Abstract:
:The complex mechanism of platelet activation creates an optimal target for pharmacological treatment in patients with acute coronary syndromes. Current antiplatelet medications that are used in addition to aspirin include the thienopyridines, clopidogrel and prasugrel, but there are several limitations to the use of these medications. Clopidogrel and prasugrel irreversibly bind to the P2Y12 receptor, creating a prolonged antiplatelet effect which can be undesirable when surgery is needed. Clopidogrel requires hepatic activation and produces variable platelet inhibition based on genetic polymorphisms. Prasugrel has more consistent platelet inhibition than clopidogrel but carries with it an increased risk of serious bleeds. Ticagrelor is a drug in a new chemical class that reversibly binds the P2Y12 receptor and noncompetitively blocks adenosine diphosphate-induced platelet activation. It was specifically designed to address the limitations of the available antiplatelet agents while maintaining comparable or better antiplatelet effects. It does not require metabolic activation and demonstrates greater platelet inhibition, a faster offset of action and comparable bleeding risk compared to clopidogrel. The pivotal PLATO (The Study of Platelet Inhibition and Patient Outcomes) trial in patients with an acute coronary syndrome demonstrated improved cardiovascular outcomes, including a reduction in myocardial infarctions and vascular events using ticagrelor as compared to clopidogrel with comparable rates of major bleeds. A puzzling finding from that trial was the lack of benefit with ticagrelor in patients enrolled from the United States, which has led to ticagrelor not being approved at this time in this country. The main adverse events with ticagrelor are bleeding and dyspnea, the latter of which is of unclear etiology and of unknown long-term clinical concern. In summary, ticagrelor is an exciting new oral antiplatelet drug that seems to be more efficacious than clopidogrel, with comparable safety. Whether issues of geographic disparities in response and the unusual side effect of dyspnea ultimately prove problematic has yet to be determined. Nonetheless, ticagrelor is a drug that has the potential to change the standard of care of patients with acute coronary syndromes.
journal_name
Cardiol Revjournal_title
Cardiology in reviewauthors
Nawarskas JJ,Clark SMdoi
10.1097/CRD.0b013e3182099d86subject
Has Abstractpub_date
2011-03-01 00:00:00pages
95-100issue
2eissn
1061-5377issn
1538-4683pii
00045415-201103000-00011journal_volume
19pub_type
杂志文章,评审abstract::Automated validated devices should be used for measuring blood pressure (BP). A systolic BP between 120 and 129 mm Hg with a diastolic BP < 80 mm Hg should be treated by lifestyle measures. Lifestyle measures plus BP lowering drugs should be used for secondary prevention of recurrent cardiovascular disease (CVD) event...
journal_title:Cardiology in review
pub_type: 杂志文章,评审
doi:10.1097/CRD.0000000000000187
更新日期:2018-03-01 00:00:00
abstract::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 o...
journal_title:Cardiology in review
pub_type: 杂志文章,评审
doi:10.1097/CRD.0b013e318275cf01
更新日期:2013-07-01 00:00:00
abstract::Pulmonary arterial hypertension (PAH) is a progressive disorder with a poor prognosis. It is characterized by sustained elevation of pulmonary artery pressure (PAP) and pulmonary vascular resistance (PVR). It is defined hemodynamically by a mean PAP over 25 mm Hg, a pulmonary arterial wedge pressure of 15 mm Hg or les...
journal_title:Cardiology in review
pub_type: 杂志文章,评审
doi:10.1097/01.crd.0000240529.49704.2e
更新日期:2006-11-01 00:00:00
abstract::Chagas disease, caused by the parasite Trypanosoma cruzi, is an important cause of cardiac disease in endemic areas of Latin America. It is now being diagnosed in nonendemic areas because of immigration. Typical cardiac manifestations of Chagas disease include dilated cardiomyopathy, congestive heart failure, arrhythm...
