Cardiovascular Prevention and Pharmacotherapy

From articles published in Cardiovascular Prevention and Pharmacotherapy during the past two years (2022 ~ ).

Review Article

Adverse effects of statin therapy and their treatment: Dae Young Cheon, Sang-Ho Jo; Cardiovasc Prev Pharmacother. 2022;4(1):1-6. Published online January 20, 2022; DOI: https://doi.org/10.36011/cpp.2022.4.e4

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Statins are one of the most widely used drugs worldwide as first-line drugs for the treatment of hyperlipidemia and the prevention and treatment of cardiovascular diseases. Most of the side effects of statins are known to be mild, and mainly hepatotoxicity and various muscle symptoms are known. Recently, there have been studies on concerns about an increase in the incidence of diabetes after using statins, but it was found that the benefits sufficiently outweigh the risk of side effects. Therefore, the use of statins in the appropriate group should be actively performed, and it seems that the side effects can be prevented through close physical observation and appropriate examination.

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The Link between Magnesium Supplements and Statin Medication in Dyslipidemic Patients
Roxana Nartea, Brindusa Ilinca Mitoiu, Ioana Ghiorghiu
Current Issues in Molecular Biology.2023; 45(4): 3146. CrossRef
The effects of L-carnitine in reducing hepatotoxicity of statins in rats
Doaa Ibrahim, Shahad Bader, Omar Bader
Medicinski casopis.2023; 57(3): 59. CrossRef

Original Article

Effects of physical activity on cardiovascular outcomes and mortality in Korean patients with diabetes: a nationwide population-based cohort study: Inha Jung, Sun Joon Moon, Hyemi Kwon, Se Eun Park, Kyung-Do Han, Eun-Jung Rhee, Won-Young Lee; Cardiovasc Prev Pharmacother. 2022;4(1):42-55. Published online January 20, 2022; DOI: https://doi.org/10.36011/cpp.2022.4.e3

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Abstract PDF Supplementary Material

Background
Since a sedentary lifestyle is considered a modifiable risk factor for cardiovascular disease (CVD), physical activity (PA) is recommended for type 2 diabetes mellitus (T2DM) patients to prevent CVD. We investigated the association between different levels of PA and the risk for CVD and all-cause mortality in patients with T2DM using nationwide data.
Methods
We examined health examination data and claims records of 2,745,637 participants with T2DM at baseline from the Korean National Health Insurance Service who underwent health examinations between 2009 and 2012. We excluded subjects with a history of myocardial infarction or stroke. Each participant was asked to report their weekly PA levels according to three categories: vigorous, moderate, and walking. The incidence of CVD and death was analyzed until 2017.
Results
The risk of CVD was lower in regular exercisers than in nonexercisers after adjusting for confounding variables. A dose-response trend was evident in the association between the degree of PA and CVD risk. All categories of PA were inversely associated with CVD risk and mortality. The reduction in CVD risk and all-cause mortality was more profound in patients aged ≥65 years.
Conclusions
Augmenting PA might have positive effects on the prevention of CVD and all-cause death, especially in the elderly. The benefits of PA were consistently observed in various subgroups regardless of the presence of chronic conditions. Therefore, clinicians should encourage elderly patients with T2DM to increase their daily PA.

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Incentivised physical activity intervention promoting daily steps among university employees in the workplace through a team-based competition
Ayazullah Safi, Sanjoy Deb, Adam Kelly, Matthew Cole, Natalie Walker, Mohammed Gulrez Zariwala
Frontiers in Public Health.2024;[Epub] CrossRef
Effect of physical activity on incident atrial fibrillation in individuals with varying duration of diabetes: a nationwide population study
JungMin Choi, So‑Ryoung Lee, Eue-Keun Choi, Kyung-Yeon Lee, Hyo-Jeong Ahn, Soonil Kwon, Kyung‑Do Han, Seil Oh, Gregory Y. H. Lip
Cardiovascular Diabetology.2024;[Epub] CrossRef

Review Articles

Calcium channel blockers for hypertension: old, but still useful: Eun Mi Lee; Cardiovasc Prev Pharmacother. 2023;5(4):113-125. Published online October 30, 2023; DOI: https://doi.org/10.36011/cpp.2023.5.e16

