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

Area of Science:

• Cardiovascular Medicine
• Pharmacology
• Clinical Translation

Background:

• Cardioprotection strategies show significant promise in experimental models.
• However, translating these findings into clinical benefits for acute myocardial infarction (AMI) and cardiovascular surgery patients has been challenging.
• Confounding factors, including patient co-morbidities and co-medications, are suspected reasons for this translational gap.

Purpose of the Study:

• To critically analyze the evidence for confounding factors affecting cardioprotection in patients with AMI.
• To review the impact of co-morbidities and co-medications on cardioprotection during cardiovascular surgery.
• To evaluate the clinical translation of cardioprotective therapies.

Main Methods:

• Review of existing experimental and clinical data.
• Retrospective analysis of clinical data.
• Critical appraisal of evidence regarding co-morbidities and co-medications as confounders.

Main Results:

• Experimental evidence strongly supports confounding of cardioprotection by single co-morbidities and co-medications.
• Clinical evidence from retrospective analyses is less robust but suggests significant interference.
• Platelet inhibitors can interfere with cardioprotection, and propofol anesthesia may negate remote ischemic conditioning benefits.

Conclusions:

• Co-morbidities and co-medications significantly confound cardioprotection, hindering clinical translation.
• Specific co-medications, such as platelet inhibitors and propofol, have demonstrable negative impacts.
• Further research is needed to overcome these confounding factors for effective clinical cardioprotection.