Effects of Lipid-Altering Therapies on Ventricular Arrhythmias and Sudden Cardiac Death

Majmudar, Maulik D.; Tompkins, Christine; Bachmann, Justin M.; Blumenthal, Roger S.; Marine, Joseph E.

doi:10.1097/crd.0b013e3181861be8

Cited by 7 publications

(5 citation statements)

References 90 publications

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“…36 The Diet and Reinfarction Trial (DART), 37 one of the first randomized trials of fish oil in CAD, has been interpreted as potential support for fish oil’s role in sudden death reduction because the primary outcome of all-cause mortality occurred within 2 months of the trial’s onset. 38 After such a short time span, it was believed that atherosclerosis would not be altered and therefore another mechanism was reducing mortality.…”

Section: Clinical Trialsmentioning

confidence: 99%

Fish Oil for the Treatment of Cardiovascular Disease

Weitz

Weintraub

Fisher

et al. 2010

Cardiology in Review

113

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Omega-3 fatty acids, which are found abundantly in fish oil, are increasingly being used in the management of cardiovascular disease. It is clear that fish oil, in clinically used doses (typically 4 g/d of eicosapentaenoic acid and docosahexaenoic acid) reduce high triglycerides. However, the role of omega-3 fatty acids in reducing mortality, sudden death, arrhythmias, myocardial infarction, and heart failure has not yet been established. This review will focus on the current clinical uses of fish oil and provide an update on their effects on triglycerides, coronary artery disease, heart failure, and arrhythmia. We will explore the dietary sources of fish oil as compared with drug therapy, and discuss the use of fish oil products in combination with other commonly used lipid-lowering agents. We will examine the underlying mechanism of fish oil’s action on triglyceride reduction, plaque stability, and effect in diabetes, and review the newly discovered anti-inflammatory effects of fish oil. Finally, we will examine the limitations of current data and suggest recommendations for fish oil use.

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Section: Clinical Trialsmentioning

confidence: 99%

Fish Oil for the Treatment of Cardiovascular Disease

Weitz

Weintraub

Fisher

et al. 2010

Cardiology in Review

113

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“…Patients with recognizable structural heart abnormalities such as congenital artery disease, myocardial infarction, hypertrophic cardiomyopathy, dilated cardiomyopathy, and congestive heart failure are believed to be at a high risk for the development of ventricular arrhythmias and subsequent sudden cardiac death [6,7]. Although different interventions such as β‐adrenoceptor blockers, angiotensin‐converting enzyme inhibitors, angiotensin II receptor blockers, lipid‐lowering agents, and omega‐3 fatty acids have been reported to prevent sudden cardiac death by varying degrees, cardiac defibrillators have been proven to be most effective for the treatment [8–11]. Likewise, acetylsalicylic acid alone or with the combination of streptokinase has been shown to reduce sudden cardiac death because of reinfarction [12].…”

Section: Introductionmentioning

confidence: 99%

Role of catecholamine oxidation in sudden cardiac death

Dhalla¹,

Adameová²,

Kaur

2010

Fundamemntal Clinical Pharma

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Although sudden cardiac death is a leading cause of mortality, the mechanisms for its pathogenesis are poorly understood. Because overactivation of sympathetic nervous system is invariably seen in subjects with high risk for sudden cardiac death, elevated levels of circulating catecholamine levels are considered to result in lethal ventricular arrhythmias and subsequent sudden cardiac death. Such arrhythmogenic effects of catecholamines are generally believed to occur by their actions on α‐adrenoceptors in coronary arteries for inducing coronary spasm and subsequent myocardial ischemia as well as on β‐adrenoceptors in cardiomyocytes for increasing the concentration of cyclic AMP excessively and producing defects in intracellular Ca2+‐handling. Experimental evidence from our laboratory has revealed that excessive amounts of circulating catecholamines are oxidized to aminochromes, which are highly reactive quinine compounds. The oxidation products of catecholamines have been demonstrated to produce subcellular alterations, intracellular Ca2+‐overload, coronary spasm, myocardial cell damage, depletion of high energy stores, and ventricular arrhythmias. In addition, oxyradicals, which are known to generate oxidative stress and produce cardiotoxic effects, including arrhythmias, are formed during the oxidation of catecholamines. Accordingly, it is proposed that oxidation of catecholamines and the generation of oxidative stress under stressful conditions may play a critical role in the genesis of ventricular arrhythmias that may result in sudden cardiac death.

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“…100 Additional data obtained from AICD studies suggest a reduced risk of recurrent VT with statin use in patients having ischemic cardiomyopathy. 100 Additional research is needed to determine whether statins have antiarrhythmic effects in patients who do not have a conventional indication. Current guidelines do not recommend using statins solely for their antiarrhythmic effects.…”

Section: Lipid-lowering Therapiesmentioning

confidence: 99%

Section: Lipid-lowering Therapiesmentioning

confidence: 99%

“…100 Statins appear to improve heart rate variability and have been shown to reduce ventricular arrhythmias after MI. 100 Additional data obtained from AICD studies suggest a reduced risk of recurrent VT with statin use in patients having ischemic cardiomyopathy. 100 Additional research is needed to determine whether statins have antiarrhythmic effects in patients who do not have a conventional indication.…”

Section: Lipid-lowering Therapiesmentioning

confidence: 99%

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Treatment of Ventricular Arrhythmias in the Elderly

Aronow¹

2009

Cardiology in Review

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Underlying causes of ventricular tachycardia (VT) or complex ventricular arrhythmias (VA) should be treated if possible. Antiarrhythmic drugs should not be administered to treat asymptomatic individuals with complex VA and no heart disease. Beta-blockers are the only antiarrhythmic drugs that have been documented to reduce mortality in patients with VT or complex VA. Radiofrequency catheter ablation of VT has been beneficial in treating selected patients with arrhythmogenic foci of monomorphic VT. The automatic implantable cardioverter-defibrillator (AICD) is the most effective treatment for patients with life-threatening VT or ventricular fibrillation. Patients with AICDs should be treated with biventricular pacing, not with dual-chamber rate-responsive pacing at a rate of 70/min. Patients with AICDs should also be treated with beta-blockers, statins, and angiotensin-converting enzyme inhibitors or angiotensin blockers.

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Effects of Lipid-Altering Therapies on Ventricular Arrhythmias and Sudden Cardiac Death

Cited by 7 publications

References 90 publications

Fish Oil for the Treatment of Cardiovascular Disease

Fish Oil for the Treatment of Cardiovascular Disease

Role of catecholamine oxidation in sudden cardiac death

Treatment of Ventricular Arrhythmias in the Elderly

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