cardiovascular-agents and Multiple-Sclerosis

Thought to be an autoimmune inflammatory CNS disease, multiple sclerosis (MS) involves multiple pathologies with heterogeneous clinical presentations. An impaired neurovisceral integration of cardiovascular modulation, indicated by sympathetic and parasympathetic autonomic nervous system (ANS) dysfunction, is among common MS clinical presentations. ANS dysfunction could not only enhance MS inflammatory and neurodegenerative processes, but can also lead to clinical symptoms such as depression, fatigue, sleep disorder, migraine, osteoporosis, and cerebral hemodynamic impairments. Therefore, factors influencing ANS functional activities, in one way or another, will have a significant impact on MS disease course. This review describes the genetic and epigenetic factors, and their interactions with a number of environmental factors contributing to the neurovisceral integration of cardiovascular modulation, with a focus on MS. Future studies should investigate the improvement in cardiovascular ANS function, as a strategy for preventing and minimizing MS-related morbidities, and improving patients' quality of life.

Topics: Acetylcholine; Aging; Autonomic Nervous System; Cardiovascular Agents; Epigenesis, Genetic; Female; Fourier Analysis; Gene-Environment Interaction; Gonadal Steroid Hormones; Heart Conduction System; Heart Rate; Humans; Infections; Male; Multiple Sclerosis; Nerve Tissue Proteins; Norepinephrine; Polymorphism, Genetic; Racial Groups; Receptors, Neurotransmitter; Smoking; Vagus Nerve

The US Food and Drug Administration (FDA) has approved several new drugs in the past 2 years. This article provides an overview of some of the newer drugs that are likely to find wider use in the future. The drugs reviewed in this article can be used to treat cardiovascular system problems, diabetes mellitus, multiple sclerosis, hepatitis B infection, hyponatremia, Parkinson's disease, rheumatoid arthritis, pain, constipation, and insomnia. Another drug discussed can be used to help a patient stop smoking. The article also discusses Gardasil, the recombinant vaccine against human papilloma virus (types 6, 11, 16, and 18).

Topics: Abatacept; Acetanilides; Amides; Antibodies, Monoclonal; Antibodies, Monoclonal, Humanized; Antiparkinson Agents; Antirheumatic Agents; Antiviral Agents; Apomorphine; Benzazepines; Cardiovascular Agents; Fumarates; Hepatitis B; Human Papillomavirus Recombinant Vaccine Quadrivalent, Types 6, 11, 16, 18; Humans; Hypoglycemic Agents; Immunoconjugates; Multiple Sclerosis; Natalizumab; Nucleosides; Papillomavirus Vaccines; Pharmacology, Clinical; Piperazines; Pyrazines; Pyrimidinones; Quinoxalines; Ranolazine; Sitagliptin Phosphate; Smoking Cessation; Telbivudine; Thymidine; Triazoles; Varenicline; Viral Vaccines

Multiple sclerosis (MS) is a multifocal demyelinating disease of the central nervous system, leading to chronic disability. Fatigue is a common and distressing symptom of MS which is unrelated to its clinical form, stage of development, the degree of disability, or the lesion load on magnetic resonance imaging. Fatigue in MS is associated with excessive daytime sleepiness and autonomic dysfunction. Recently it has been reported that the wakefulness-promoting drug modafinil may relieve fatigue in MS patients and ameliorate the associated cognitive difficulties. However, it is not clear to what extent the anti-fatigue effect of modafinil may be related to its alerting and sympathetic activating effects. We addressed this question by comparing three groups of subjects, MS patients with fatigue, MS patients without fatigue and healthy controls, matched for age and sex, on measures of alertness (self-ratings on the Epworth and Stanford Sleepiness Scales and on a battery of visual analogue scales; critical flicker fusion frequency; Pupillographic Sleepiness Test; choice reaction time) and autonomic function (systolic and diastolic blood pressure, heart rate, pupil diameter), and by examining the effect of a single dose (200 mg) of modafinil on these measures. MS patients with fatigue, compared with healthy controls, had reduced level of alertness on all the tests used; MS patients without fatigue did not differ from healthy controls. MS patients with fatigue had a reduced level of cardiovascular sympathetic activation compared to the other two groups. Modafinil displayed alerting and sympathomimetic effects in all three groups of subjects. As fatigue in MS is associated with reduced levels of alertness and sympathetic activity, modafinil may exert its anti-fatigue effect in MS by correcting these deficiencies. The anti-fatigue effect of modafinil may reflect the activation of the noradrenergic locus coeruleus (LC), since there is evidence that this wakefulness-promoting nucleus is damaged in MS, and that modafinil, probably via the dopaminergic system, can stimulate the LC. This article is part of a Special Issue entitled 'Cognitive Enhancers'.

