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  1. Article ; Online: Colchicine's Role in Cardiovascular Disease Management.

    Buckley, Leo F / Libby, Peter

    Arteriosclerosis, thrombosis, and vascular biology

    2024  Volume 44, Issue 5, Page(s) 1031–1041

    Abstract: Colchicine-an anti-inflammatory alkaloid-has assumed an important role in the management of cardiovascular inflammation ≈3500 years after its first medicinal use in ancient Egypt. Primarily used in high doses for the treatment of acute gout flares during ...

    Abstract Colchicine-an anti-inflammatory alkaloid-has assumed an important role in the management of cardiovascular inflammation ≈3500 years after its first medicinal use in ancient Egypt. Primarily used in high doses for the treatment of acute gout flares during the 20th century, research in the early 21st century demonstrated that low-dose colchicine effectively treats acute gout attacks, lowers the risk of recurrent pericarditis, and can add to secondary prevention of major adverse cardiovascular events. As the first Food and Drug Administration-approved targeted anti-inflammatory cardiovascular therapy, colchicine currently has a unique role in the management of atherosclerotic cardiovascular disease. The safe use of colchicine requires careful monitoring for drug-drug interactions, changes in kidney and liver function, and counseling regarding gastrointestinal upset. Future research should elucidate the mechanisms of anti-inflammatory effects of colchicine relevant to atherosclerosis, the potential role of colchicine in primary prevention, in other cardiometabolic conditions, colchicine's safety in cardiovascular patients, and opportunities for individualizing colchicine therapy using clinical and molecular diagnostics.
    MeSH term(s) Colchicine/therapeutic use ; Colchicine/adverse effects ; Humans ; Cardiovascular Diseases/drug therapy ; Cardiovascular Diseases/prevention & control ; Gout Suppressants/therapeutic use ; Gout Suppressants/adverse effects ; Anti-Inflammatory Agents/therapeutic use ; Anti-Inflammatory Agents/adverse effects ; Animals ; Treatment Outcome ; Drug Interactions
    Chemical Substances Colchicine (SML2Y3J35T) ; Gout Suppressants ; Anti-Inflammatory Agents
    Language English
    Publishing date 2024-03-21
    Publishing country United States
    Document type Journal Article ; Review ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
    ZDB-ID 1221433-4
    ISSN 1524-4636 ; 1079-5642
    ISSN (online) 1524-4636
    ISSN 1079-5642
    DOI 10.1161/ATVBAHA.124.319851
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Trends in Oral Anticoagulant Use and Individual Expenditures Across the United States from 2014 to 2020.

    Alkhezi, Omar S / Buckley, Leo F / Fanikos, John

    American journal of cardiovascular drugs : drugs, devices, and other interventions

    2024  

    Abstract: Background: Landmark clinical trials have expended the indications for the direct oral anticoagulants (DOACs), but contemporary data on usage and expenditure patterns are lacking.: Objective: This study aimed to assess annual trends in oral ... ...

    Abstract Background: Landmark clinical trials have expended the indications for the direct oral anticoagulants (DOACs), but contemporary data on usage and expenditure patterns are lacking.
    Objective: This study aimed to assess annual trends in oral anticoagulant (OAC) utilization and expenditure across the United States (US) from 2014 to 2020.
    Methods: We utilized the Medical Expenditure Panel Survey (MEPS) to study the trends of use and expenditures of warfarin, dabigatran, rivaroxaban, apixaban, and edoxaban between 2014 and 2020 in the US. Survey respondents reported OAC use within the past year, which was verified against pharmacy records. Payment information was obtained from the respondent's pharmacy and was categorized as third-party or self/out-of-pocket. Potential indications and medical conditions of interest for OAC therapy were identified from respondent-reported medical conditions. We estimated the national number of OAC users and total expenditures across age, sex, race, ethnicity, insurance, and medical condition subgroups. Trends of OAC users' characteristics, expenditure, and number of prescriptions were evaluated using the Mann-Kendall test for trends.
    Results: Between 2014 and 2020, the number of warfarin users decreased from 3.8 million (70% of all OAC users) to 2.2 million (p = 0.007) [29% of all OAC users], while the number of DOAC users increased from 1.6 million (30% of all OAC users) to 5.4 million (p = 0.003) [70% of all OAC users]. The total expenditure of OACs in the US increased from $3.4 billion in 2014 to $17.8 billion in 2020 (p = 0.003), which was driven by the increase in DOAC expenditures (p = 0.003).
    Conclusions: DOACs have replaced warfarin as the preferred OAC in the US. The increased costs associated with DOAC use may decline when generic formulations are approved.
    Language English
    Publishing date 2024-04-07
    Publishing country New Zealand
    Document type Journal Article
    ZDB-ID 2052547-3
    ISSN 1179-187X ; 1175-3277
    ISSN (online) 1179-187X
    ISSN 1175-3277
    DOI 10.1007/s40256-024-00638-4
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: Expanding the Impact of SGLT2 Inhibitors in Chronic Kidney Disease.

