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PubMed1983

Electron microscopy of hypertensive pulmonary vascular disease.

Hypertensive pulmonary vascular disease secondary to chronic alveolar hypoxia is the result of vasoconstriction and then muscularization of the terminal portions of the pulmonary arterial tree. Ultrastructurally these two phases are characterized respectively by muscular evaginations and the hyperplasia of smooth muscle cells. Plexogenic pulmonary arteriopathy secondary to congenital cardiac shunts, primary pulmonary hypertension or rare cases of cirrhosis of the liver are characterized by concentric-laminar proliferation of myofibroblasts. Later there is a development of plexiform lesions which consist of vascular channels separated by a matrix of proteoglycan containing fibrillary cells and myofibroblasts. Fibrinoid necrosis results from the passage of fibrinogen from the vascular lumen into the arterial wall.

Adult↗
PubMed2003

Prevalence of vascular risk factors and vascular disease in predialysis chronic renal failure.

Patients with end-stage renal disease have a high mortality, with the majority of deaths due to vascular disease. The prevalence of vascular risk factors and vascular disease in predialysis chronic renal failure (CRF) is poorly characterized. The aim of the present study was to determine the prevalence of vascular risk factors and clinically overt vascular disease in an Australian cohort of patients with predialysis CRF. We performed a retrospective chart review of outpatients with CRF and noted demographic data, the cause of renal failure, the presence or otherwise of vascular risk factors and vascular disease and calculated glomerular filtration rate. The prevalence of overt vascular disease and modifiable vascular risk factors was calculated. One hundred and eighty patients completed the study. Eighty-nine per cent of patients had hypertension, 68% had dyslipidaemia, 32% were diabetic and 38% were previous smokers. The subgroup with diabetic nephropathy had significantly more risk factors (P < 0.001) than other groups. Twenty-seven per cent of the group had cardiovascular disease, 22% had cerebrovascular disease, 23% had peripheral vascular disease and 9% had renal artery stenosis. Patients with ischaemic nephropathy had significantly more vascular disease than other groups (P < 0.001). Patients with overt vascular disease were older, had a higher number of risk factors and a higher calcium phosphate product than those without vascular disease. In conclusion, the present study suggests a high prevalence of vascular risk factors and vascular disease in predialysis CRF. Early detection provides an opportunity for early intervention and may help reduce the development of vascular disease, and the associated mortality, once these patients progress to dialysis.

Age Distribution↗
PubMed1986

Cardiac tumours simulating collagen vascular disease.

Cardiac tumours can mimic collagen vascular disease and they are often accompanied by profound systemic upset. Both benign and malignant tumours may present in this way. Three cases of cardiac tumour, two malignant and one benign, are reported with just such a presentation. A review of fifteen similar case reports showed that a spectrum of different collagen vascular diseases was diagnosed and treated before the true diagnosis emerged. In half of these cases the cardiac tumour was only diagnosed at necropsy. The diagnosis of collagen vascular disease should not be made in the absence of corroborative laboratory data. In cases of malignant cardiac tumour, and less commonly with atrial myxoma, M mode and cross sectional echocardiography may not exclude the diagnosis. There may be a good response to steroid treatment in cases of suspected but not confirmed collagen vascular disease in which the true diagnosis is cardiac tumour.

Adolescent↗
PubMed1994

Augmentation of the synthesis of plasminogen activator inhibitor type-1 by precursors of insulin. A potential risk factor for vascular disease.