Topics: Adult; Arousal; Autonomic Nervous System; Benzhydryl Compounds; Cardiovascular Agents; Central Nervous System Stimulants; Cross-Over Studies; Double-Blind Method; Fatigue; Female; Humans; Male; Middle Aged; Modafinil; Multiple Sclerosis; Nootropic Agents; Psychomotor Performance; Sleep Stages; Sleep Wake Disorders; Sympathetic Nervous System; Sympathomimetics

To explore the potential of dexrazoxane to suppress subclinical cardiotoxicity in MS patients receiving mitoxantrone.. An open-label study was performed to evaluate possible subclinical cardiotoxicity in multiple sclerosis patients treated quarterly with mitoxantrone (48 mg/m(2) cumulative), with and without concomitant dexrazoxane, using blinded serial radionucleide ventriculography.. No patient experienced symptoms of heart failure. Patients receiving dexrazoxane, which is cardioprotective for anthracyclines, exhibited a significantly lesser decline in left ventricular ejection fraction (mean change, -3.80% vs -8.55%, p < 0.001).. These results support a cardioprotective effect of dexrazoxane in mitoxantrone treated multiple sclerosis patients.

Topics: Adult; Animals; Antineoplastic Agents; Cardiovascular Agents; Female; Heart Failure; Humans; Male; Middle Aged; Mitoxantrone; Multiple Sclerosis; Razoxane; Stroke Volume; Troponin I

This retrospective study aimed to determine (1) the association between the use of three major disease modifying therapies (DMTs) (Interferon-beta [IFN-β], Glatiramer acetate [GA], Natalizumab [NTZ]) and cardiovascular (CV) risk factors in multiple sclerosis (MS) patients, and (2) the association between the use of CV drugs (antihypertensive, hypolipidemic, and antiplatelets) and other drugs acting on the CV system (antispastics/anticonvulsants/anxyolitics, antidepressants/stimulants), and MS disease severity.. The charts of 188 patients with MS, who were taking one of the three DMTs, and 110 patients, who were naïve to these drugs, were retrospectively reviewed. The obtained data included height and weight, fasting lipid profiles, plasma glucose, systolic and diastolic BP, smoking habit, list of medications, and indicators of MS disease severity.. The use of DMTs was associated with higher diastolic BP readings, as well as higher plasma glucose and HDL-C plasma levels. In addition, there was an association between CV risk factors and the type of DMTs. When compared to DMT-naïve patients with MS, the use of IFN-β and GA was associated with higher CV risk factors, whereas the use of NTZ was associated with lower CV risk factors. In DMT-naïve patients, the use of CV and related drugs was associated with higher Extended Disability Status Scale (EDSS) and higher MS Severity Scale (MSSS).. There is an association between higher CV risk factors and the use of DMTs. Furthermore, CV and related drugs have the potential for modulating MS disease severity.

Topics: Adult; Aged; Antibodies, Monoclonal, Humanized; Cardiovascular Agents; Cardiovascular Diseases; Cross-Sectional Studies; Disability Evaluation; Female; Glatiramer Acetate; Humans; Immunologic Factors; Interferon-beta; Male; Middle Aged; Multiple Sclerosis; Natalizumab; Peptides; Retrospective Studies; Risk Factors; Severity of Illness Index; Treatment Outcome

Topics: Alzheimer Disease; Anti-Infective Agents; Anticonvulsants; Cardiovascular Agents; Drug Approval; Drug Prescriptions; Drug Therapy; Drugs, Generic; Fibrinolytic Agents; Humans; Hypnotics and Sedatives; Multiple Sclerosis; United States; United States Food and Drug Administration

Topics: Adrenocorticotropic Hormone; Cardiovascular Agents; Chlordiazepoxide; Climate; Exercise Therapy; Humans; Massage; Multiple Sclerosis; Muscle Relaxants, Central; Occupational Therapy; Physical Therapy Modalities; Switzerland

Topics: Cardiovascular Agents; Chlorzoxazone; Disease; Extrapyramidal Tracts; Humans; Multiple Sclerosis; Muscle Spasticity; Paralysis; Spinal Diseases; Spine; Zoxazolamine

Topics: Cardiovascular Agents; Disease; Multiple Sclerosis; Muscle Relaxants, Central; Muscle Spasticity; Muscle, Skeletal; Muscles; Muscular Diseases; Parkinson Disease

Topics: Cardiovascular Agents; Humans; Multiple Sclerosis; Psychotherapy, Multiple; Succinylcholine

Topics: Cardiovascular Agents; Humans; Multiple Sclerosis; Muscle Relaxants, Central; Oils; Psychotherapy, Multiple; Sulfur

Topics: Cardiovascular Agents; Ergot Alkaloids; Multiple Sclerosis; Oxytocics; Psychotherapy, Multiple

Topics: Cardiovascular Agents; Ergoloid Mesylates; Ergot Alkaloids; Humans; Multiple Sclerosis; Radiotherapy; X-Ray Therapy

Topics: Cardiovascular Agents; Central Nervous System; Ergot Alkaloids; Multiple Sclerosis; Oxytocics; Psychotherapy, Multiple