Cardioselective Beta‐Blockers in Patients with Asthma and Concomitant Heart Failure or History of Myocardial Infarction: When Do Benefits Outweigh Risks?

Self, Timothy H.; Soberman, Judith E.; Bubla, Jamie M.; Chafin, Carol C.

doi:10.1081/jas-120025582

Cited by 14 publications

(6 citation statements)

References 66 publications

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“…Our findings support the findings from a review of cardioselective ␤-blockers in patients with asthma, suggesting that these agents can be safely administered when started at low dosages and titrated up to effect, and when given in combination with anticholinergic bronchodilators (e.g., ipratropium) and ␤-agonists (e.g., albuterol). 27 The authors' conclusion that atenolol is one of the safest cardioselective ␤-blockers is supported by our finding that atenolol had the lowest hazard ratio of hospital admissions relative to propranolol (Table 5). Further, we found that atenolol was safer than metoprolol, perhaps due to the loss of cardioselectivity of metoprolol given at higher doses relative to atenolol.…”

Section: ␤-Blockermentioning

confidence: 51%

β-Blocker Therapy in Veterans with Asthma or Chronic Obstructive Pulmonary Disease

Barnett¹,

Milavetz²,

Kaboli³

2005

Pharmacotherapy

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Section: ␤-Blockermentioning

confidence: 51%

β-Blocker Therapy in Veterans with Asthma or Chronic Obstructive Pulmonary Disease

Barnett¹,

Milavetz²,

Kaboli³

2005

Pharmacotherapy

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“…15 Concern about side effects may discourage clinicians from prescribing beta-blockers and lipid-lowering agents in the elderly, but in clinical practice absolute contraindications are rare. 16 The women in the Canadian ACS Registry population were nearly 5 years older than the men, on average, which, at first glance, could be taken to support this hypothesis. In our study, age was independently associated with lower use of beta-blockers (0.80 and OR: 0.83; 95% CI: 0.78-0.88) and lipid-lowering agents (OR: 0.80; 95% CI: 0.75-0.84) as recommended therapy at discharge.…”

Section: Discussionmentioning

confidence: 89%

Factors influencing underutilization of evidence-based therapies in women

Bugiardini

Yan

et al. 2011

European Heart Journal

173

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Aims Previous studies have reported differences in the use of cardiovascular medications for acute coronary syndromes (ACSs) according to the sex of the patient. We analysed which clinical factors are associated with underutilization of evidence-based therapies in women. Methods and results From the Canadian Registry of ACS I and II, 6558 patients (4471 men and 2087 women) with a final diagnosis of ACS were selected for the current analysis. Covariates were chosen using the approach described by Blackstone. The final selected model included 23 patient clinical variables. Women were less likely than men to receive beta-blockers (75.76 vs. 79.24%; P < 0.01), lipid-modifying agents (56.37 vs. 65.44%; P < 0.0001), and angiotensin-converting enzyme (ACE)-inhibitors (55.52 vs. 59.99%; P < 0.01). Female sex and clinical decision not to investigate with cardiac catheterization were the strongest independent predictors for not receiving lipid-modifying agents and ACE-inhibitors. Age, Killip class 2, and Killip class 3/4 were significant independent predictors of underutilization of beta-blocker use. Women were older (69 ± 12 vs. 64 ± 12; P < 0.01) with a higher prevalence of Killip class ≥ 2 (19.95 vs. 15.54%; P < 0.068), and they were less likely to be referred for cardiac catheterization (41.9 vs. 49.6 %; P < 0.001). Conclusions The current findings demonstrate that underutilization of evidence-based therapies in women with ACS compared with men is associated with multiple factors related to the patient (age), the consequences of the disease (congestive heart failure), and the physician's assessment of patient risk (decision to catheterize). Female gender remains associated with underutilization of lipid-modifying agents and ACE-inhibitors despite adjustment for these confounders.

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“…101 Conversely, nonselective ␤-blockers can be contraindicated in asthma and chronic obstructive pulmonary disease because of induced bronchoconstriction, and even ␤ 1 -selective antagonists can cause problems in some patients. 102 At higher doses, the selectivity of the "cardioselective" ␤-blockers is lost and an increase in pulmonary side effects are seen. In the treatment of asthma, the use of ␤ 2 -agonists leads to an increase in heart rate and is associated with an increased risk of adverse cardiovascular events.…”

Section: Rgs Proteins As Drug Targetsmentioning

confidence: 99%

Multi-Tasking RGS Proteins in the Heart

Riddle

Schwartzman²,

Bond³

et al. 2005

Circulation Research

113

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Abstract-Regulator of G-protein-signaling (RGS) proteins play a key role in the regulation of G-protein-coupled receptor(GPCR) signaling. The characteristic hallmark of RGS proteins is a conserved Ϸ120-aa RGS region that confers on these proteins the ability to serve as GTPase-activating proteins (GAPs) for G ␣ proteins. Most RGS proteins can serve as GAPs for multiple isoforms of G ␣ and therefore have the potential to influence many cellular signaling pathways. However, RGS proteins can be highly regulated and can demonstrate extreme specificity for a particular signaling pathway. RGS proteins can be regulated by altering their GAP activity or subcellular localization; such regulation is achieved by phosphorylation, palmitoylation, and interaction with protein and lipid-binding partners. Many RGS proteins have GAP-independent functions that influence GPCR and non-GPCR-mediated signaling, such as effector regulation or action as an effector. Hence, RGS proteins should be considered multifunctional signaling regulators. GPCR-mediated signaling is critical for normal function in the cardiovascular system and is currently the primary target for the pharmacological treatment of disease. Alterations in RGS protein levels, in particular RGS2 and RGS4, produce cardiovascular phenotypes. Thus, because of the importance of GPCR-signaling pathways and the profound influence of RGS proteins on these pathways, RGS proteins are regulators of cardiovascular physiology and potentially novel drug targets as well.

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Cardioselective Beta‐Blockers in Patients with Asthma and Concomitant Heart Failure or History of Myocardial Infarction: When Do Benefits Outweigh Risks?

Cited by 14 publications

References 66 publications

β-Blocker Therapy in Veterans with Asthma or Chronic Obstructive Pulmonary Disease

β-Blocker Therapy in Veterans with Asthma or Chronic Obstructive Pulmonary Disease

Factors influencing underutilization of evidence-based therapies in women

Multi-Tasking RGS Proteins in the Heart

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