Cardiovascular disorders in the context of non-alcoholic fatty liver disease: a literature review

Non-alcoholic fatty liver disease [NAFLD] is the leading cause of chronic liver disease in the United States and other industrialized countries, and the reported prevalence in the developing countries is also rather high. This disease is associated with a high rate of morbidity and mortality and damage to the other organs. The cardiovascular system is, perhaps, the most vulnerable organ to NAFLD adverse effects to the extent that most mortality associated with this disease is reportedly from the cardiovascular system rather than from the liver itself. In this article, we review the significant aspects of cardiovascular disorders associated with NAFLD, including the epidemiology of cardiovascular diseases in NAFLD patients, factors that interfere in this relationship like hypertension, severity of NAFLD, and age of the patients, and finally preventive strategies whose employment could significantly improve the outcome

Treatment of hepatitis C virus infection and associated vascular complications: a literature review

Interferon [IFN]-based therapy, the cornerstone for treatment of hepatitis C virus [HCV] infection, is generally considered to be the single most effective treatment strategy for this infection. Although most adverse effects of IFN therapy respond very well to the cessation of this drug, there are reports of serious irreversible adverse effects. This review article evaluates the adverse effects of IFN therapy in HCV-infected patients. We have undertaken an extensive search for articles regarding IFN and pegylated- IFN [PEG-IFN] therapy and their vascular complications using multiple sources that include PubMed, publishers' websites, and Google Scholar. The prevalence of ocular disorders in the early period [first 8 weeks] after IFN administration was high with over half of the patients experiencing these adverse effects. Several authors strongly propose screening programs for retinopathy in the early period after IFN administration. Pulmonary hypertension due to IFN therapy is a serious side effect due to its irreversible nature in most patients. Patients who develop signs of acute abdomen up to months after IFN administration should be rapidly assessed for potential adverse effects of IFN. The literature suggests a broad spectrum of vascular injuries to different organs in humans as adverse effects of IFN therapy in HCV-infected patients

[ effect of renal arteries sympathectomy on refractory hypertension]

Sympathetic complex of over-activation kidneys is one of the main causes of primary hypertension [HTN]. We aimed to assess the efficacy and safety of sympathectomy using 5Fr mariner catheter ablation on patients with refractory hypertension. In this prospective cohort study, patients who received three or more antihypertensive medications with 160mmHg systolic blood pressure [BP] or more were randomly included and divided into 2 groups. Cases in the first group were undergone to renal denervation and the second group was treated by previous antihypertensive medications. Both groups were followed for six month by assessing BP and adverse effects. One hundred and seventeenth patients [54%] out of 212 screened patients were included in the first group [renal denervation] and 95 patients as the second group. The mean of BP changes in the first group was 35.15 mmHg with standard deviation of 22.11mmHg. [P<0.001] in the second group, the mean changes of BP was not statistically significant. [5.0mmHg +/- 22.11, P=0.79 for systolic BP and P=0.96 for diastolic BP].92% of 117 patients in the first group had a favorable BP decrease, which was defined as a 20mmHg or more decrease in BP, in comparison with 15% of 95 patients as controls [P=0.001]. There was no observed complication after denervation in the first group. It seems that the sympathetic renal denervation can be an effective and safe method for treatment of refractory hypertensive patients indeed of routine medications although further studies with longer follow up duration and more cases are suggested for confirming this issue.

[Effects of simvastatin with or without fenofibrate on echocardiographic findings of patients with coronary artery disease and dyslipidemia: a brief report]