BACKGROUND: Both vascular disease and elevated concentrations in plasma of plasminogen activator inhibitor type-1 (PAI-1) are prominent in patients with non-insulin-dependent diabetes mellitus (NIDDM). We and others have hypothesized that the increased PAI-1 may contribute to acceleration of atherosclerosis in this condition and in other states characterized by insulin resistance as well. Surprisingly, however, elevations of PAI-1 decrease when type II diabetic patients are treated with exogenous insulin, as do circulating concentrations of the precursor of insulin, proinsulin, in plasma. Accordingly, the increased PAI-1 in patients with NIDDM may reflect effects of precursors of insulin rather than or in addition to those of insulin itself. To assess this possibility directly, this study was performed to identify potential direct effects of proinsulin and proinsulin split products on synthesis of PAI-1 in liver cells, thought to be the major source of circulating PAI-1 in vivo. METHODS AND RESULTS: Hep G2 cells (highly differentiated human hepatoma cells) were exposed to human proinsulin, des(31,32)proinsulin and des(64,65)proinsulin (split products of proinsulin), or C-peptide. Accumulation of PAI-1 in conditioned media increased in a time- and concentration-dependent fashion in response to the two des-intermediates [3.3-fold with des(31,32)proinsulin and 4.5-fold with des(64,65)proinsulin]. C-peptide elicited no increase. Stimulation was transduced at least in part by the insulin receptor as shown by inhibition of stimulation by insulin receptor antibodies, mediated at the level of PAI-1 gene expression as shown by the 2.2- to 2.9-fold increases in steady-state concentrations of PAI-1 mRNA, and indicative of newly synthesized protein as shown by results in metabolic labeling experiments. CONCLUSIONS: Our results are consistent with the hypothesis that precursors of insulin (proinsulin and proinsulin split products), known to be present in relatively high concentrations in plasma in patients with NIDDM and conditions characterized by insulin resistance, may directly stimulate PAI-1 synthesis, thereby attenuating fibrinolysis and accelerating atherogenesis.

Arteriosclerosis↗
PubMed1989

Pulmonary manifestations of the collagen vascular diseases.

The collagen vascular diseases are a heterogeneous group of immunologically mediated inflammatory disorders. The organs and tissues that compose the respiratory system are frequently affected by these diseases. Potential targets of the inflammation and injury include the lung parenchyma, tracheobronchial tree, pulmonary vasculature, pleura, larynx, and respiratory muscles. In this article, the spectrum of respiratory disease caused by systemic lupus erythematosus, rheumatoid arthritis, scleroderma, polymyositis/dermatomyositis, mixed connective tissue disease, ankylosing spondylitis, relapsing polychondritis, and Sjögren's syndrome is reviewed. Where appropriate, therapeutic options are discussed.

Arthritis, Rheumatoid↗
PubMed2006

Smoking causes erectile dysfunction through vascular disease.

OBJECTIVES: To investigate whether smoking either directly or through vascular disease causes erectile dysfunction (ED) and to determine whether ED is an early marker of vascular disease in smokers. METHODS: The target population consisted of all men 50, 60, or 70 years old who resided in the study areas in Finland in 1994. Questionnaires were mailed to 3143 men in 1994, to 2837 men in 1999, and to 2510 men in 2004. A total of 1368 men (55% of those alive) responded to the three surveys. RESULTS: Men who smoked in 1994 and developed a vascular disease during 1994 to 1999 had a three times (adjusted incidence density ratio [IDR] 3.1, 95% confidence interval [CI] 1.3 to 7.5) greater risk of ED during 1999 to 2004 compared with those who had never smoked who did not develop vascular disease. In contrast, smokers without episodes of vascular disease were not at an increased risk of ED (adjusted IDR 1.0, 95% CI 0.5 to 1.8). Among men who were exsmokers and had ED in 1994, the incidence of vascular disease was greater than among those who had never smoked who were free of ED at entry (IDR 1.5, 95% CI 1.0 to 2.2). No greater risk of vascular disease owing to ED was found in smokers (IDR 1.1, 95% CI 0.6 to 2.0) or those who had never smoked (IDR 1.1, 95% CI 0.6 to 1.9) at entry. CONCLUSIONS: The results of this study have shown that smoking may cause ED because it can cause vascular disease, and ED may be a marker of silent vascular disease in exsmokers.

Aged↗
PubMed2006

Primary prevention of ischemic stroke: a guideline from the American Heart Association/American Stroke Association Stroke Council: cosponsored by the Atherosclerotic Peripheral Vascular Disease Interdisciplinary Working Group; Cardiovascular Nursing Council; Clinical Cardiology Council; Nutrition, Physical Activity, and Metabolism Council; and the Quality of Care and Outcomes Research Interdisciplinary Working Group: the American Academy of Neurology affirms the value of this guideline.

