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Biomedical subjects

Michael Golding

Publications and source records attributed to Michael Golding.

9 recordsLinked to original sources
PubMed2005

Effects of paroxetine on cardiovascular response to mental stress in subjects with a history of coronary artery disease and no psychiatric diagnoses.

RATIONALE: Paroxetine may decrease mental stress-induced cardiovascular responses and so benefit individuals with heart disease, even those with no psychiatric illness. OBJECTIVES: The effects of paroxetine on cardiovascular measures during a speech task were evaluated in psychiatrically healthy subjects with a history of coronary artery disease (CAD). METHODS: Eight subjects completed this double-blind, placebo-controlled, cross-over study in which each subject took 1 month of paroxetine and 4 weeks of placebo in random order. While on each study, medication, blood pressure, heart rate, and plasma norepinephrine concentrations were measured during a period of relaxation and during a mental stressor. The mental stressor consisted of thinking about a stressful topic, speaking about the topic, and listening to a tape-recorded replay of the speech. RESULTS: While on paroxetine, systolic blood pressure and diastolic blood pressure were 10-15% lower (p < 0.005) during the stressor, relative to measures obtained while on placebo. Pulse and plasma norepinephrine concentrations during stress trended lower during paroxetine treatment but did not reach statistical significance. CONCLUSION: Paroxetine has antihypertensive properties during periods of psychological stress in psychiatrically healthy subjects with a history of CAD, and so should be evaluated for potential cardio-protective qualities.

Aged↗
PubMed2004

Bupropion and paroxetine differentially influence cardiovascular and neuroendocrine responses to stress in depressed patients.

BACKGROUND: There exists a need to identify safe and effective treatments for depression in patients with coronary heart disease (CHD). METHODS: Using a cross-sectional design, 17 depressed patients being treated with bupropion (200-450 mg/day) were compared with 17 depressed patients being treated with paroxetine (10-50 mg/day) and with a group of 15 unmedicated, non-depressed controls for cardiovascular, neuroendocrine and heart rate variability (HRV) measures at rest and in response to mental and physical stressors. RESULTS: Regardless of treatment, both treated groups exhibited blunted plasma cortisol, plasma epinephrine, systolic blood pressure, cardiac output, and pre-ejection period responses to mental stressors relative to controls. Bupropion treated individuals exhibited greater total peripheral resistance (TPR) increases than either the paroxetine or control groups, and greater plasma norepinephrine (NE) increases to mental stressors than the paroxetine group. The bupropion group also displayed reduced HRV at rest relative to the controls and during orthostatic challenge relative to both the control and paroxetine groups. LIMITATIONS: Despite the fact that the treated groups were well matched for depression and other psychiatric histories, lack of randomization into treatment arms may be associated with a selection bias in the two treated groups. CONCLUSIONS: Although both pharmacological treatments were associated with a blunting of some cardiovascular and neuroendocrine responses to stress relative to controls, which may be reflective of their therapeutic mechanisms of action, the results of our study also suggest that bupropion is associated with a more detrimental autonomic profile than paroxetine, as reflected in increased TPR and NE, and reduced HRV. The results of this study may have implications for the pharmacological treatment of depression in CHD patients.

Adult↗
PubMed2003

Nefazodone inhibits methylprednisolone disposition and enhances its adrenal-suppressant effect.

Nefazodone is a potent and selective inhibitor of cytochrome P450 3A4 (CYP3A4), an enzyme pathway responsible for the biotransformation of a number of steroid compounds. The potential therefore exists that nefazodone inhibits the disposition of methylprednisolone. In this open label, repeated measures study, the effect of 9 days of nefazodone administration on the pharmacokinetic disposition of a single 0.6 mg/kg intravenous dose of methylprednisolone was assessed. Additionally the effect of concomitant nefazodone use on duration of cortisol suppression after methylprednisolone administration was assessed. Eight healthy volunteers completed the study. Following nefazodone administration, the mean (+/-SD) area under the methylprednisolone concentration-time curve was significantly higher (1393 +/- 343 vs. 2966 +/- 928 ug*h/L; P < 0.005), apparent clearance was lower (28.7 +/- 7.2 vs. 14.6 +/- 7.8 L/h; P < 0.02) and the terminal elimination half-life was longer (2.28 +/- 0.49 vs. 3.32 +/- 0.95 hours; P < 0.02). The duration of cortisol suppression after methylprednisolone administration was longer (> or =32 vs. 23.3 +/- 3.43 hours) during nefazodone administration.

