Heart drugs
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Heart Drugs: Efficacy, Safety, and Adverse Effects
Primary Prevention of Atherosclerotic Cardiovascular Disease (ASCVD)
Aspirin, Blood Pressure-Lowering Therapy, and Statins
Aspirin, blood pressure (BP)-lowering therapy, and statins are widely used for the primary prevention of ASCVD. Systematic reviews have shown that aspirin reduces the risk of ASCVD events by 10% but increases the risk of major bleeding by 54%. BP-lowering therapy significantly reduces the risk of coronary heart disease by 16% and stroke by 36%. Statins are highly effective, reducing ASCVD risk by 25% without increasing the overall risk of adverse effects.
Tobacco Cessation Drugs
Tobacco cessation drugs are effective in increasing the odds of continued abstinence from smoking, which indirectly benefits ASCVD prevention. However, their direct effects on ASCVD outcomes are not well-documented.
Drug-Induced Heart Failure
Non-Cardiac Drugs
Several non-cardiac drugs can induce or exacerbate heart failure. Notable examples include anticancer agents like anthracyclines, which can cause cardiomyopathy, and NSAIDs, which can lead to renal dysfunction and elevated BP, precipitating heart failure in vulnerable individuals . Other drugs such as immunomodulating agents, antidiabetics, and certain antidepressants also pose risks .
Cardiotoxicity of Common Medications
Many commonly used drugs, including psychotropic medications, antimicrobials, and antiarrhythmics, can adversely affect heart function. These drugs can cause changes that may be potentially lethal, especially when used in combination .
Pharmacokinetics in Heart Failure Patients
Intravenous and Oral Administration
Heart failure can alter the pharmacokinetics of drugs, affecting their absorption, distribution, and elimination. For instance, the systemic clearance of drugs like milrinone and hydralazine is significantly reduced in patients with severe heart failure. Oral administration of drugs such as ACE inhibitors and ARBs also shows altered pharmacokinetics, particularly in patients with symptomatic or decompensated heart failure.
Monitoring and Adjustments
Given the altered pharmacokinetics in heart failure patients, close monitoring of drug efficacy and adverse effects is crucial. Adjustments in dosing may be necessary to ensure therapeutic effectiveness while minimizing risks .
Mechanistic Insights and Modeling
Drug-Induced Arrhythmias
Drugs can interact with ion channels in heart cells, leading to arrhythmias. Computational modeling has shown that drugs like dofetilide can increase heart rate and cause mechanical dyssynchrony, affecting cardiac output. Understanding these effects is vital for drug safety evaluation and personalized medicine.
Conclusion
The use of heart drugs for the prevention and treatment of cardiovascular diseases is supported by substantial evidence. However, the potential for drug-induced heart failure and altered pharmacokinetics in heart failure patients necessitates careful monitoring and individualized treatment plans. Awareness of these factors can help healthcare professionals optimize therapy and improve patient outcomes.
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