Various therapeutic protocols have been recommended for treating dyslipidemia, particularly in patients with coronary artery disease. The purpose of this study was to assess the efficacy of statin use with or without fenofibrate on echocardiographic findings of patients with coronary artery disease and dyslipidemia. This clinical trial was conducted on 124 patients with coronary artery disease and dyslipidemia in Baqiyatallah Hospital in Tehran, Iran during 2008 to 2010. The first group of patients [64] received simvastatin [20 mg] and fenofibrate [200 mg] with low lipid diet and exercise while the second group [60] only received simvastatin with low lipid diet and exercise for one year. The mean age of the participants was 54.3 +/- 6.5 years. The first group showed significant changes in lipid profile and left ventricular ejection fraction [LVEF], [P<0.05]. Left ventricular diastolic function parameters showed no significant changes in both groups upon 12 months of treatment. The results of this study show, one-year treatment by simvastatin and fenofibrate can be effective on lipid profiles, and improve LVEF with resultant positive effect on heart function

Echocardiographic and exercise test findings in patients with dyslipidemia and coronary artery disease before and after treatment with simvastatin with or without fenofibrate

Various treatment protocols for dyslipidemia and coronary artery disease have been suggested. In spite of lipid-lowering effects, various effects of statins and fi-brates have been reported in the literature. The aim of this study was to assess the cardiac efficacy of Simvastatin with or without fenofibrate on cardiac function. A cohort study was conducted on 124 patients with dyslipidemia and coronary artery disease. Patients were randomly divided into two groups: the first group [n = 64] received Simvastatin [60 - 20 mg/day] and fenofibrate [200 mg/day], and the second group [n = 60] received Simvastatin [20 - 60 mg/day] alone. Treatment lasted l year, and the patients were evaluated after treatment. The mean age was 54.3 + 6.5 years, and 53.2% of patients were male. Compared to baseline, after 12 months of treatment the lipid profiles of both groups decreased significantly [P< 0.05]. The change in left-ventricular ejection fraction in the first group was statistically significant [P = 0.01]. The exercise test time and metabolic equivalent of tasks index significantly increased in the first group [P = 0.014, P = 0.006], but these changes were not significant in the second group [P = 0.289, P = 0.744]. Lipid-regulating therapies including Simvastatin and fenofibrate improved myocardial function and reduced myocardial ischemia, so combined therapy is recommended for treating dyslipidemia in high-risk patients for cardiovascular problems

Prevention of atrioventricular block during radiofrequency ablation by pace mapping of Koch's triangle

Complete atrioventricular block [AV block] is a serious complication of slow pathway ablation therapy in the treatment of atrioventricular nodal re-entrant tachycardia [AVNRT]. The present study was aimed at determining whether the electroanatomical pace mapping of Koch's triangle could significantly improve the safety, efficiency, and efficacy of selective slow pathway ablation in the treatment of AVNRT. A total number of 124 patients were selected to be studied consecutively for radiofrequency [RF] ablation therapy in the treatment of AVNRT. The subjects were divided into two groups: one, designated Group 1, to serve as the control group, and the other, designated Group 2, to serve as the study group. Conventional fluoroscopic slow pathway ablation was performed on the Group 1 subjects [n=66], with the Group 2 subjects receiving slow pathway ablation therapy guided by pace mapping of Koch's triangle. The slow pathway ablation in Group 2 [n=58] was performed with regard to the pace mapping data obtained on the basis of the St-H interval in the anteroseptal [AS], midseptal [MS], and posteroseptal [PS] regions of Koch's triangle. The anterograde fast pathway [AFP] location was determined based on the shortest St-H interval obtained by stimulating the anteroseptal [AS], midseptal [MS], and posteroseptal [PS] aspects of Koch's triangle. In the Group 2 subjects, AFP location was AS in 50 [86.2%] of the cases, MS in 7 [12%] of the cases, and PS in 1 case [1.7%]. One patient with posteroseptal AFP was administered retrograde fast pathway ablation therapy. One patient in the control group [Group 1], representing 1.5% of the group, developed persistent AV block in the course of the treatment, but none of the subjects in the study group [Group 2] developed any complications. It was concluded that an atypical fast pathway location is conducive to the development of atrioventricular block in the ablation therapy in AVNRT, with pace mapping of Koch's triangle having the capacity to eliminate the risk of any such complication developing. It follows that it helps to identify the AFP location before ablation therapy is administered in AVNRT, thereby improving the safety of the treatment