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

The translation of cardioprotection from robust experimental evidence to beneficial clinical outcome 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...

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Bibliographic Details
Published in:British journal of pharmacology 2020-12, Vol.177 (23), p.5252-5269
Main Authors: Kleinbongard, Petra, Bøtker, Hans Erik, Ovize, Michel, Hausenloy, Derek J., Heusch, Gerd
Format: Article
Language:English
Subjects:
Anesthesia
Heart attacks
Heart surgery
Humans
Life Sciences
Morbidity
Myocardial infarction
Myocardial Infarction - drug therapy
Myocardial Infarction - epidemiology
Patients
Propofol
Retrospective Studies
Review
Risk Factors
Surgery
Translation
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Summary:The translation of cardioprotection from robust experimental evidence to beneficial clinical outcome 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 negate the protection from remote ischaemic conditioning in cardiovascular surgery. LINKED ARTICLES This article is part of a themed issue on Risk factors, comorbidities, and comedications in cardioprotection. To view the other articles in this section visit http://onlinelibrary.wiley.com/doi/10.1111/bph.v177.23/issuetoc
ISSN:0007-1188
1476-5381
1476-5381
DOI:10.1111/bph.14839