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Abstract PDF

Calcium channel blockers (CCBs) constitute a heterogeneous class of drugs that can be divided into dihydropyridines (DHPs) and non-DHPs. DHP-CCBs are subcategorized into four generations based on the duration of activity and pharmacokinetics, while non-DHP-CCBs are subcategorized into phenylethylamine and benzodiazepine derivatives. DHP-CCBs are vascular-selective and function as potent vasodilators, whereas non-DHP-CCBs are cardiac-selective and are useful for treating tachyarrhythmia, but reduce cardiac contractility and heart rate. Traditional DHP-CCBs (nifedipine) mainly block L-type calcium channels, whereas novel CCBs block N-type (amlodipine) and/or T-type channels (efonidipine) in addition to L-type channels, leading to organ-protective effects. DHP-CCBs have a potent blood pressure–lowering effect and suppress atherosclerosis and coronary vasospasm. Diltiazem, a non-DHP-CCB, is highly effective for vasospasm control. CCBs reduce left ventricular hypertrophy and arterial stiffness. Amlodipine, a DHP-CCB, reduces blood pressure variability. L/N- and L/T-type CCBs combined with renin-angiotensin system blockers reduce proteinuria and improve kidney function compared with L-type CCBs. According to large-scale trials, DHP-CCBs reduce cardiovascular events in patients with isolated systolic hypertension, as well as in elderly and high-risk patients. Accordingly, CCBs are indicated for hypertension in elderly patients, isolated systolic hypertension, angina pectoris, and coronary vasospasm. Non-DHP-CCBs are contraindicated in high-grade heart block, bradycardia (<60 beats per minute [bpm]), and heart failure with reduced ejection fraction (HFrEF). DHP-CCBs should be used with caution in patients with tachyarrhythmia, HFrEF, and severe leg edema, and non-DHP-CCBs should be used carefully in those with constipation. Each CCB has distinct pharmacokinetics and side effects, underscoring the need for meticulous consideration in clinical practice.

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Design of Experimental Approach for Development of Rapid High Performance Liquid Chromatographic Process for Simultaneous Estimation of Metoprolol, Telmisartan, and Amlodipine from Formulation: Greenness and Whiteness Evaluation
Mahesh Attimarad, Mohammed Jassim Alali, Hussain Ali Alali, Dana Hisham Alabdulmuhsin, Aljohara Khalid Alnajdi, Katharigatta Narayanaswamy Venugopala, Anroop B. Nair
Molecules.2024; 29(5): 1087. CrossRef

COVID-19 vaccination–related cardiovascular complications: Jae Yeong Cho, Kye Hun Kim; Cardiovasc Prev Pharmacother. 2023;5(4):134-143. Published online October 27, 2023; DOI: https://doi.org/10.36011/cpp.2023.5.e17

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Abstract PDF

The global response to the COVID-19 pandemic has led to rapid vaccine development and distribution. As vaccination efforts continue, concerns have arisen regarding potential adverse events associated with COVID-19 vaccination. This article examines emerging evidence on adverse events, including myocarditis, pericarditis, and thrombotic complications, in relation to COVID-19 vaccination. Reports of myocarditis and pericarditis cases following messenger RNA vaccines have sparked interest, with discussions revolving around potential mechanisms and genetic predispositions. The contrasting findings on pericarditis risk postvaccination highlight the complexity of studying this phenomenon. Thrombotic events, particularly vaccine-induced thrombotic thrombocytopenia, have garnered attention, prompting investigations into antibody responses and mechanisms. This article underscores the importance of ongoing research, collaboration, and data analysis for accurately understanding adverse events. While the COVID-19 vaccination campaign may have ended, it is still vital to maintain vigilance, collect comprehensive data and foster interdisciplinary collaboration to uphold vaccine safety and steer public health strategies in the upcoming period.

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The Role of COVID-19 Vaccination for Patients With Atherosclerotic Cardiovascular Disease in the Upcoming Endemic Era
Kye Hun Kim
Journal of Lipid and Atherosclerosis.2024; 13(1): 21. CrossRef

Original Article

Changes in cardiovascular-related health behaviors during the COVID-19 pandemic: Eunji Kim, Chan-Hee Jung, Dae Jung Kim, Seung-Hyun Ko, Hae-Young Lee, Kyung-Yul Lee, Dae Ryong Kang, Sung Kee Ryu, Won-Young Lee, Eun-Jung Rhee, Hyeon Chang Kim; Cardiovasc Prev Pharmacother. 2023;5(1):15-23. Published online January 27, 2023; DOI: https://doi.org/10.36011/cpp.2023.5.e2

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Abstract PDF Supplementary Material

