Metabolic effects of cardiovascular drugs

Fragasso, Gabriele; Margonato, Alberto; Spoladore, Roberto; Lopaschuk, Gary D.

doi:10.1016/j.tcm.2018.08.001

Cited by 13 publications

(7 citation statements)

References 126 publications

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“…Additionally, hypocalcemia, which may affect cardiac contractility, can be brought on by these medications. Last but not least, loop diuretics can contribute to all of the metabolic changes associated with RAAS activation (as previously described) by stimulating the RAAS through volume depletion and decreased blood pressure [65].…”

Section: Loop Diureticsmentioning

confidence: 70%

Metabolic Approaches for the Treatment of Dilated Cardiomyopathy

Spoladore

Pinto

Daus

et al. 2023

JCDD

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In dilated cardiomyopathy (DCM), where the heart muscle becomes stretched and thin, heart failure (HF) occurs, and the cardiomyocytes suffer from an energetic inefficiency caused by an abnormal cardiac metabolism. Although underappreciated as a potential therapeutic target, the optimal metabolic milieu of a failing heart is still largely unknown and subject to debate. Because glucose naturally has a lower P/O ratio (the ATP yield per oxygen atom), the previous studies using this strategy to increase glucose oxidation have produced some intriguing findings. In reality, the vast majority of small-scale pilot trials using trimetazidine, ranolazine, perhexiline, and etomoxir have demonstrated enhanced left ventricular (LV) function and, in some circumstances, myocardial energetics in chronic ischemic and non-ischemic HF with a reduced ejection fraction (EF). However, for unidentified reasons, none of these drugs has ever been tested in a clinical trial of sufficient size. Other pilot studies came to the conclusion that because the heart in severe dilated cardiomyopathy appears to be metabolically flexible and not limited by oxygen, the current rationale for increasing glucose oxidation as a therapeutic target is contradicted and increasing fatty acid oxidation is supported. As a result, treating metabolic dysfunction in HF may benefit from raising ketone body levels. Interestingly, treatment with sodium-glucose cotransporter-2 inhibitors (SGLT2i) improves cardiac function and outcomes in HF patients with or without type 2 diabetes mellitus (T2DM) through a variety of pleiotropic effects, such as elevated ketone body levels. The improvement in overall cardiac function seen in patients receiving SGLT2i could be explained by this increase, which appears to be a reflection of an adaptive process that optimizes cardiac energy metabolism. This review aims to identify the best metabolic therapeutic approach for DCM patients, to examine the drugs that directly affect cardiac metabolism, and to outline all the potential ancillary metabolic effects of the guideline-directed medical therapy. In addition, a special focus is placed on SGLT2i, which were first studied and prescribed to diabetic patients before being successfully incorporated into the pharmacological arsenal for HF patients.

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Section: Loop Diureticsmentioning

confidence: 70%

Metabolic Approaches for the Treatment of Dilated Cardiomyopathy

Spoladore

Pinto

Daus

et al. 2023

JCDD

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“…For instance, beta-blockers may decrease the release of fatty acids from adipose tissue. 20 This could explain why hypertension was associated with a significant reduction in urinary ketosis.…”

Section: Discussionmentioning

confidence: 99%

Perioperative urinary ketosis and metabolic acidosis in patients fasted for undergoing gynecologic surgery

Lim,

Park,

Kang

et al. 2024

Acta Anaesthesiol Scand

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BackgroundOur bodies have adaptive mechanisms to fasting, in which glycogen stored in the liver and muscle protein are broken down, but also lipid mobilisation is triggered. As a result, glycerol and fatty acids are released into the bloodstream, increasing the production of ketone bodies in liver. However, there are limited studies on the incidence of perioperative urinary ketosis, the intraoperative blood glucose changes and metabolic acidosis after fasting for surgery in non‐diabetic adult patients.MethodsWe conducted a retrospective cohort study involving 1831 patients undergoing gynecologic surgery under general anesthesia from January to December 2022. Ketosis was assessed using a postoperative urine test, while blood glucose levels and acid–base status were collected from intraoperative arterial blood gas analyses.ResultsOf 1535 patients who underwent postoperative urinalysis, 912 (59.4%) patients had ketonuria. Patients with ketonuria were younger, had lower body mass index, and had fewer comorbidities than those without ketonuria. After adjustments, younger age, higher body mass index and surgery starting late afternoon were significant risk factors for postoperative ketonuria. Of the 929 patients assessed with intraoperative arterial blood gas analyses, 29.0% showed metabolic acidosis. Multivariable logistic regression revealed that perioperative ketonuria and prolonged surgery significantly increased the risk for moderate‐to‐severe metabolic acidosis.ConclusionPerioperative urinary ketosis and intraoperative metabolic acidosis are common in patients undergoing gynecologic surgery, even with short‐term preoperative fasting. The risks are notably higher in younger patients with lower body mass index. Optimization of preoperative fasting strategies including implementation of oral carbohydrate loading should be considered for reducing perioperative metabolic derangement due to ketosis.

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“…Depending on the extent, severity, and clinical presentation of CAD, the current treatments include medical, surgical, or a combination of the two approaches. Although the aim of diminishing the risk of cardiovascular events is attained in a considerable proportion of treated patients, there is substantial patient-to-patient variation in efficacy and adverse effects, as well as frequent treatment discontinuation [ 5 , 6 ]. Additionally, the absence of regenerative properties in cardiomyocytes can lead to chronic cardiac dysfunction and heart failure following cardiac events.…”

Section: Introductionmentioning

confidence: 99%

Tailoring Treatment in Cardiovascular Diseases: The Role of Targeted Therapies

Dankar,

Wehbi,

Refaat

2024

Pharmaceutics

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Cardiovascular diseases (CVDs) remain the leading cause of morbidity and mortality around the globe. To address this public health burden, innovative therapeutic agents are being developed to specifically target molecular and genetic markers. Various therapeutic modalities have been implemented, including vaccines, monoclonal or bispecific antibodies, and gene-based therapies. Such drugs precisely target the underlying disease pathophysiology, aiming at notable molecules such as lipid metabolism regulators, proinflammatory cytokines, and growth factors. This review focuses on the latest advancements in different targeted therapies. It provides an insightful overview of the current landscape of targeted cardiovascular therapies, highlighting promising strategies with potential to transform the treatment of CVDs into an era of precision medicine.

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Metabolic effects of cardiovascular drugs

Cited by 13 publications

References 126 publications

Metabolic Approaches for the Treatment of Dilated Cardiomyopathy

Metabolic Approaches for the Treatment of Dilated Cardiomyopathy

Perioperative urinary ketosis and metabolic acidosis in patients fasted for undergoing gynecologic surgery

Tailoring Treatment in Cardiovascular Diseases: The Role of Targeted Therapies

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