Pharmacology articles within Nature Reviews Cardiology

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  • Review Article |

    Drugs can be repurposed for new therapeutic indications. In this Review, Mercola and colleagues summarize the latest techniques for systematic drug repurposing and re-engineering, which could increase the pace, efficiency and cost-effectiveness of drug discovery for the treatment of cardiovascular disease.

    • Mena Abdelsayed
    • , Eric J. Kort
    •  & Mark Mercola

  • Review Article |

    Novel peroxisome proliferator-activated receptor (PPAR) agonists are providing new opportunities in the management of metabolic and cardiovascular diseases. In this Review, Staels and colleagues discuss the physiological regulation and actions of the PPAR family and their modulation of the atherogenic lipid profile, atherosclerosis and cardiac remodelling.

    • David Montaigne
    • , Laura Butruille
    •  & Bart Staels

  • Year in Review |

    Despite favourable results in pivotal clinical trials involving novel direct oral anticoagulants, vitamin K antagonists remain the most commonly prescribed anticoagulant. Newer oral anticoagulants are slated for a wide range of additional indications, and specific antidotes to neutralize associated bleeding complications are currently under development.

    • Jawed Fareed

  • News & Views |

    Trials in patients with dyslipidaemia or cardiovascular disease have shown no beneficial effects on 'hard' clinical end points, and increased rates of adverse effects, when niacin is added to statin therapy. These findings lead us to question whether niacin has a role in modern lipid-lowering strategies.

    • Anthony S. Wierzbicki

  • Review Article |

    Gliptins are a novel class of oral antihyperglycaemic agent that inhibit dipeptidyl peptidase 4. Professor Scheen describes the pleiotropic beneficial effects of these drugs, beyond basic glycaemic control in patients with type 2 diabetes mellitus, to emerging data and ongoing trials on cardiovascular protection in patients with ischaemic heart disease or congestive heart failure.

    • André J. Scheen

  • News & Views |

    A new, observational study suggests that aspirin only marginally increases the bleeding risk in patients with diabetes mellitus, perhaps reflecting impaired platelet inhibition. Inconclusive evidence from small, randomized trials and mechanistic studies reinforces the need for larger trials to determine the relative cardioprotective benefits and bleeding risks of aspirin in these patients.

    • Carlo Patrono

  • Review Article |

    Direct inhibitors of thrombin are a novel class of anticoagulant. The authors critically review the data from clinical trials on the use of the parenteral and oral forms of these drugs for primary or secondary prevention or treatment in patients with acute coronary syndrome, atrial fibrillation, or venous thromboembolism, or those undergoing percutaneous coronary intervention or orthopedic surgery.

    • Kyle A. Arsenault
    • , Jack Hirsh
    •  & John W. Eikelboom

  • Review Article |

    Dr. Moss and colleagues review data from randomized clinical trials which suggest that important sex-specific differences in the epidemiology and clinical characteristics of patients with heart failure can affect their response to both medical and device therapies.

    • Alon Barsheshet
    • , Andrew Brenyo
    •  & Arthur J. Moss

  • Year in Review |

    Studies published in 2011 in the field of heart failure have reinforced the benefit of cardiac resynchronization therapy in patients with mild symptoms and confirmed the value of left ventricular assist devices and CABG surgery in selected patients. Conversely, the efficacy of nesiritide in acute heart failure has been questioned.

    • John J. V. McMurray

  • Review Article |

    Antiplatelet agents effectively reduce the incidence of ischemic events associated with plaque rupture but can cause adverse effects, most notably hemorrhage. Drs Kalyanasundaram and Lincoff address key adverse effects that are associated with antiplatelet agents and discuss potential interactions between these drugs and other medications.

    • Arun Kalyanasundaram
    •  & A. Michael Lincoff

  • Review Article |

    Drs. Chaitman and Laddu review the various approved and experimental pharmacological approaches to treating angina in the context of data from clinical trials, and discuss ongoing and future studies. They also compare the merits of optimal medical therapy with prompt or delayed revascularization by percutaneous coronary intervention or CABG surgery as antianginal strategies.

