Book Review

Cardiovascular Pharmacotherapeutics

N Engl J Med 1997; 337:864September 18, 1997

Article

Cardiovascular Pharmacotherapeutics
Edited by William H. Frishman and Edmund H. Sonnenblick. 1722 pp., illustrated. New York, McGraw-Hill, 1997. $85. ISBN: 0-07-022481-1

The editors of Cardiovascular Pharmacotherapeutics have endeavored to summarize the latest information on the mechanisms of action, pharmacokinetics, drug interactions, therapeutic efficacy, and direct application to patients of drug treatment for cardiac and vascular conditions. The result of their efforts is a comprehensive book in which they have identified nearly every possible pharmacologic issue that a clinician would face in caring for patients with cardiovascular diseases.

This well-organized book covers five main topics, with concise chapters and a large and up-to-date bibliography. In contrast to numerous multiauthored books, in which a common problem is the patchy contributions, this book has a consistent text, achieved by close editing and the personal input of the two editors.

Besides the classic topics of basic pharmacology, mechanisms of drug interactions, and development of new drugs, the book also considers future aspects of drug therapy in chapters on gene therapy and innovative drug targets, such as nitric oxide, endothelin-receptor antagonists, prostacyclin, thromboxane-receptor antagonists, and tissue growth-factor inhibitors. The authors also address important aspects of apoptosis and speculate about therapeutic approaches that could modulate this process.

The authors take into consideration that 10 to 20 percent of the general population is taking some form of psychoactive medication by describing their potential therapeutic benefits, possible drug interactions, and toxic effects as regards cardiovascular treatment. In this context, psychiatric side effects of drugs are described, with special emphasis on depression, which is common among patients seeking outpatient treatment for cardiac diseases. One chapter addresses the immense problem of substance abuse and its effects on the cardiovascular system. The discussion includes the effects of cocaine, alcohol, amphetamines, heroin, marijuana, and caffeine and provides information about smoking-cessation programs and various nicotine-replacement strategies.

The book includes three excellent chapters on the important issue of cardiovascular drug therapy in the elderly, in patients with chronic renal failure, and in those who are pregnant or lactating. Because many patients nowadays seek medical help from providers of alternative medicine, the book includes a chapter that pays particular attention to alternative medicine, with emphasis on some of the pharmacologically active substances such as herbal medicine, megavitamin therapy, and such folk remedies as homeopathy and acupuncture.

The quality of the writing is quite high; there are black-and-white photographs and a reasonable number of well-designed diagrams. An extensive summary of the pharmacokinetic properties of cardiovascular drugs appears in appendix 1, and appendix 2 provides excellent and well-structured practical information on the prescription of cardiovascular drugs.

This survey of current knowledge of mechanisms of drug treatment for patients with cardiovascular diseases provides important information for both generalists and specialists. It includes all the important current advances in molecular biology and pharmacology at a time when even more spectacular developments are coming from the molecular and genetic revolution in biology.

Günter Riegger, M.D.
University of Regensburg, 93053 Regensburg, Germany