Adherence in Hypertension and Coronary Heart Disease
Lynn B. Myers, Kenny Midence in Adherence to Treatment in Medical Conditions, 2020
While the main challenge of adherence in HT is ensuring that prescribed medication is taken, this is only one of several challenges for CHD patients. Firstly, patients with CHD are normally treated with a more complex medication regimen than are patients with HT (e.g. aspirin, beta-blockers for myocardial oxygen demand; glyceryl trinitrate for angina pain). Secondly, treatment for CHD may include performance of physical exercises, and dramatic changes in health behaviours such as diet, smoking cessation and stress modification (Owens, McCann and Hutelmyer, 1978), all which attempt to reduce recurrent CHD episodes by targeting CHD risk factors (Jenkins, 1988). Thus, patients with CHD need to adhere to a more complex and personally demanding therapeutic regimen. As patients with CHD are often more ill than those who suffer from HT, CHD-related symptoms and disability may motivate some patients to increase their adherence, and may be a barrier or a source of helplessness for others. The greater challenges in performing the complex medical regimes in CHD and in coping with CHD need to be considered when assessing and planning interventions to enhance adherence in CHD.
Alcohol Pharmacology and Pharmacotherapy of Alcoholism
Sahab Uddin, Rashid Mamunur in Advances in Neuropharmacology, 2020
Epidemiological data implies that moderate ethanol consumption (20–30 g ethanol per day) confers a cardioprotective effect and prevents cardiovascular diseases like coronary heart disease (CHD), stroke and peripheral arterial disease (Goldberg et al., 2001; Mukamal et al., 2006). Around 10–40% have decreased risk of CHD as compared to non-alcoholics, in those who consume 1–3 drinks per day. This association between mortality and dose of the ethanol has a J-shaped dose-mortality curve. Ethanol decreases CHD risk through its effect on blood lipids. Ethanol increases the levels of high-density lipoprotein (HDL) which further decreases plasma cholesterol levels and the accumulation of cholesterol in the walls of the arteries, thereby decreasing the risk of ischemia. Additionally, red wine has flavonoids that protect low-density lipoprotein (LDL) from oxidative stress thereby contributing to an antiatherogenic role. Eventually, ethanol decreases clot formation by increasing the levels of tissue plasminogen activator (clot-dissolving enzyme) and by decreasing fibrinogen concentrations (Rimm et al., 1999). Despite its benefits, there has yet to be randomized clinical trials conducted to test the efficacy of daily alcohol use in decreasing rates of cardiovascular diseases and mortality. Patients with the possibility of progressing CHD should be advised to modify lifestyle changes or medical treatments.
Swarm Intelligence and Evolutionary Algorithms for Heart Disease Diagnosis
Sandeep Kumar, Anand Nayyar, Anand Paul in Swarm Intelligence and Evolutionary Algorithms in Healthcare and Drug Development, 2019
According to statistics of WHO (2019), there exists 17% of annual mortality rate due to CHD. This accounts to about one-third of the mortality caused by other diseases across the globe. CHD has evolved as the killer disease in the recent evolutionary world. Further, from the context of evolutionary genetics, impact toward CHD has been explored by researchers in detail. In recent years, CHD are susceptible to be part of the evolutionary genetics according to [1]. In the recent years, there is significant advancement toward CHD and impact from the perspective of evolutionary genetics. The several evolutionary factors that might lead to CHD are hypertension, metabolic syndrome, and dyslipidemia. These factors lead to high blood pressure, weak lipid and glucose metabolism activities, blood vessel coagulation, and heart inflammation and weak energy metabolism activities.