BACKGROUND AND PURPOSE: This guideline provides an overview of the evidence on various established and potential stroke risk factors and provides recommendations for the reduction of stroke risk. METHODS: Writing group members were nominated by the committee chair on the basis of each writer's previous work in relevant topic areas and were approved by the American Heart Association Stroke Council's Scientific Statement Oversight Committee. The writers used systematic literature reviews (covering the time period since the last review published in 2001 up to January 2005), reference to previously published guidelines, personal files, and expert opinion to summarize existing evidence, indicate gaps in current knowledge, and when appropriate, formulate recommendations based on standard American Heart Association criteria. All members of the writing group had numerous opportunities to comment in writing on the recommendations and approved the final version of this document. The guideline underwent extensive peer review before consideration and approval by the AHA Science Advisory and Coordinating Committee. RESULTS: Schemes for assessing a person's risk of a first stroke were evaluated. Risk factors or risk markers for a first stroke were classified according to their potential for modification (nonmodifiable, modifiable, or potentially modifiable) and strength of evidence (well documented or less well documented). Nonmodifiable risk factors include age, sex, low birth weight, race/ethnicity, and genetic factors. Well-documented and modifiable risk factors include hypertension, exposure to cigarette smoke, diabetes, atrial fibrillation and certain other cardiac conditions, dyslipidemia, carotid artery stenosis, sickle cell disease, postmenopausal hormone therapy, poor diet, physical inactivity, and obesity and body fat distribution. Less well-documented or potentially modifiable risk factors include the metabolic syndrome, alcohol abuse, drug abuse, oral contraceptive use, sleep-disordered breathing, migraine headache, hyperhomocysteinemia, elevated lipoprotein(a), elevated lipoprotein-associated phospholipase, hypercoagulability, inflammation, and infection. Data on the use of aspirin for primary stroke prevention are reviewed. CONCLUSIONS: Extensive evidence is available identifying a variety of specific factors that increase the risk of a first stroke and providing strategies for reducing that risk.

Brain Ischemia↗
PubMedDate not supplied

[Atheroembolism: a form of systemic vascular disease].

Atheroembolism, a systemic vascular disease. Cholesterol crystal embolization (CCE) is an infrequent but serious disorder that is often an unrecognized medical problem. CCE may occur spontaneously from eroded atherosclerotic plaques or most frequently following procedures such as angiography, angioplasty, cardiac catheterization, anticoagulant therapy and aortic surgery. CCE predominantly affects elderly males with a frequent history of hypertension, atherosclerotic vascular diseases and renal insufficiency. CCE may result in protean clinical manifestations and may produce a spectrum of functional impairment. Confusion over the disease's natural history arises because the difficulty of establishing an antemortem diagnosis, and because the laboratory findings are non-diagnostic and non-specific. The mortality was 81% and the causes of death was most often due to multiorgan failure especially renal involvement. The definitive diagnosis depends upon finding the presence of intravascular cholesterol crystal in biopsy or autopsy specimens. The skin, muscle and kidney were the three most common sites for obtaining a premortem diagnostic biopsy.

Arteriosclerosis↗
PubMed2005

Endovascular excimer laser atherectomy techniques to treat complex peripheral vascular disease: an orderly process.

Peripheral vascular disease represents the largest obstructive subsegment within the vascular system. Advances in equipment, techniques, biochemical treatments, and the influx of multiple specialties into this arena indicate a coming tidal wave of change to the standard treatment plan for patients with claudication and especially critical limb ischemia. Initial attempts in the 1980s to utilize the "laser" to treat peripheral vascular disease led to a clinical debacle: wavelengths and methods were not optimized; tissue heating was excessive, resulting in restenosis. Since then the "laser" has fallen from grace for endovascular treatment, although it has an infinite set of potential wavelengths, energy levels, and delivery methods. The xenon chloride, excimer laser, a pulsed 308-nm system, has overcome many of these early catastrophes. The long, ongoing success of this method of photoablating thrombus and plaque represents a true step forward in the endovascular treatment of occlusive disease. Although only a tool, the excimer laser provides a means to utilize electromagnetic energy instead of shearing mechanical force to resolve occlusions. With its active element at the tip, the excimer laser requires much less mechanical translation force to cross total occlusions, find the distal lumen, and thereby cause less plaque destabilization. In addition, removing the firm surface layer of plaque, decapping, and some of the plaque volume, debulking, exposes the softer subsegments of the plaque to balloon angioplasty. Utilizing this method, more complex lesions can be approached safely, with a high likelihood of successful revascularization and a low risk of potentially limb-threatening complication.