    Makawi, Alaa T / Tawfik, Yahya M K / Dixon, Dave L / McMahon, Gearoid M / Buckley, Leo F

    American journal of nephrology

    2024  , Page(s) 1–4

    Language English
    Publishing date 2024-02-28
    Publishing country Switzerland
    Document type Journal Article
    ZDB-ID 604540-6
    ISSN 1421-9670 ; 0250-8095
    ISSN (online) 1421-9670
    ISSN 0250-8095
    DOI 10.1159/000536540
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article ; Online: Acute Myocardial Infarction after Laboratory-Confirmed Influenza Infection.

    Buckley, Leo F

    The New England journal of medicine

    2018  Volume 378, Issue 26, Page(s) 2539–2540

    MeSH term(s) Humans ; Influenza A Virus, H1N1 Subtype ; Influenza, Human ; Myocardial Infarction
    Keywords covid19
    Language English
    Publishing date 2018--28
    Publishing country United States
    Document type Letter ; Comment
    ZDB-ID 207154-x
    ISSN 1533-4406 ; 0028-4793
    ISSN (online) 1533-4406
    ISSN 0028-4793
    DOI 10.1056/NEJMc1805679
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article ; Online: Management of direct oral anticoagulant drug interactions in hospitalized patients.

    Al Zaria, Mohsen H / Buckley, Leo F / Dell'orfano, Heather / Manzo, Peter / Fanikos, John

    Journal of thrombosis and thrombolysis

    2024  Volume 57, Issue 4, Page(s) 598–602

    Abstract: Moderate-strong CYP3A4 or Pgp inhibitors and inducers alter direct oral anticoagulant (DOAC) pharmacokinetics. Whether the presence of a DOAC drug-drug interaction (DDI) prompts in- hospital changes in management remains unknown. We identified all ... ...

    Abstract Moderate-strong CYP3A4 or Pgp inhibitors and inducers alter direct oral anticoagulant (DOAC) pharmacokinetics. Whether the presence of a DOAC drug-drug interaction (DDI) prompts in- hospital changes in management remains unknown. We identified all hospitalized patients at our institution who were admitted with a clinically relevant DOAC DDI from 01/2021 to 06/2021. Clinically relevant DOAC DDIs were defined as those listed in the prescribing information or FDA CYP3A4/Pgp inhibitors clinical indexes. We assessed the prevalence of DOAC DDIs and categorized their management as: drug stopped, drug held, or drug continued. For drugs that were continued we assessed whether the dose of the DOAC or interacting drug was increased, decreased or unchanged during the admission. We ascertained the number of DOAC DDIs that prompted an automated prescribing alert in our electronic health record (EHR). Finally, we conducted a logistic regression model to compare users of DOACs with DDI who had their regimen adjusted versus those without adjustments, focusing on outcomes of rehospitalization and death, adjusting for age and gender. Among 3,725 hospitalizations with a DOAC admission order, 197 (5%) had a clinically relevant DOAC DDI. The DOAC and the interacting drug were continued at discharge for 124 (63%) hospitalizations. The most frequent adjustments were stopping the interacting drug (73%) and stopping the DOAC (15%). Only 7 (4%) of DOAC DDIs prompted an EHR alert. The adjusted odds ratios for rehospitalizations and death, respectively, among patients whose regimens were adjusted compared to those whose were not, were 1.29 (95% CI, 0.67 to 2.48; P = 0.44) and 1.88 (95% CI, 0.91 to 3.89; P = 0.09). Clinically relevant DDIs with DOACs occur infrequently among hospitalized patients and usually are managed without stopping the DOAC. The clinical impact of such DDIs and subsequent adjustments on thrombotic and hemorrhagic outcomes requires further investigation.
    MeSH term(s) Humans ; Cytochrome P-450 CYP3A ; Drug Interactions ; Hemorrhage/drug therapy ; Cytochrome P-450 CYP3A Inhibitors ; Anticoagulants/therapeutic use ; Administration, Oral
    Chemical Substances Cytochrome P-450 CYP3A (EC 1.14.14.1) ; Cytochrome P-450 CYP3A Inhibitors ; Anticoagulants
    Language English
    Publishing date 2024-03-30
    Publishing country Netherlands
    Document type Journal Article
    ZDB-ID 1230645-9
    ISSN 1573-742X ; 0929-5305
    ISSN (online) 1573-742X
    ISSN 0929-5305
    DOI 10.1007/s11239-024-02967-2
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  6. Article ; Online: Cardiac Myosin Activation for the Treatment of Systolic Heart Failure.

