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Intradermal Microdialysis: An Approach to Investigating Novel Mechanisms of Microvascular Dysfunction in Humans
Published on: July 21, 2023
Clinical pharmacology and vascular risk
G Silvestrelli1, F Corea, S Micheli
1Stroke Unit, Section of Neurology, C. Poma Hospital, Mantova, Italy.
Insights
Pharmacological treatments and drug abuse pose risks for vascular diseases (VD), including ischemic heart disease (IHD) and cerebrovascular diseases (CVD). Identifying and managing these risks is crucial for public health and future vascular disease prevention strategies.
Area of Science:
- Cardiovascular Medicine
- Pharmacology
- Public Health
Background:
- Pharmacological treatments and drug abuse are linked to vascular diseases (VD), specifically ischemic heart disease (IHD) and cerebrovascular diseases (CVD).
- Existing data on the independent risk of VD from pharmacological treatments and the impact of abstinence is limited.
- Epidemiological studies on drug abuse and VD primarily focus on urban populations.
Purpose of the Study:
- To review the relevance of IHD and CVD associated with pharmacological treatments and drug abuse, with a focus on ischemic disease.
- To analyze clinical evidence and experimental data on the role of new drugs as potential vascular disease risk factors.
- To identify modifiable risk factors for vascular disease stemming from drug use and abuse.
Main Methods:
- Literature review of clinical evidence and experimental studies.
- Analysis of associations between specific pharmacological treatments (estrogen, oncologic drugs, antipsychotics) and cerebrovascular events.
- Examination of the impact of drugs of abuse (cocaine, amphetamines, heroin) on vascular risk.
Main Results:
- Drugs of abuse can induce abrupt blood pressure changes, vasculitic changes, embolization, and hematologic abnormalities increasing blood viscosity and platelet aggregation.
- The link between certain pharmacological treatments and cerebrovascular events remains debated.
- Long-term treatment strategies involving medication, psychological support, and outreach are vital for drug dependency.
Conclusions:
- Pharmacological treatments and drug abuse represent significant, often modifiable, risk factors for vascular diseases.
- Further research is needed to fully elucidate the mechanisms and extent of VD associated with various substances and treatments.
- Effective management of drug dependency and recognition of emerging risk factors are critical for future public health initiatives in vascular disease prevention.
Abstract:
Pharmacological treatment and several drugs of abuse have been associated with ischemic heart disease (IHD) and cerebrovascular diseases (CVD). However, there is a paucity of data on the independent risk of vascular disease (VD) associated with pharmacological treatment and no controlled trials demonstrating a reduction in risk with abstinence. Information about IHD and CVD-related drug abuse is mainly limited to epidemiological studies focused on urban populations. The potential link between some pharmacological treatments (estrogen, some oncologic drugs and some atypical antipsychotics) and cerebrovascular adverse events was analyzed, but disagreement about an association persists. Drugs of abuse, including cocaine, amphetamines and heroin, have been associated with an increased vascular risk. These drugs can cause abrupt changes in blood pressure, vasculitic-type changes, lead to embolization caused by infective endocarditis, and hemostatic and hematologic abnormalities that can result in increased blood viscosity and platelet aggregation. Long-term treatment strategies based on medication, psychological support, and outreach programs play an important role in treatment of drug dependency. In these last years public interest in risk factors for VD has been constantly increasing and the successful identification and management of pharmacological treatment and drug abuse can be challenging. One of the major public health issues for the future will be to focus more on new vascular risk factor recognition and management. The objective of this chapter is to review the relevance of IHD and CVD associated with various pharmacological treatments and drug abuse with focusing on ischemic disease. This chapter reports the clinical evidence of this association and analyzes the experimental role of new drugs as a growing risk factor of VD with the hypothetical new association. In conclusion, in this chapter great attention is paid to evaluating the scientific and real evidence of cerebrovascular effect and drug use and abuse so as to identify a new groups of "modifiable" risk factors.
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