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Doody's Review ServiceReviewer: Irwin Klein, MD (Northshore University Hospital)
Description: Anatomists and physiologists have described the classic endocrine organs as those that release hormones that act at distant sites. The importance of the many individual hormones to regulate a multitude of homeostatic processes is well known. It is well accepted that the heart and vascular systems are important end-organs for hormone action and many disease states involving changes in hormone secretion are recognized for their effects on this system. In this book, the editor has enlisted the aid of 29 contributors to address fourteen different areas in which hormones can potentially alter cardiovascular physiology.
Purpose: The editor states that the purpose is to systematically review a variety of specific hormones as they affect both normal and pathologic states. The attempt to further our understanding of the regulation of cardiac function is clearly laudable and in each chapter the contributors make a significant contribution to the basic understanding of how a variety of molecules including nitric oxide, the eicosanoids, and the recently identified adrenomedullin can act on the heart and systemic vasculature.
Audience: While the title suggests a clinical bent, it appears that this book is primarily directed to basic scientists. The linchpin chapter deals with naturetic peptides and the heart. The reader is guided through the molecular biology of the structure and processing of the various cardiac derived naturetic peptides, and a discussion of the transcriptional regulation is provided. This forms the basis for understanding the regulation of the naturetic peptides in the pathologic states of cardiac hypertrophy, heart failure, and myocardial infarction. Unfortunately the vast majority of this work is directed at the cell, organ, and intact animal and those observations which have been made in the human disease states or the clinical implications of that work are not fully explored.
Features: Each of the contributors is an acknowledged expert in the field and the chapters are carefully prepared and contain sufficient citations to make these contributions of reference value. The chapter on estrogen and the heart stands out from the others in that it is primarily clinically oriented and quickly departs from molecular biology and the effects of estrogen to a very useful clinical discussion. This includes the clinical findings of estrogen on vasomotor tone, echocardiography and other measures of myocardial contractility, and on changes in lipid levels in patients receiving estrogen replacement and contrasting that to estrogen deficiency. The comprehensive nature of the book is further supported by the review of renin-angiotensin, endothelin, and insulin. The emphasis in most of these chapters is on the more basic issues such as glucose transport in the heart rather than incorporation of the recent important clinical data dealing with pathologic bases for diabetic cardiomyopathy (if one exists) or on the alterations in insulin sensitivity, lipid metabolism, blood pressure, and atherosclerosis, which form an important metabolic syndrome.
Assessment: I find this book to be useful as a reference source and also for its completeness. I am personally disappointed to find that in any discussion of the effects of hormones on the heart that one of the most recognized and well established areas, that of thyroid hormone (and its effects on the heart and cardiovascular system), is not discussed. Nor is the recent and potentially clinically important data of the role of growth hormone and cardiac function reviewed. The field of cardiovascular endocrinology is moving forward and this book does make an important contribution, however, the clinician may need to look elsewhere to fully understand the significance of this evolving field.