    Bernier, Thomas D / Buckley, Leo F

    Journal of cardiovascular pharmacology

    2020  Volume 77, Issue 1, Page(s) 4–10

    Abstract: Abstract: Left ventricular systolic dysfunction is the hallmark pathology in heart failure with reduced ejection fraction. Increasing left ventricular contractility with beta-adrenergic receptor agonists, phosphodiesterase-3 inhibitors, or levosimendan ... ...

    Abstract Abstract: Left ventricular systolic dysfunction is the hallmark pathology in heart failure with reduced ejection fraction. Increasing left ventricular contractility with beta-adrenergic receptor agonists, phosphodiesterase-3 inhibitors, or levosimendan has failed to improve clinical outcomes and, in some situations, increased the risk of sudden cardiac death. Beta-adrenergic receptor agonists and phosphodiesterase-3 inhibitors retain an important role in advanced heart failure. Thus, there remains an unmet need for safe and effective therapies to improve left ventricular systolic function. Two novel cardiac myotropes, omecamtiv mecarbil and danicamtiv, target cardiac myosin to increase left ventricular systolic performance. Neither omecamtiv mecarbil nor danicamtiv affects cardiomyocyte calcium handling, the proposed mechanism underlying the life-threatening arrhythmias associated with cardiac calcitropes and calcium sensitizers. Phase 2 clinical trials have demonstrated that these cardiac myosin activators prolong left ventricular systolic ejection time and promote left ventricular and atrial reverse remodeling. At higher plasma concentrations, these agents may be associated with myocardial ischemia and impaired diastolic function. An ongoing phase 3 clinical trial will estimate the clinical efficacy and safety of omecamtiv mecarbil. An additional study of these agents, which have minimal hemodynamic and renal effects, is warranted in patients with advanced heart failure refractory to guideline-directed neurohormonal blockers.
    MeSH term(s) Animals ; Cardiac Myosins/metabolism ; Cardiotonic Agents/adverse effects ; Cardiotonic Agents/therapeutic use ; Heart Failure, Systolic/drug therapy ; Heart Failure, Systolic/metabolism ; Heart Failure, Systolic/physiopathology ; Humans ; Myocardium/metabolism ; Recovery of Function ; Signal Transduction ; Stroke Volume/drug effects ; Treatment Outcome ; Urea/adverse effects ; Urea/analogs & derivatives ; Urea/therapeutic use ; Ventricular Dysfunction, Left/drug therapy ; Ventricular Dysfunction, Left/metabolism ; Ventricular Dysfunction, Left/physiopathology ; Ventricular Function, Left/drug effects ; Ventricular Remodeling/drug effects
    Chemical Substances Cardiotonic Agents ; omecamtiv mecarbil (2M19539ERK) ; Urea (8W8T17847W) ; Cardiac Myosins (EC 3.6.1.-)
    Language English
    Publishing date 2020-11-09
    Publishing country United States
    Document type Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't ; Review
    ZDB-ID 391970-5
    ISSN 1533-4023 ; 0160-2446
    ISSN (online) 1533-4023
    ISSN 0160-2446
    DOI 10.1097/FJC.0000000000000929
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  7. Article ; Online: Targeting pharmacotherapies for inflammatory and cardiorenal endpoints in kidney disease.

    Huck, Daniel M / Buckley, Leo F / Chandraker, Anil / Blankstein, Ron / Weber, Brittany

    Journal of cardiovascular pharmacology

    2023  

    Abstract: Abstract: Inflammation is an important contributor to excess cardiovascular risk and progressive renal injury in people with CKD. Dysregulation of the innate and adaptive immune system is accelerated by CKD and results in increased systemic inflammation, ...