Background
The COVID-19 pandemic has been the most pressing health challenge in recent years. Meanwhile, prevention for other diseases, such as cardiovascular disease (CVD) has been less prioritized during the pandemic. COVID-19, a novel infectious disease, both had a direct impact on public health and provoked changes in health-related behaviors, including those for CVD prevention. This study sought to examine changes in CVD-related health behaviors during the COVID-19 pandemic and related sociodemographic factors.
Methods
We used data from the Cardiovascular Disease Prevention Awareness Survey conducted in Korea in June 2022. A total of 2,000 adults across Korea’s 17 provinces completed a structured questionnaire online or on a mobile device. Self-reported changes in CVD-related health behaviors were investigated. We used unadjusted and adjusted logistic regression models to explore the associations between negative changes and sociodemographic factors.
Results
In smoking, drinking, and healthcare service use, the proportion of those with positive changes surpassed the proportion of respondents who reported negative changes. In contrast, negative changes predominated for diet, exercise, and stress. Most individuals (52.6%) reported a deterioration of psychological distress. These negative changes were significantly associated with age, sex, marital status, and the presence of cardiometabolic disease.
Conclusions
The COVID-19 pandemic has affected CVD-related health behaviors. Based on these changes, CVD prevention should be encouraged with appropriate and prioritized strategies.

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Cardiovascular-related health behavior changes: lessons from the COVID-19 pandemic and post-pandemic challenges
Inha Jung, Won-Young Lee
Cardiovascular Prevention and Pharmacotherapy.2023; 5(4): 99. CrossRef

Review Article

Blood pressure control in hypertensive disorders of pregnancy: Helsi Rismiati, Hae-Young Lee; Cardiovasc Prev Pharmacother. 2022;4(3):99-105. Published online July 29, 2022; DOI: https://doi.org/10.36011/cpp.2022.4.e16

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Abstract PDF

Hypertension is a major cause of maternal morbidity and occurs as a complication in up to one in ten pregnancies. Hypertensive disorders of pregnancy encompass gestational hypertension, preeclampsia, chronic hypertension, and chronic hypertension with superimposed preeclampsia. However, the management of hypertensive disorders of pregnancy remains a matter of debate, particularly the blood pressure thresholds and targets for managing hypertension in pregnancy. Previously, there was no clear evidence of the effectiveness of aggressive blood pressure control in pregnancy due to the risk of fetal growth restriction. Recent clinical trials have shown that aggressive control of blood pressure in pregnant women is safe for both the mother and fetus. The purpose of this paper is to present a clinically oriented guide to the drugs of choice in patients with hypertension during pregnancy, present contrasts among different guidelines and recent clinical trials, and discuss the blood pressure thresholds and targets for hypertension during pregnancy based on recent studies.

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Combined Effects of Methyldopa and Baicalein or Scutellaria baicalensis Roots Extract on Blood Pressure, Heart Rate, and Expression of Inflammatory and Vascular Disease-Related Factors in Spontaneously Hypertensive Pregnant Rats
Michał Szulc, Radosław Kujawski, Przemysław Ł. Mikołajczak, Anna Bogacz, Marlena Wolek, Aleksandra Górska, Kamila Czora-Poczwardowska, Marcin Ożarowski, Agnieszka Gryszczyńska, Justyna Baraniak, Małgorzata Kania-Dobrowolska, Artur Adamczak, Ewa Iwańczyk-S
Pharmaceuticals.2022; 15(11): 1342. CrossRef

Original Article

Development of a predictive model for the side effects of liraglutide: Jiyoung Min, Jiwon Shinn, Hun-Sung Kim; Cardiovasc Prev Pharmacother. 2022;4(2):87-93. Published online April 27, 2022; DOI: https://doi.org/10.36011/cpp.2022.4.e12

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Background
Liraglutide, a drug used for the management of obesity, has many known side effects. In this study, we developed a predictive model for the occurrence of liraglutide-related side effects using data from electronic medical records (EMRs).
Methods
This study included 237 patients from Seoul St. Mary's Hospital and Eunpyeong St. Mary's Hospital who were prescribed liraglutide. An endocrinologist obtained medical data through an EMR chart review. Model performance was evaluated using the mean of the area under the receiver operating characteristic curve (AUROC) with a 95% confidence interval (CI).
Results
A predictive model was developed for patients who were prescribed liraglutide. However, 37.1% to 75.5% of many variables were missing, and the AUROC of the developed predictive model was 0.630 (95% CI, 0.551–0.708). Patients who had previously taken antiobesity medication had significantly fewer side effects than those without previous antiobesity medication use (20.7% vs. 41.4%, P<0.003). The risk of side effect occurrence was significantly higher in patients with diabetes than in patients without diabetes by 2.389 times (odds ratio, 2.389; 95% CI, 1.115–5.174).
Conclusions
This study did not successfully develop a predictive model for liraglutide-related side effects, primarily due to issues related to missing data. When prescribing antiobesity drugs, detailed records and basic blood tests are expected to be essential. Further large-scale studies on liraglutide-related side effects are needed after obtaining high-quality data.

