warfarin has been an efficacious anticoagulant for this purpose, but its use has been limited by frequent laboratory monitoring, drug interactions, unpredictable individual response, delayed onset of action, and bleeding. Apixaban is the second oral direct selective factor Xa inhibitor approved for the prevention of stroke/systemic embolism in patients with nonvalvular AF. It was si...
Source: Cardiology in Review - June 6, 2013 Category: Cardiology Tags: New Therapy Update Source Type: research

Adenovirus Infections in Heart Transplantation
Adenovirus infections have been associated with significant morbidity and mortality in immunocompromised hosts. The clinical significance of adenovirus disease in heart transplantation is not well-defined; in particular, the significance of adenovirus identification in myocardium remains unclear. Although severe adenovirus disease has been described in heart transplant recipients, adenovirus infections seem to be more frequently associated with increased risk of adverse cardiac events, such as rejection, ventricular dysfunction, coronary vasculopathy, need for retransplantation, and graft loss because of death. Cidofovir i...
Source: Cardiology in Review - June 6, 2013 Category: Cardiology Tags: Review Article Source Type: research

Increased 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. However, various studies have shown that airflow limitation is an independent risk factor for cardiovascular diseases. Chronic low-grade systemic inflammation, oxidative stress and increased platelet activation have been widely reported to be pathophysiological links between COPD and atherosclerosis. Statins and...
Source: Cardiology in Review - June 6, 2013 Category: Cardiology Tags: Review Article Source Type: research

Clinical Utility of Three-Dimensional Echocardiography for the Evaluation of Ventricular Function
The evaluation of ventricular function is a core component of 2-dimensional echocardiography (2DE). Given the known limitations of 2DE, a more accurate assessment of ventricular function has long been desired. Three-dimensional echocardiography (3DE) holds promise to fulfill this role while still maintaining the same benefits of low cost, portability, and efficiency of 2DE. Although 3DE has been investigated for over 30 years, the technology has seen little use in the modern clinical echocardiography lab. Although the benefit provided by the additional dimension of 2DE over M-Mode was immediately apparent, the clinical adv...
Source: Cardiology in Review - June 6, 2013 Category: Cardiology Tags: Review Article Source Type: research

Contemporary Management of Tricuspid Regurgitation: An Updated Clinical Review
Tricuspid regurgitation (TR) is a complex and insidious valvular pathology that represents a complex decision and management algorithm for patients. TR is present in a significant proportion of the population and is especially prevalent in patients with advanced heart failure. Patients with TR have been demonstrated to have a decreased survival even with normal left heart function. TR can be a result of pathology that directly affects the valvular structure (ie, Ebstein anomaly) or as a result of increased forward pressures (ie, pulmonary hypertension, left heart failure). Conservative management of patients with TR is pri...
Source: Cardiology in Review - June 6, 2013 Category: Cardiology Tags: Review Article Source Type: research

Pulmonary Hypertension in Pregnancy
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. Currently, most pregnant patients receive advanced therapy for treatment of PAH, particularly prostacyclin analogues. Particular attention is paid to volume stat...
Source: Cardiology in Review - June 6, 2013 Category: Cardiology Tags: Review Article Source Type: research

A New Potential Approach to Inotropic Therapy in the Treatment of Heart Failure: Urocortin
Urocortins (UCNs), peptides that belong to the corticotrophin-releasing hormone family, represent a novel group of inotropic agents that have a multifaceted effect on the body with significant effects on the cardiovascular, hemodynamic, neurohormonal, and renal systems. UCNs can potentially improve the overall picture of heart failure by targeting not only the cardiovascular and hemodynamic systems like many current inotropic agents but also other systemic tissues that contribute significantly to the mortality and morbidity of heart failure. The 3 types of UCNs (1, 2, and 3) have been shown in preclinical studies to be eff...
Source: Cardiology in Review - April 12, 2013 Category: Cardiology Tags: Review Article Source Type: research

A New Approach to Inotropic Therapy in the Treatment of Heart Failure: Cardiac Myosin Activators in Treatment of HF
Systolic heart failure remains a leading cause of death and disability, and available pharmacologic treatments for heart failure are limited in both safety and effectiveness. Existing drugs focus on diverse mechanisms related to the pathophysiology of heart failure, yet none directly target the central feature of systolic heart failure, decreased cardiac contractility. Cardiac myosin activators, specifically omecamtiv mecarbil (formerly CK-1827452), directly activate the enzymatic pathway within the cardiac myocyte leading to ventricular contraction. This unique inotropic agent has been shown in preclinical and clinical st...
Source: Cardiology in Review - April 12, 2013 Category: Cardiology Tags: Review Article Source Type: research

Sarcoendoplasmic Reticulum Calcium Transport ATPase 2a: A Potential Gene Therapy Target in Heart Failure
The development of cardiac-specific adeno-associated viral vectors capable of long-term transgenic expression has opened new avenues in the therapeutic approach to heart failure. Failing cardiomyocytes demonstrate altered calcium-handling secondary to depressed expression and activity of myocardial sarcoendoplasmic reticulum calcium ATPase 2a (SERCA2a). This observation has led to a large body of research investigating the therapeutic utility of SERCA2a gene therapy in heart failure. (Source: Cardiology in Review)
Source: Cardiology in Review - April 12, 2013 Category: Cardiology Tags: Review Article Source Type: research

Remote Patient Monitoring in Chronic Heart Failure
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. Readmission for decompensated HF is often preceded by a stage of subclinical hemodynamic decompensation, where therapeutic interventions would prevent subsequent clinical decompensation and hospitalization. Various methods of remote patient monitoring include structured telephone support, advanced telemonitoring technologies, remote monitoring of patients with implanted cardiac devices such as pacemakers...
Source: Cardiology in Review - April 12, 2013 Category: Cardiology Tags: Review Article Source Type: research