    Abstract Abstract: Inflammation is an important contributor to excess cardiovascular risk and progressive renal injury in people with CKD. Dysregulation of the innate and adaptive immune system is accelerated by CKD and results in increased systemic inflammation, a heightened local vascular inflammatory response leading to accelerated atherosclerosis, and dysfunction of the cardiac and renal endothelium and microcirculation. Understanding and addressing the dysregulated immune system is a promising approach to modifying cardiorenal outcomes in people with CKD. However, targeted pharmacotherapies adopted from trials of non-CKD and cardio-rheumatology populations are only beginning to be developed and tested in human clinical trials. Pharmacotherapies that inhibit activation of the NLRP3 inflammasome and the downstream cytokines IL-1 and IL-6 are the most well-studied. However, most of the available evidence for efficacy is from small clinical trials with inflammatory and cardiorenal biomarker endpoints, rather than cardiovascular event endpoints, or from small CKD subgroups in larger clinical trials. Other pharmacotherapies that have proven beneficial for cardiorenal endpoints in people with CKD have been found to have pleiotropic anti-inflammatory benefits including statins, mineralocorticoid receptor antagonists, SGLT-2 inhibitors, and GLP-1 agonists. Finally, emerging therapies in CKD such as IL-6 inhibition, small-interfering RNA against lipoproteins, AhR inhibitors, and therapies adopted from the renal transplant population including mTOR inhibitors and T regulatory cell promoters may have benefits for cardiorenal and inflammatory endpoints but require further investigation in clinical trials.
    Language English
    Publishing date 2023-09-05
    Publishing country United States
    Document type Journal Article
    ZDB-ID 391970-5
    ISSN 1533-4023 ; 0160-2446
    ISSN (online) 1533-4023
    ISSN 0160-2446
    DOI 10.1097/FJC.0000000000001482
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  8. Article ; Online: Recent advances in the treatment of chronic heart failure.

    Buckley, Leo F / Shah, Amil M

    F1000Research

    2019  Volume 8

    Abstract: After more than a decade of relatively modest advancements, heart failure therapeutic development has accelerated, with the PARADIGM-HF trial and the SHIFT trial demonstrated significant reductions in cardiovascular death and heart failure ... ...

    Abstract After more than a decade of relatively modest advancements, heart failure therapeutic development has accelerated, with the PARADIGM-HF trial and the SHIFT trial demonstrated significant reductions in cardiovascular death and heart failure hospitalization for sacubitril-valsartan and in heart failure hospitalization alone for ivabradine. Several heart failure therapies have since received or stand on the verge of market approval and promise substantive advances in the treatment of chronic heart failure. Some of these improve clinical outcomes, whereas others improve functional or patient-reported outcomes. In light of these rapid advances in the care of adults living with chronic heart failure, in this review we seek to update the general practitioner on novel heart failure therapies. Specifically, we will review recent data on the implementation of sacubitril-valsartan, treatment of functional mitral regurgitation, sodium-glucose co-transporter-2 (SGLT-2) inhibitor therapy, agents for transthyretin amyloid cardiomyopathy, treatment of iron deficiency in heart failure, and the use of biomarkers or remote hemodynamic monitoring to guide heart failure therapy.
    MeSH term(s) Aminobutyrates/therapeutic use ; Amyloid Neuropathies, Familial/therapy ; Angiotensin Receptor Antagonists/therapeutic use ; Biomarkers/blood ; Chronic Disease ; Drug Combinations ; Heart Failure/therapy ; Hemodynamics ; Humans ; Iron/deficiency ; Mitral Valve Insufficiency/therapy ; Monitoring, Physiologic/methods ; Sodium-Glucose Transporter 2 ; Tetrazoles/therapeutic use ; Treatment Outcome
    Chemical Substances Aminobutyrates ; Angiotensin Receptor Antagonists ; Biomarkers ; Drug Combinations ; SLC5A2 protein, human ; Sodium-Glucose Transporter 2 ; Tetrazoles ; Iron (E1UOL152H7) ; sacubitril and valsartan sodium hydrate drug combination (WB8FT61183)
    Language English
    Publishing date 2019-12-20
    Publishing country England
    Document type Journal Article ; Research Support, N.I.H., Extramural ; Review
    ZDB-ID 2699932-8
    ISSN 2046-1402 ; 2046-1402
    ISSN (online) 2046-1402
    ISSN 2046-1402
    DOI 10.12688/f1000research.20447.1
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  9. Article ; Online: Inhibiting NLRP3 Inflammasome Activity in Acute Myocardial Infarction: A Review of Pharmacologic Agents and Clinical Outcomes.

    Buckley, Leo F / Libby, Peter

    Journal of cardiovascular pharmacology

    2019  Volume 74, Issue 4, Page(s) 297–305

    Abstract: The NLRP3 inflammasome is an intracellular, multimeric protein complex that initiates a potent inflammatory response to danger signals. After acute myocardial infarction, NLRP3 inflammasome-dependent inflammation promotes adverse left ventricular ... ...