journal_title:Cardiology in review
pub_type: 杂志文章,评审
doi:10.1097/CRD.0b013e31823efde2
更新日期:2012-03-01 00:00:00
abstract::The field of durable left ventricular assist devices has advanced dramatically since its introduction into the clinical realm. From the first-generation pulsatile HeartMate XVE device to the second-generation continuous axial flow HeartMate-2 to the current third-generation centrifugal flow devices, the left ventricul...
journal_title:Cardiology in review
pub_type: 杂志文章,评审
doi:10.1097/CRD.0000000000000268
更新日期:2019-11-01 00:00:00
abstract::Reverse redistribution is a well-known pattern found when performing thallium myocardial scintigraphy, and it has been implicated as an indicator of myocardial ischemia. Much more rarely, when using technetium compounds, which do not redistribute, a similar pattern is noted after the second injection of the radiotrace...
journal_title:Cardiology in review
pub_type: 杂志文章
doi:10.1097/01.crd.0000115927.76990.25
更新日期:2004-05-01 00:00:00
abstract::Abdominal aortic aneurysm is a multifactorial disease with genetic risk factors and an immunologic component. Immune cells, including macrophages, neutrophils, mast cells, B- and T- lymphocytes, along with vascular smooth muscle cells and adventitial fibroblasts, produce cytokines and enzymes, promoting an inflammator...
journal_title:Cardiology in review
pub_type: 杂志文章,评审
doi:10.1097/CRD.0b013e3181b04698
更新日期:2009-09-01 00:00:00
abstract::Cardiac computed tomographic angiography (CCTA) has evolved at an unprecedented pace over the past decade, during which time it has proven to be an accurate and effective tool for imaging of the heart in a growing list of clinical applications. However, the rapid growth in the use of CT imaging in general has prompted...
journal_title:Cardiology in review
pub_type: 杂志文章,评审
doi:10.1097/CRD.0b013e31821daa8f
更新日期:2011-07-01 00:00:00
abstract::Patients presenting to the Emergency Department with chest pain are common and often present diagnostic difficulties. Because of the limitations of the initial evaluation, the majority of patients are admitted, although many are later found to have noncardiac causes for their symptoms. Recognition of these limitations...
journal_title:Cardiology in review
pub_type: 杂志文章,评审
doi:10.1097/00045415-200109000-00006
更新日期:2001-09-01 00:00:00
abstract::Established coronary artery disease has a prevalence of 7% in adult Americans, accounting for 16 million people. As morbidity and mortality rates have risen, research efforts to identify the pathophysiologic mechanisms of systolic dysfunction have risen in parallel. The current goal is to develop new therapeutic strat...
journal_title:Cardiology in review
pub_type: 杂志文章,评审
doi:10.1097/CRD.0000000000000024
更新日期:2014-09-01 00:00:00
abstract::Antiplatelet therapy reduces the risks for cardiovascular morbidity and mortality in patients with atherosclerotic disease, and it is also beneficial in managing peripheral arterial disease (PAD). These agents work through various therapeutic pathways to achieve antithrombotic effects. Although single- or two-drug reg...
journal_title:Cardiology in review
pub_type: 杂志文章,评审
doi:10.1097/CRD.0000000000000075
更新日期:2015-09-01 00:00:00
abstract::The physiologic effect of the sauna in human beings has been studied extensively, but only recently have there been studies to suggest sauna can be an effective therapeutic modality for patients with cardiovascular disease, especially for those with congestive heart failure. The data reported to date have been promisi...
journal_title:Cardiology in review
pub_type: 杂志文章
doi:10.1097/01.crd.0000124844.56479.05
更新日期:2004-11-01 00:00:00
abstract::Mitral regurgitation (MR) is the most common cardiac valvular disease in the United States. Approximately 4 million people have severe MR and roughly 250,000 new diagnoses of MR are made each year. Mitral valve surgery is the only treatment that prevents progression of heart failure and provides sustained symptomatic ...
