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Co-morbidities and co-medications as confounders of cardioprotection - does it matter in the clinical setting?

Kleinbongard, P; Bøtker, HE; Ovize, M; Hausenloy, DJ; Heusch, G; (2019) Co-morbidities and co-medications as confounders of cardioprotection - does it matter in the clinical setting? British Journal of Pharmacology 10.1111/bph.14839. (In press).

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Abstract

The translation of cardioprotection from robust experimental evidence to clinical outcome benefit for patients suffering acute myocardial infarction or undergoing cardiovascular surgery has been largely disappointing. The present review attempts to critically analyse the evidence for confounders of cardioprotection in patients with acute myocardial infarction and in patients undergoing cardiovascular surgery. One reason that has been proposed to be responsible for such lack of translation is the confounding of cardioprotection by co‐morbidities and co‐medications. Whereas there is solid experimental evidence for such confounding of cardioprotection by single co‐morbidities and co‐medications, the clinical evidence from retrospective analyses of the limited number of clinical data is less robust. The best evidence for interference of co‐medications is that for platelet inhibitors to recruit cardioprotection per se and thus limit the potential for further protection from myocardial infarction and for propofol anaesthesia to abrogate protection from remote ischaemic conditioning in cardiovascular surgery.

Type: Article
Title: Co-morbidities and co-medications as confounders of cardioprotection - does it matter in the clinical setting?
Location: England
DOI: 10.1111/bph.14839
Publisher version: https://doi.org/10.1111/bph.14839
Language: English
Additional information: This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions.
Keywords: acute myocardial infarction, cardioprotection, cardiovascular surgery, ischaemic conditioning, myocardial ischaemia, reperfusion
UCL classification: UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Pop Health Sciences > Institute of Cardiovascular Science
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Pop Health Sciences > Institute of Cardiovascular Science > Pre-clinical and Fundamental Science
URI: https://discovery.ucl.ac.uk/id/eprint/10080567
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