Energy Metabolism in Cardiac Remodeling and Heart Failure
Fatty acids are the main substrates used by mitochondria to provide myocardial energy under normal conditions. During heart remodeling, however, the fuel preference switches to glucose. In the earlier stages of cardiac remodeling, changes in energy metabolism are considered crucial to protect the heart from irreversible damage. Furthermore, low fatty acid oxidation and the stimulus for glycolytic pathway lead to lipotoxicity, acidosis, and low adenosine triphosphate production. While myocardial function is directly associated with energy metabolism, the metabolic pathways could be potential targets for therapy in heart fai...
Source: Cardiology in Review - April 12, 2013 Category: Cardiology Tags: Review Article Source Type: research

Using Biomarkers to “Guide” Heart Failure Management: Current Perspectives and Future Directions
Over the last several years, cardiac biomarkers have proven to be increasingly useful for disease screening, diagnosis, and prognostication. The most widely used biomarkers in heart failure (HF) are natriuretic peptides (NPs), which can aid in diagnosing HF, while also identifying those who are at higher risk of adverse outcomes. Multiple clinical trials have investigated the role of NPs as therapeutic targets for HF management, but results have been conflicting. Collectively, however, the data suggest that NP levels may be useful in guiding HF management and improving HF-related morbidity and mortality. In this review, we...
Source: Cardiology in Review - April 12, 2013 Category: Cardiology Tags: Review Article Source Type: research

Evolution of the Chronic Congestive Heart Failure Paradigm
Paradigms are a part of our human nature. In the world of medicine and science, they allow investigators to work within a particular, previously accepted framework that provides certain constraints. This is the crux of Newton’s quote, “If I’ve seen so far it’s because I stood upon the shoulders of giants.” However, in the same way that it allows us to build, it can constrain our thought processes if we fail to accept new data that are ill suited to an accepted paradigm. The physiological mechanisms to explain the phenomenon of chronic congestive heart failure are similar to other paradigms of ...
Source: Cardiology in Review - April 12, 2013 Category: Cardiology Tags: Review Article Source Type: research

The Existence of Myocardial Repair: Mechanistic Insights and Enhancements
The lack of myocardial repair after myocardial infarction and the heart failure that eventually ensues was thought of as proof that myocardial cell regeneration and myocardial repair mechanisms do not exist. Recently, growing experimental and clinical evidence has proven this concept wrong. Cardiac stem cells and endogenous myocardial repair mechanisms do exist; however, they do not produce significant myocardial repair. Similarly, the preliminary results of stem cell therapy for myocardial repair have shown early promise but modest results. Preclinical studies are the key to understanding stem cell senescence and lack of ...
Source: Cardiology in Review - April 12, 2013 Category: Cardiology Tags: Review Article Source Type: research

Saphenous Vein Graft Disease: Review of Pathophysiology, Prevention, and Treatment
Saphenous vein graft (SVG) disease after coronary artery bypass grafting (CABG) occurs in three phases: thrombosis, intimal hyperplasia, and atherosclerosis. Within the first month, thrombosis plays a major role. From month 1 to month 12, intimal hyperplasia occurs. Beyond 12 months, atherosclerosis becomes the primary cause for late graft failure. Endothelial damage has been shown to be the major underlying pathophysiology of SVG disease. Many factors contribute to endothelial damage from the moment the vein is harvested to when the vein is grafted into an arterial environment. To address this disease process, various the...
Source: Cardiology in Review - February 15, 2013 Category: Cardiology Tags: Review Articles Source Type: research

Second-Hand Tobacco Smoke and Cardiovascular Disease Risk: An Epidemiological Review
In this review, we have sought to examine the epidemiological, basic science, and public health data regarding the association between second-hand smoke (SHS) exposure and the development of coronary heart disease (CHD). SHS increases the risk of CHD by 25–30% according to multiple cohort, case-control, and meta-analytical studies. Physiologic and basic science research suggest that the mechanisms by which SHS affects the cardiovascular system are multiple and include increased thrombogenesis and low-density lipoprotein oxidation, decreased exercise tolerance, dysfunctional flow-mediated vasodilatation, and activatio...
Source: Cardiology in Review - February 15, 2013 Category: Cardiology Tags: Review Articles Source Type: research

A Systematic Literature Review of Risk Factors for Stroke in China
Other countries have seen a decline in stroke incidence after improved treatment and prevention of known risk factors for stroke. China is still experiencing significant increases in the incidence rate of total stroke. We systematically reviewed the evidence on the impact of 5 modifiable risk factors (hypertension, dyslipidemia, obesity, diabetes, and smoking) for the risk of stroke in the Chinese population, with the aim to develop more effective prevention and disease management programs. A literature search was conducted in MEDLINE and EMBASE for all observational studies that reported on the association between risk of...
Source: Cardiology in Review - February 15, 2013 Category: Cardiology Tags: Review Articles Source Type: research

Transcatheter Aortic Valve Replacement: Current Developments, Ongoing Issues, Future Outlook
Since the first clinical implantation in 2002, transcatheter aortic valve implantation or transcatheter aortic valve replacement (TAVR) has become an established therapy in the treatment of symptomatic severe aortic stenosis in patients deemed too high risk for surgical aortic valve replacement. With over 50,000 implants performed in more than 40 countries, a large amount of clinical data have emerged in this rapidly growing field. Careful patient selection, systematic risk stratification, optimal valve sizing, meticulous procedural techniques, and complications management are all important elements to achieve good outcome...
Source: Cardiology in Review - February 15, 2013 Category: Cardiology Tags: Review Articles Source Type: research