journal_title:Cardiology in review
pub_type: 杂志文章,评审
doi:10.1097/CRD.0000000000000036
更新日期:2014-11-01 00:00:00
abstract::Sudden death (SD) is the most dramatic event in hypertrophic cardiomyopathy (HCM), often representing the first clinical manifestation of the disease, and the first concern of the clinicians who take care of such patients. HCM is now recognized as the primary cause of SD in young persons (<35 years of age), including ...
journal_title:Cardiology in review
pub_type: 杂志文章,评审
doi:10.1097/CRD.0000000000000017
更新日期:2014-09-01 00:00:00
abstract::Atrial fibrillation (AF), a very common cardiac arrhythmia, is a well-recognized predisposing factor for embolic stroke. While warfarin remains the cornerstone of anticoagulant treatment in patients with AF, it is often underutilized because of increased bleeding complications and frequent monitoring requirements. It ...
journal_title:Cardiology in review
pub_type: 杂志文章,评审
doi:10.1097/CRD.0b013e3181e53abb
更新日期:2010-09-01 00:00:00
abstract::An estimated 400,000 coronary artery bypass graft operations are performed annually in the United States. Saphenous vein grafts are the most commonly used conduits; however, graft failure is common. In contrast, left internal mammary artery grafts have more favorable long-term patency rates. Guidelines recommend aggre...
journal_title:Cardiology in review
pub_type: 杂志文章,评审
doi:10.1097/CRD.0000000000000261
更新日期:2020-01-01 00:00:00
abstract::Acute decompensated heart failure (ADHF) is a common syndrome with diverse etiologies and precipitating factors, which is associated with significant morbidity and mortality. Tremendous resources are used in treating this syndrome, with few prospectively designed clinical trials to guide therapy. Patients suffering fr...
journal_title:Cardiology in review
pub_type: 杂志文章,评审
doi:10.1097/CRD.0b013e318214022b
更新日期:2011-05-01 00:00:00
abstract::Loop diuretics are central to the management of fluid overload in acute decompensated heart failure. However, a variance in the response to loop diuretics can alter a patient's clinical course and has an adverse effect on clinical outcomes. Thus, a diminished response to loop diuretics is an important clinical issue. ...
journal_title:Cardiology in review
pub_type: 杂志文章,评审
doi:10.1097/CRD.0000000000000116
更新日期:2016-09-01 00:00:00
abstract::Hypertrophic cardiomyopathy (HCM) is a heart disease characterized by hypertrophy of the left ventricular myocardium and is most often caused by mutations in sarcomere genes. The structural and functional abnormalities are not explained by flow-limiting coronary artery disease or loading conditions. The disease affect...
journal_title:Cardiology in review
pub_type: 杂志文章,评审
doi:10.1097/CRD.0000000000000184
更新日期:2018-05-01 00:00:00
abstract::Cardiovascular disease is the leading cause of morbidity and mortality among women in industrialized nations. Optimizing cardiovascular risk reduction is therefore of paramount importance, particularly among postmenopausal women, in whom the incidence of cardiovascular disease is highest. Accumulated data from a serie...
journal_title:Cardiology in review
pub_type: 杂志文章,评审
doi:10.1097/00045415-200301000-00003
更新日期:2003-01-01 00:00:00
abstract::Evidence-based management of heart failure (HF) with preserved left ventricular ejection fraction (LVEF; HFpEF) remains a major gap in the care of patients with HF. Clinical trials directed toward the population with HFpEF have been disappointing, although renin-angiotensin-aldosterone system blockade appears to preve...
journal_title:Cardiology in review
pub_type: 杂志文章,评审
doi:10.1097/CRD.0000000000000057
更新日期:2015-07-01 00:00:00
abstract::Relaxin, a naturally-occurring hormone in the insulin family, was discovered to have a physiologic role in pregnancy. Named initially for its relaxing effect on the pubic ligament, relaxin receptors have since been found to be widely distributed in many organs in both males and females. Acting through multiple pathway...