    Abstract The NLRP3 inflammasome is an intracellular, multimeric protein complex that initiates a potent inflammatory response to danger signals. After acute myocardial infarction, NLRP3 inflammasome-dependent inflammation promotes adverse left ventricular remodeling and recurrent atherosclerotic events. Selective and nonselective inhibitors of the NLRP3 inflammasome or its downstream effectors (interleukin-1β and interleukin-18) may prevent adverse left ventricular remodeling and recurrent atherosclerotic events. In this review, we highlight strategies to inhibit NLRP3 inflammasome activity and their potential roles in the management of acute myocardial infarction.
    MeSH term(s) Animals ; Anti-Inflammatory Agents/adverse effects ; Anti-Inflammatory Agents/pharmacokinetics ; Anti-Inflammatory Agents/therapeutic use ; Cardiovascular Agents/adverse effects ; Cardiovascular Agents/pharmacokinetics ; Cardiovascular Agents/therapeutic use ; Humans ; Inflammasomes/antagonists & inhibitors ; Inflammasomes/immunology ; Inflammasomes/metabolism ; Inflammation/drug therapy ; Inflammation/immunology ; Inflammation/metabolism ; Inflammation/pathology ; Inflammation Mediators/antagonists & inhibitors ; Inflammation Mediators/immunology ; Inflammation Mediators/metabolism ; Molecular Targeted Therapy ; Myocardial Infarction/drug therapy ; Myocardial Infarction/immunology ; Myocardial Infarction/metabolism ; Myocardial Infarction/pathology ; NLR Family, Pyrin Domain-Containing 3 Protein/antagonists & inhibitors ; NLR Family, Pyrin Domain-Containing 3 Protein/immunology ; NLR Family, Pyrin Domain-Containing 3 Protein/metabolism ; Signal Transduction
    Chemical Substances Anti-Inflammatory Agents ; Cardiovascular Agents ; Inflammasomes ; Inflammation Mediators ; NLR Family, Pyrin Domain-Containing 3 Protein
    Language English
    Publishing date 2019-07-11
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 391970-5
    ISSN 1533-4023 ; 0160-2446
    ISSN (online) 1533-4023
    ISSN 0160-2446
    DOI 10.1097/FJC.0000000000000701
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  10. Article ; Online: Interleukin-1 Blockade in Cardiovascular Diseases: From Bench to Bedside.

    Buckley, Leo F / Abbate, Antonio

    BioDrugs : clinical immunotherapeutics, biopharmaceuticals and gene therapy

    2018  Volume 32, Issue 2, Page(s) 111–118

    Abstract: Interleukin-1 (IL-1) is the prototypical pro-inflammatory cytokine that occupies an apical place in the inflammatory cascade and also modulates cardiac function, functioning as a soluble cardiodepressant factor. Preclinical research over the past 4 ... ...

    Abstract Interleukin-1 (IL-1) is the prototypical pro-inflammatory cytokine that occupies an apical place in the inflammatory cascade and also modulates cardiac function, functioning as a soluble cardiodepressant factor. Preclinical research over the past 4 decades has shown that blocking IL-1 processing or activity favorably affects cardiomyocyte survival and cardiac function in experimental animal models, paving the way for clinical studies in patients with heart disease. The promising results of phase II clinical trials of IL-1 blockade in patients with acute myocardial infarction and heart failure have been followed by a successful phase III trial in patients with prior acute myocardial infarction. Three IL-1 blockers with different mechanism of action are currently available for clinical use, although currently none have an indication for heart disease. We herein review the bench-to-bedside clinical translation of IL-1 targeting strategies and discuss the potential use of IL-1 blockade in patients with heart disease.
    MeSH term(s) Animals ; Antibodies, Monoclonal/therapeutic use ; Atherosclerosis/metabolism ; Cardiovascular Diseases/drug therapy ; Cardiovascular Diseases/metabolism ; Clinical Trials as Topic ; Cytokines/metabolism ; Disease Models, Animal ; Heart Failure/metabolism ; Humans ; Interleukin 1 Receptor Antagonist Protein/therapeutic use ; Interleukin-1/antagonists & inhibitors ; Interleukin-1/metabolism ; Molecular Targeted Therapy/methods ; Myocardial Infarction/metabolism
    Chemical Substances Antibodies, Monoclonal ; Cytokines ; Interleukin 1 Receptor Antagonist Protein ; Interleukin-1 ; canakinumab (37CQ2C7X93)
    Language English
    Publishing date 2018-03-16
    Publishing country New Zealand
    Document type Journal Article ; Review
    ZDB-ID 1364202-9
    ISSN 1179-190X ; 1173-8804
    ISSN (online) 1179-190X
    ISSN 1173-8804
    DOI 10.1007/s40259-018-0274-5
    Database MEDical Literature Analysis and Retrieval System OnLINE

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