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Specific cardiac considerations include: Heart rhythm concerns: The heart rate-increasing effect may require additional monitoring in patients with atrial fibrillation, supraventricular tachycardia, or ventricular arrhythmias Heart failure: Patients with New York Heart Association (NYHA) Class III-IV heart failure were excluded from major clinical trials, and there is limited safety data in this population [18] [21] Recent cardiac events: Patients with recent myocardial infarction, stroke, or unstable angina may require individualized assessment during the recovery period Hemodynamic considerations: Rapid weight loss may affect fluid balance in patients with significant cardiac disease Adverse effects relevant to cardiac patients include gastrointestinal symptoms (nausea, vomiting, diarrhea) that may lead to dehydration and electrolyte disturbances

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AISI manual (2016)

Protects the Heart: Elevated homocysteine levels have been identified as a risk factor for cardiovascular disease, the No

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