journal_title:Cardiology in review
pub_type: 杂志文章,评审
doi:10.1097/CRD.0b013e3181f493e3
更新日期:2010-11-01 00:00:00
abstract::Pulmonary artery hypertension (PAH) is a sequela of a number of disparate diseases, often with a fatal consequence. Endothelial dysfunction is considered to be an early event during the development of PAH. Impaired availability of bioactive nitric oxide (NO) is a key underlying feature in most forms of clinical and ex...
journal_title:Cardiology in review
pub_type: 杂志文章,评审
doi:10.1097/01.crd.0000249381.49138.b9
更新日期:2007-05-01 00:00:00
abstract::We report a case of spontaneous coronary artery rupture associated with amphetamine abuse in a 31-year-old woman. The patient presented to the emergency department with sudden onset of central chest pain and a normal electrocardiogram. Cardiac enzymes were consistent with acute myocardial infarction. Drug screening wa...
journal_title:Cardiology in review
pub_type: 杂志文章
doi:10.1097/01.crd.0000132372.38506.45
更新日期:2004-09-01 00:00:00
abstract::Intravascular ultrasound imaging is a relatively new imaging modality that uses miniaturized ultrasound transducers, which are mounted on catheter tips and introduced into the vessel lumen to provide cross-sectional images of the vascular structure in real time. It has gained popularity rapidly among interventional ca...
journal_title:Cardiology in review
pub_type: 杂志文章,评审
doi:10.1097/00045415-199909000-00014
更新日期:1999-09-01 00:00:00
abstract::Acute pericarditis (AP) is basically a clinical diagnosis. Although specific electrocardiographic (ECG) manifestations may indeed point to its diagnosis, sole reliance on such findings in isolation of the clinical setting, however, is often the common pitfall that could lead to a misguided diagnosis. We briefly review...
journal_title:Cardiology in review
pub_type: 杂志文章,评审
doi:10.1097/01.crd.0000210645.89717.34
更新日期:2007-01-01 00:00:00
abstract::The obesity epidemic has reached unprecedented proportions in Western society. Evidence continues to accumulate that obesity is associated with significant morbidity and mortality and in particular that it is an independent risk factor for cardiovascular disease (CVD). The association of obesity with CVD and its risk ...
journal_title:Cardiology in review
pub_type: 杂志文章,评审
doi:10.1097/00045415-200107000-00005
更新日期:2001-07-01 00:00:00
abstract::Evacetrapib is a cholesteryl ester transfer protein (CETP) inhibitor that has been recently studied as a cholesterol modifying agent to reduce cardiovascular risk and mortality in high risk cardiovascular disease patients. Evacetrapib acts to decrease lipid exchange through CETP inhibition. CETP acts to transfer chole...
journal_title:Cardiology in review
pub_type: 杂志文章,评审
doi:10.1097/CRD.0000000000000137
更新日期:2017-03-01 00:00:00
abstract::Short QT syndrome is a rare inherited autosomal dominant cardiac channelopathy associated with malignant ventricular and atrial arrhythmias. A shortened corrected QT interval is a marker for risk of malignant arrhythmias, which are secondary to increased transmural dispersion of repolarization. The underlying gain of ...
journal_title:Cardiology in review
pub_type: 杂志文章,评审
doi:10.1097/CRD.0000000000000091
更新日期:2016-07-01 00:00:00
abstract::Differences in the overall mortality for acute infarction in women vs men have been appreciated for some time. Some of these differences are based on the age at the time of presentation of women compared with men. Excess mortality in women is most clear at the younger end of the age spectrum. More careful examination ...
journal_title:Cardiology in review
pub_type: 杂志文章,评审
doi:10.1097/00045415-200008040-00009
更新日期:2000-07-01 00:00:00