Angiography↗
PubMedDate not supplied

Breast-conserving therapy in the setting of collagen vascular disease.

BACKGROUND: It is unclear whether the presence of collagen vascular disease should be considered a contraindication to irradiation. This study was undertaken to determine whether women with pre-existing collagen vascular disease have an increased incidence of complications after breast-conserving therapy. METHODS AND MATERIALS: A cohort of 36 patients with documented collagen vascular disease was conservatively treated for early-stage breast cancer between 1975 and 1998. All of these patients were treated with conventional radiation therapy to a total medium dose of 64 Gy. Seventeen had rheumatoid arthritis; four, scleroderma; four, Raynaud's phenomenon; five, lupus erythematosus; two, Sjögren's disease; and four, polymyositis. Each of these patients was matched to two control patients without a history of collagen vascular disease on the basis of age, radiation therapytechnique, chemotherapy or hormone therapy use, tumor histology, and date of treatment. Acute and late complications were assessed using a six-point scale from the toxicity criteria of the Radiation Therapy Oncology Group and the European Organization for Research and Treatment of Cancer. The scoring system for both acute and late reactions ranged from 0 (no change over baseline) to 5 (radiation led to death). For the purpose of statistical analysis, patients were classified as having a significant complication if they had a score of 3 or greater. RESULTS: With a median clinical follow-up time of 12.5 years (range, 3.0-22.5 years), no significant difference was detected between the collagen vascular disease and control groups with respect to acute complications (14% vs 8%). With respect to late complications, a significant difference was observed (17% vs 3%) between the two groups. However, when patients in the collagen vascular disease group were analyzed by specific disease, this significance disappeared in all but the scleroderma group. CONCLUSIONS: Patients with scleroderma have a statistically significant increased incidence of radiation therapy complications after breast-conserving surgery and radiation therapy. The presence of other collagen vascular diseases should not be considered a contraindication for this treatment modality.

Adult↗
PubMed1994

Coronary artery disease is highly prevalent among patients with premature peripheral vascular disease.

PURPOSE: This study was designed to document the prevalence of coronary artery disease (CAD) and associated cardiac complications among patients with symptoms of premature peripheral vascular disease. METHODS: We studied the peripheral and coronary arterial circulations of 59 consecutive male military veterans diagnosed with premature peripheral vascular disease (age of onset < or = 45 years) affecting the lower extremity. Patients who had not previously undergone coronary angiography underwent exercise stress testing. Patients unable to perform exercise testing and those with abnormal exercise test results underwent coronary angiography. RESULTS: There was no evidence of CAD in 16 patients (29%) on the basis of normal exercise test results (n = 12) or normal coronary angiography results (n = 4). Forty-three patients (71%) had significant (> or = 50% lesion) CAD by coronary catheterization. Cardiac complications were frequent among the 43 patients. Eleven (65%) of the 17 patients with single-vessel CAD had previously documented myocardial infarctions, as did three (75%) of the four patients with two-vessel CAD and 18 (82%) of the 22 patients with three vessel or greater CAD. Three (18%) patients with one-vessel CAD had undergone coronary artery bypass grafting or percutaneous transluminal coronary angioplasty for symptoms, as had one patient (25%) with two-vessel CAD and 19 patients (86%) with three-vessel or greater CAD. Five patients died during the study period, four of myocardial infarction and one of stroke. CONCLUSIONS: Premature peripheral atherosclerosis is associated with a high prevalence of CAD. Detection of CAD is important in this group, because cardiac complications are frequent.

Adult↗
PubMed1994

Coronary artery disease in patients with peripheral vascular disease.