    • Bernard R. Chaitman
    •  & Abhay A. Laddu

  • News & Views |

    According to a meta-analysis of five clinical trials, high-dose statin therapy is associated with increased risk of new-onset diabetes mellitus. When treating patients with excessive levels of non-HDL cholesterols despite moderate-dose statin therapy, should we prescribe a strategy known to be efficacious, but associated with safety concerns, or should we prescribe combination therapy that has no proven effects on outcomes?

    • Michael H. Davidson

  • Review Article |

    Novel atheroprotective therapies are needed to address the residual risk associated with atherothrombotic cardiovascular disease. In this Review, Drs deGoma and Rader discuss the mechanisms of HDL-targeted drugs, including agents that enhance or mimic apolipoprotein A-I activity, and summarize the development of these pharmacotherapies in preclinical and clinical studies.

    • Emil M. deGoma
    •  & Daniel J. Rader

  • News & Views |

    Although a diminished pharmacodynamic effect of clopidogrel has been demonstrated in patients treated with proton-pump inhibitors (PPIs), whether its clinical efficacy is reduced remains highly controversial. The FDA and European Medicines Agency recommend that PPIs and clopidogrel should not routinely be coadministered, and the 2010 expert consensus guidelines support this recommendation.

    • Paul A. Gurbel
    •  & Udaya S. Tantry

  • News & Views |

    Worsening renal function is common among patients hospitalized with acute heart failure and is associated with poor outcomes. Although preliminary studies suggested that adenosine receptor antagonists could preserve renal function and improve diuretic responsiveness, the A1-receptor antagonist rolofylline did not provide benefit in patients with acute heart failure in PROTECT.

    • Frank Ruschitzka
    •  & William T. Abraham

  • Review Article |

    Antithrombotic therapy with ADP-receptor antagonists or anticoagulant agents improves outcomes in patients with acute coronary syndromes and/or undergoing percutaneous coronary intervention. However, the current standard-of-care ADP-receptor antagonist for dual antiplatelet therapy, clopidogrel, and the currently available oral anticoagulants, the coumarins, have several limitations. In this Review, the authors discuss the pharmacology and clinical potential of new antithrombotic drugs, with an emphasis on data from phase III clinical trials.

    • Jeremy S. Paikin
    • , John W. Eikelboom
    •  & Jack Hirsh

  • News & Views |

    The ankle–brachial index (ABI) can be used to assess the risk of cardiovascular events. The AAA trial aimed to determine whether low-dose aspirin was of net benefit among apparently healthy people with an ABI ≤0.95. The largely negative findings of this study raise important mechanistic and practical questions.

    • Carlo Patrono
    •  & Colin Baigent

  • News & Views |

    The two CHAMPION trials failed to show superiority of cangrelor (a rapid-acting, reversible intravenous platelet P2Y12 adenosine receptor antagonist) versus clopidogrel in patients with acute coronary syndromes undergoing percutaneous coronary intervention. The CHAMPION PCI trial, however, did show a significant reduction in death and stent thrombosis suggesting benefit in those without clopidogrel pretreatment.

    • David P. Faxon

  • Review Article |

    Atrial fibrillation (AF) has multifactorial intracardiac and extracardiac causes. Current development of anti-AF agents is focused on modulation of ion channel activity as well as on upstream therapies that reduce structural substrates. In this Review, Burashnikov and Antzelevitch examine new and emerging pharmacological approaches to rhythm control in patients with AF and summarize the available data on these drugs.

    • Alexander Burashnikov
    •  & Charles Antzelevitch

  • News & Views |

    Amiodarone effectively maintains sinus rhythm in patients with atrial fibrillation, and although dronedarone is less effective it has a better safety profile. The choice of antiarrhythmic drug (or nonpharmacological strategy) depends on the ultimate goal of therapy, which should be considered in the context of the patient's clinical presentation and the treatment tailored to the individual.

    • Eric N. Prystowsky

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