Adrenal Cortex↗
PubMed2002

[Guidelines for pharmacological primary prevention of cardiovascular diseases--who should be treated?].

BACKGROUND: Several clinical practice guidelines for the treatment of hypertension and hypercholesterolaemia are available. The quality of these guidelines varies and the basis for their conclusions is often not clear. We have used systematic and explicit methods in the development of a new set of recommendations. This is the first of three articles describing these guidelines. MATERIAL AND METHODS: Evidence was found by a systematic search in databases and reference lists in guidelines and articles. A set of recommendations was prepared based on a critical appraisal of the literature. These recommendations were revised through discussions with a panel of physicians and agreed upon after several iterations. The guidelines were circulated to professional, governmental and patient organisations, with a request for feedback on errors or shortcomings. RESULTS AND INTERPRETATION: The absolute risk of cardiovascular disease should be used as the basis for discussing with a patient whether drug treatment should be initiated. A 20% risk of developing angina or myocardial infarction over the next ten years is a reasonable threshold for considering treatment. The effects of antihypertensives for persons older than 80 years and of cholesterol-lowering drugs for persons older than 70 years are uncertain. Treatment of blood pressure above 170/100 mm Hg is recommended independent of the risk of cardiovascular disease.

Adult↗
PubMed2002

[Which antihypertensive drugs should be used in the primary prevention of cardiovascular disease?].

BACKGROUND: Several clinical practice guidelines for the treatment of hypertension are available. The quality of these guidelines varies and the basis for their conclusions is often not clear. We have used systematic and explicit methods in the development of a new set of recommendations. This is the second of three articles describing these guidelines. MATERIAL AND METHODS: Evidence was found by a systematic search in databases and reference lists in guidelines and articles. A set of recommendations was prepared based on a critical appraisal of the literature. These were revised through discussions with a panel of physicians, and agreed upon after several iterations. The guidelines were circulated to professional, governmental and patient organisations. RESULTS AND INTERPRETATION: Thiazides should be first-choice drugs for the treatment of uncomplicated hypertension. Beta-blockers are a reasonable second choice. The treatment goal should be below 140/90 mm Hg. For combination therapy, thiazides and beta-blockers should be first choice. Diabetic patients should be treated aggressively with a diastolic blood pressure goal below 80 mm Hg. Angiotensin-II antagonists or angiotensin converting enzyme-inhibitors should be first choice drugs for diabetics with microalbuminuria. Patients with hypercholesterolaemia are not given a particular recommendation for choice of drug. Patients with asthma or chronic obstructive pulmonary disease should choose other drugs than beta-blockers. Thiazides should be avoided if the patient has, or has had, gout.

Antihypertensive Agents↗
PubMed2002

[Which cholesterol-lowering drugs should be used in the primary prevention of cardiovascular disease?].

BACKGROUND: Several clinical practice guidelines for the treatment of hypercholesterolaemia are available. The quality of these guidelines varies and the basis for their conclusions is often not clear. We have used systematic and explicit methods in developing a new set of recommendations. This is the last of three articles describing these guidelines. MATERIAL AND METHODS: Evidence was found by a systematic search in databases and reference lists in guidelines and articles. A set of recommendations was prepared based on a critical appraisal of the literature. These were revised through discussions with a panel of physicians, and agreed upon after several iterations. The guidelines were circulated to professional, governmental and patient organisations. RESULTS AND INTERPRETATION: Statins should be first-choice drugs for the treatment of hypercholesterolaemia. Total cholesterol below 5 mmol/l and/or LDL cholesterol below 3 mmol/l are the recommended treatment goals for persons at high risk of coronary heart disease.

Anticholesteremic Agents↗