For patients requiring peripheral vascular surgery, coronary artery disease is the major determinant of perioperative mortality and long-term survival. The management of coronary artery disease in these patients is controversial as no randomized blinded prospective studies have been conducted. Data on the prevalence, diagnosis and management are reviewed.

Adult↗
PubMed1997

Mosaic attenuation pattern on thin-section CT scans of the lung: differentiation among infiltrative lung, airway, and vascular diseases as a cause.

PURPOSE: To determine whether infiltrative lung, airway, or vascular disease can be differentiated as the cause of mosaic attenuation on thin-section computed tomographic (CT) scans of the lung. MATERIALS AND METHODS: Thin-section CT scans were reviewed in 70 patients examined at three institutions. A mosaic attenuation pattern and pathologic or clinical proof of a specific type of disease were demonstrated. Causes of the mosaic pattern included infiltrative lung disease (n = 37), airway disease (n = 22), and vascular disease (n = 11). Thin-section CT findings were assessed independently by two observers blinded to clinical findings. RESULTS: The type of disease was identified correctly at CT in 58 (83%) of 70 patients by observer 1 and 57 (81%) of 70 patients by observer 2. Infiltrative lung disease was diagnosed correctly by both observers in 34 (92%) of 37 cases. Observer 1 identified 21 (95%) of 22 cases of airway disease and three (27%) of 11 cases of vascular disease. Observer 2 identified 19 (86%) of 22 cases of airway disease and four (36%) of 11 cases of vascular disease. CONCLUSION: Infiltrative lung disease and airway disease may be differentiated reliably as the cause of mosaic attenuation on lung CT scans, whereas vascular disease is often misinterpreted as infiltrative lung disease or airway disease.

Adult↗
PubMed2006

Incidence of noncardiac vascular disease in rheumatoid arthritis and relationship to extraarticular disease manifestations.

OBJECTIVE: To investigate the incidence of noncardiac vascular disease in patients with rheumatoid arthritis (RA) and its relationship to systemic extraarticular disease in a community-based cohort. METHODS: A retrospective medical record review of 609 patients with incident RA diagnosed during 1955-1994 was carried out in Olmsted County, Minnesota. Patients were followed up from 1955 to 2000 (median followup 11.8 years). Incident noncardiac vascular disease and severe extraarticular RA manifestations (including pericarditis, pleuritis, and vasculitis) were recorded according to predefined criteria, and incidence rates were estimated. Using Cox proportional hazards models, the risk (hazard ratio [HR]) of developing vascular events was assessed in patients with and without severe extraarticular RA. RESULTS: Cerebrovascular and peripheral arterial events occurred in 139 patients (22.8%). The 30-year cumulative incidence rates of peripheral arterial events, cerebrovascular events, and venous thromboembolic events were estimated to be 19.6%, 21.6%, and 7.2%, respectively. The presence of severe extraarticular RA manifestations was found to be associated with all subgroups of noncardiac vascular disease except cerebrovascular disease alone (HR 2.3, 95% confidence interval [95% CI] 1.2-4.3 for peripheral arterial events; HR 3.7, 95% CI 1.3-10.3 for venous thromboembolic events; HR 1.5, 95% CI 0.7-3.2 for cerebrovascular events) after adjusting for age, sex, body mass index, smoking, and rheumatoid factor status. CONCLUSION: This is the first study to assess the incidence of noncardiac vascular disease in RA. Severe extraarticular RA was associated with all forms of noncardiac vascular disease except cerebrovascular disease alone. Similar to cardiac disease, the excess risk of noncardiac vascular disease in RA is likely to be related, in part, to the systemic inflammation associated with the extraarticular manifestations of RA.

Arthritis, Rheumatoid↗
PubMed1984

Embolotherapy in vascular disease.

Embolotherapy for nonneoplastic vascular diseases including hemorrhage and congenital vascular malformations is reviewed. Application of short, intermediate, and long-acting embolic materials to these conditions is presented along with potential complications associated with their misuse. Successful application of embolotherapy results from a thorough understanding of the disease process being treated, the distinctive features of the circulation to be embolized, and the embolic material used for the occlusion.

Angiography↗