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The effects and side effects of liraglutide as a treatment for obesity
Jeonghoon Ha, Jin Yu, Joonyub Lee, Hun-Sung Kim
Cardiovascular Prevention and Pharmacotherapy.2022; 4(4): 142. CrossRef

Review Article

Targets for rescue from fatty acid-induced lipotoxicity in pancreatic beta cells: Seok-Woo Hong, Won-Young Lee; Cardiovasc Prev Pharmacother. 2022;4(2):57-62. Published online April 26, 2022; DOI: https://doi.org/10.36011/cpp.2022.4.e9

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Abstract PDF

A persistent intake of excess calories increases plasma levels of free fatty acids, particularly the saturated form that has been shown to exert toxic effects on pancreatic beta cells by inducing dysfunction and apoptosis (i.e., lipotoxicity). An insufficient supply of insulin due to beta cell failure is a major factor in the onset and progression of type 2 diabetes; therefore, it is crucial to understand the cellular mechanisms of lipotoxicity to prevent beta cell failure. Many studies on the effects of lipotoxicity have demonstrated the various factors responsible for beta cell impairment, but the mechanisms of dysfunction and apoptosis resulting from lipotoxicity have not been fully described. This review discusses lipotoxicity-induced alterations of cellular mechanisms, and assesses drugs such as incretin mimetics, thiazolidinedione, and clusterin. Understanding the molecular mechanisms of lipotoxicity-induced beta cell failure is useful in guiding the development of new therapeutic targets for diabetes treatment.

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ВПЛИВ ПОЛІВІТАМІННОГО КОМПЛЕКСУ НА СТАН ПІДШЛУНКОВОЇ ЗАЛОЗИ ХОМ’ЯКІВ ЗА УМОВ ЕКСПЕРИМЕНТАЛЬНОГО МЕТАБОЛІЧНОГО СИНДРОМУ
Н. Ю. Духніч, К. О. Калько, О. Я. Міщенко
Medical and Clinical Chemistry.2023; (3): 72. CrossRef

Original Article

Safety and efficacy of low-dose aspirin in patients with coronary artery spasm: long-term clinical follow-up: Byoung Geol Choi, Kyung-Hee Kim, Seung-Woon Rha; Cardiovasc Prev Pharmacother. 2022;4(1):26-33. Published online January 21, 2022; DOI: https://doi.org/10.36011/cpp.2022.4.e6

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Background
Aspirin is known to aggravate coronary artery spasm (CAS) regardless of the dose (100–325 mg/day). However, it is unclear whether low-dose aspirin (LDA; 100 mg) has deleterious impacts on the clinical course of CAS patients in the long-term. Thus, we investigated the impact of LDA on the long-term clinical outcomes of CAS patients.
Methods
A total of 5,697 consecutive patients without significant coronary artery disease who underwent an acetylcholine provocation test from November 2004 to May 2015 were enrolled. Of these patients, 3,072 CAS patients were enrolled in the study and divided into two groups based on whether they took LDA: the LDA group (n=338) and the non-LDA group (n=2,734). All CAS patients were prescribed anti-anginal medication as appropriate. To adjust for any potential confounders that could cause bias, a propensity score matching analysis was performed using a logistic regression model.
Results
After propensity score matching, two propensity-matched groups (524 pairs, 1,048 patients, C-statistic=0.827) were generated, and the baseline characteristics of the two groups were balanced. The two groups were showed no significant differences in any follow-up events, such as major adverse cardiac events and recurrent angina.
Conclusions
The main finding of the present study is that the use of LDA did not affect cardiovascular events up to 5 years in CAS patients. Therefore, the prescription of LDA in these patients should be individualized considering their clinical status.

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Long-term prognostic factors for cardiovascular events in patients with chest pain without diabetes mellitus nor significant coronary stenosis
Seung-Woon Rha, Kyuho Lee, Se Yeon Choi, Jae Kyeong Byun, Jinah Cha, Sujin Hyun, Woo Jin Ahn, Soohyung Park, Dong Oh Kang, Eun Jin Park, Cheol Ung Choi, Byoung Geol Choi
Heart and Vessels.2024; 39(5): 382. CrossRef

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