Pregnancy in women with congenital heart disease: a focus on management and preventing the risk of complications
Published in Expert Review of Cardiovascular Therapy, 2023
Gurleen Wander, Johanna A. van der Zande, Roshni R Patel, Mark R Johnson, Jolien Roos-Hesselink
Cardiac disease remains the single largest indirect cause of maternal mortality in the developed world. CHD is a birth defect that affects the function of the heart. It occurs in 1% of the population and, during pregnancy in western countries, it is the most frequent cardiac disease accounting for 75–82% of cases [1,2] (Figure 1). The etiology of CHD is multifactorial, due to both genetic predisposition and environmental causes. Typically, the term CHD excludes cardiomyopathies and rhythm and conduction system problems, although these can be present at birth but have a distinct and, most of the time, later presentation. As the management of CHD has improved, predominantly through better surgical approaches, most patients are surviving to adulthood and are considering pregnancy [3]. For women, preconception counseling involves considering the impact of pregnancy on their condition both in the short and long term and the impact of their underlying condition on the fetus, which is mediated through their cardiac function, medication, and any heritable risk that their condition carries. Increasingly, more men are attending pre-conception counseling to determine the heritable risk of their condition and their personal prognosis. In this review, we focus on the antenatal management of CHD and strategies to prevent maternal and fetal complications.
Reproductive health in adults with congenital heart disease: a review on fertility, sexual health, assisted reproductive technology and contraception
Published in Expert Review of Cardiovascular Therapy, 2023
J.A. van der Zande, G. Wander, K.P. Ramlakhan, J.W. Roos-Hesselink, M.R. Johnson
Congenital heart disease (CHD) affects around 1% of all live births worldwide and is the most frequently diagnosed congenital disorder [1,2]. Bicuspid aortic valve, ventricular septal defect, and atrial septal defect are the most common subtypes of CHD and are relatively mild compared with more complex abnormalities such as hypoplastic left heart syndrome and pulmonary atresia [3]. The survival rates vary between the different subtypes of CHD and substantially across the world [3,4]. Due to improvements in diagnosis, surgical and medical treatments, more people with CHD are reaching adulthood and considering pregnancy [5]. The European Society of Cardiology (ESC) guideline and the American Heart Association (AHA) guideline provide information on the management and organization of care for adults with CHD and give a clear overview of the risks and treatments of the different types of CHD [6,7]. However, due to the improved survival in individuals with CHD, considering their reproductive health has become more important, and this topic is still underexplored. In this review, we will discuss multiple aspects of reproductive health in both women and, when applicable, in men, including fertility, sexual health, assisted reproductive technology and contraception.
Prenatal sonographic findings in a cohort of foetuses with a confirmed 22q11.2 microdeletion at a single Chinese Tertiary Centre
Published in Journal of Obstetrics and Gynaecology, 2022
Xiang-Yi Jing, Yong-Ling Zhang, Li Zhen, Yan-Lin Li, Dong-Zhi Li
In this study, we first report the indications for prenatal diagnosis of del22q11.2 in a cohort of Chinese patients. In our series, CHD remains the most striking sonographic feature in del22q11.2 foetuses, affecting 61.8% of cases at the time of prenatal diagnosis, and 73.4% of cases with structural anomalies. Similar to other studies (Anilkumar et al. 2011; Besseau-Ayasse et al. 2014; Schindewolf et al. 2018; Kong et al. 2019; Sarac Sivrikoz et al. 2022), the most frequent category of CHD with del22q11.2 is conotruncal defects, with TOF, interrupted aortic arch and truncus arteriosus being the three most common types. Other significant CHD types were RAA and ventricular septal defect (VSD). RAA was found in 11 cases in our series, and as an isolated cardiac finding in 9 cases. The del22q11.2 has been reported to be present in 8.5% (7/82) of foetuses with a prenatal diagnosis of RAA without intracardiac anomalies (Perolo et al. 2016). VSD was found in 4 cases as an isolated finding, and all are the perimembranous type. Although approximately 15% of del22q11.2 patients manifest VSD, one study reported that perimembranous VSD can be associated with del.22q11, but del.22q11 is not a common cause of conal-septal VSD (Yamagishi et al. 2000). Therefore, when any of these cardiac defects are identified during pregnancy, del22q11.2 must be considered as one of differential diagnoses and included in parental counselling.
Related Knowledge Centers
- Birth Defect
- Childbirth
- Ethanol
- Cardiovascular Disease
- Cyanosis
- Heart
- Rubella
- Pregnancy
- Great Vessels
- Heart Failure