New developments in the pharmacotherapeutic management of heart failure in elderly patients: concerns and considerations

Screever, Elles M.; Meijers, Wouter C.; Veldhuisen, Dirk J. van; Boer, Rudolf A. de

doi:10.1080/14656566.2017.1316377

Cited by 10 publications

(6 citation statements)

References 114 publications

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“…The two major pathophysiological processes contributing to HF development are inflammation and fibrosis, which affect tissue architecture, electrical conduction, mechano-electrical coupling and force generation by cardiomyocytes [75]. The prevalence of HF is globally increasing, mainly due to population aging [76] and the more successful treatment of cardiovascular diseases preceding HF, such as myocardial infarction, myocarditis and hypertension [77].…”

Section: Gal-3 In Cardiac Fibrosis and Heart Failurementioning

confidence: 99%

Galectin-3 in Cardiovascular Diseases

Blanda

Bracale

Taranto

et al. 2020

IJMS

112

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Galectin-3 (Gal-3) is a β-galactoside-binding protein belonging to the lectin family with pleiotropic regulatory activities and several physiological cellular functions, such as cellular growth, proliferation, apoptosis, differentiation, cellular adhesion, and tissue repair. Inflammation, tissue fibrosis and angiogenesis are the main processes in which Gal-3 is involved. It is implicated in the pathogenesis of several diseases, including organ fibrosis, chronic inflammation, cancer, atherosclerosis and other cardiovascular diseases (CVDs). This review aims to explore the connections of Gal-3 with cardiovascular diseases since they represent a major cause of morbidity and mortality. We herein discuss the evidence on the pro-inflammatory role of Gal-3 in the atherogenic process as well as the association with plaque features linked to lesion stability. We report the biological role and molecular mechanisms of Gal-3 in other CVDs, highlighting its involvement in the development of cardiac fibrosis and impaired myocardium remodelling, resulting in heart failure and atrial fibrillation. The role of Gal-3 as a prognostic marker of heart failure is described together with possible diagnostic applications to other CVDs. Finally, we report the tentative use of Gal-3 inhibition as a therapeutic approach to prevent cardiac inflammation and fibrosis.

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Section: Gal-3 In Cardiac Fibrosis and Heart Failurementioning

confidence: 99%

Galectin-3 in Cardiovascular Diseases

Blanda

Bracale

Taranto

et al. 2020

IJMS

112

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“…A majority of these people are elderly [8]. Even though heart failure is a disease with high prevalence in the elderly, these people are often excluded or underrepresented in clinical studies [9][10][11]. Underrepresentation in studies and less contact with specialist care are possible reasons for the sparse evidence for disease management of heart failure in elderly people [9].…”

Section: Introductionmentioning

confidence: 99%

Cardiovascular drug use among people with cognitive impairment living in nursing homes in northern Sweden

Svahn

Lövheim

Isaksson

et al. 2020

Eur J Clin Pharmacol

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The aim of this study was to describe changes in the pattern of cardiovascular agents used in elderly people living in nursing homes between 2007 and 2013. Further, the aim was to analyse the use of cardiovascular drugs in relation to cognitive impairment and associated factors within the same population, where prescription of loop diuretics was used as a proxy for heart failure. Methods Two questionnaire surveys were performed including 2494 people in 2007 and 1654 people in 2013 living in nursing homes in northern Sweden. Data were collected concerning drug use, functioning in activities of daily living (ADL) and cognition, using the Multi-Dimensional Dementia Assessment Scale (MDDAS). The use of different drugs and drug classes among people at four different levels of cognitive function in 2007 and 2013 were compared. Results The proportion of people prescribed ASA and diuretics was significantly lower at all four levels of cognitive function in 2013 compared to 2007. Among people prescribed loop diuretics, the use of angiotensin-converting enzyme inhibitors/ angiotensin II receptor blockers (ACEI/ARBs) increased from 37.8 to 45.6%, β-blockers from 36.0 to 41.8% and warfarin from 4.4 to 11.4%. The use of warfarin, ACEI/ARBs, β-blockers and mineralocorticoid receptor antagonists (MRAs) were less common among individuals with more severe cognitive impairment. Conclusion The results indicate that cardiovascular drug treatment has improved between 2007 and 2013, but there is room for further improvement, especially regarding adherence to guidelines for heart failure. Increasing cognitive impairment had an effect on treatment patterns for heart failure and atrial fibrillation.

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“…The cGMP pathway plays a role in HFpEF pathophysiology. Improved characterization of cGMP signaling and its relation to cardiac function revealed multiple options for targeted therapy [ 33 , 34 ]. To date, no large phase III HFpEF trial has definitively tested the effects of a pharmacologically mediated increase in cGMP activity.…”

Section: Main Hf Clinical Trialsmentioning

confidence: 99%

Vericiguat in Heart Failure: Characteristics, Scientific Evidence and Potential Clinical Applications

et al. 2022

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Despite recent advances in heart failure (HF) management, the risk of death and hospitalizations remains high in the long term. HF is characterized by endothelial dysfunction, inflammation and increased oxidative stress, due to a reduction in the activity of the nitric oxide (NO)-soluble guanylate cyclase (sGC)-cyclic guanosine monophosphate (cGMP) signaling pathway. All these factors contribute to direct damage at the myocardial, vascular and renal level. Vericiguat restores the deficiency in this signaling pathway, through stimulation and activation of sGC, aiming to increase cGMP levels, with a reduction in HF-related oxidative stress and endothelial dysfunction. Two main clinical trials were developed in this setting: the SOCRATES-REDUCED phase II study and the VICTORIA phase III study. They found that vericiguat is safe, well tolerated and effective with an absolute event-rate reduction in patients affected by HF with reduced ejection fraction (HFrEF) and recent cardiac decompensation. In patients with HF with preserved ejection fraction (HfpEF), the SOCRATES-PRESERVED trial demonstrated an improvement in quality of life and health status, but the proven beneficial effects with vericiguat are still limited. Further studies are needed to correctly define the role of this drug in heart failure syndromes. Our paper reviews the potential applications and pharmacological characteristics of vericiguat in HFrEF and HFpEF.

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New developments in the pharmacotherapeutic management of heart failure in elderly patients: concerns and considerations

Cited by 10 publications

References 114 publications

Galectin-3 in Cardiovascular Diseases

Galectin-3 in Cardiovascular Diseases

Cardiovascular drug use among people with cognitive impairment living in nursing homes in northern Sweden

Vericiguat in Heart Failure: Characteristics, Scientific Evidence and Potential Clinical Applications

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