Pharmacotherapy for Cardiac Diseases
Clinical trial design inclusion criteria typically require that patients be on optimal medical therapy prior to their enrollment or randomization, i.e., they are currently being managed by medical regimens proven to be safe and effective and considered st
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Anna Legreid Dopp and Katie Willenborg
Abstract
Clinical trial design inclusion criteria typically require that patients be on optimal medical therapy prior to their enrollment or randomization, i.e., they are currently being managed by medical regimens proven to be safe and effective and considered standard in clinical practice for the particular disease state being studied. Only if this is the case can any trial’s clinical or statistical significance be determined between study groups. This chapter outlines the current optimal medical management/therapy for patients eliciting: (1) hypertension, (2) acute coronary syndromes and myocardial infarction, (3) heart failure, and/or (4) arrhythmias. Keywords
Diuretics • Beta-blockers • Angiotensin-converting enzyme inhibitors • Angiotensin receptor blockers • Calcium channel blockers • Antiplatelets • Anticoagulants • Aldosterone antagonists
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Abbreviations
ACE AF ARB CHD CRT CVD HF ICD NSTEMI PCI STEMI
Angiotensin-converting enzyme Atrial fibrillation Angiotensin receptor blocker Coronary heart disease Cardiac resynchronization therapy Cardiovascular disease Heart failure Implantable cardioverter defibrillator Non-ST segment elevation myocardial infarction Percutaneous coronary intervention ST segment elevation myocardial infarction
A.L. Dopp, PharmD (*) Pharmacy Society of Wisconsin, 701 Heartland Trail, Madison, WI 53717, USA e-mail: [email protected]; [email protected] K. Willenborg, PharmD, BCPS University of Wisconsin Hospital and Clinics, Madison, WI, USA
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Introduction
Chronic disorders such as heart disease, diabetes, stroke, obesity, and cancer remain today as the leading causes of death and disability in the United States. Nearly half of all Americans have at least one chronic condition, and seven out of the top ten causes of death are due to chronic diseases [1]. Importantly, heart disease, or cardiovascular disease (CVD), is the chronic disorder that is the leading cause of death in the United States, accounting for 600,000 deaths annually or roughly 25 % of all deaths [2]. Yet this represents a 2 % rate of decline for deaths attributed to heart disease over the past few years. In addition, between 1999 and 2010, the prevalence of adults with at least one of the three following CVD risk factors: uncontrolled high blood pressure, uncontrolled high levels of low-density lipoproteins cholesterol, or current smoking, decreased from 58 to 47 % [3]. For a complete list of CVD risk factors, see (Table 26.1). While these morbidity and mortality improvements represent important successes, the medical management of patients living with CVD
© Springer International Publishing Switzerland 2015 P.A. Iaizzo (ed.), Handbook of Cardiac Anatomy, Physiology, and Devices, DOI 10.1007/978-3-319-19464-6_26
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A.L. Dopp and K. Willenborg
Table 26.1 Cardiovascular disease risk factors • Tobacco use • Dyslipidemia • Overweight (body mass index > 25 kg/m2) • Diabetes mellitus • Age (>45 years for men; >55 years for women) • Physical inactivity • Family
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