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PubMed1987

Cardiovascular disease in the elderly. Hypertensive cardiovascular disease.

Hypertension is a common problem with advancing age, approaching or exceeding a 50% prevalence in the aging population. When blood pressure consistently exceeds 140/90 mm Hg, it should be treated. Patients with borderline isolated systolic hypertension should have their blood pressure measured at 6 month intervals. Risk of isolated systolic hypertension is sufficient to justify cautiously administering drug therapy if nonpharmacologic therapy fails to bring the systolic pressure less than 160 mm Hg, even though controlled studies have not been completed to prove efficacy. Both nonpharmacologic and pharmacologic therapy are recommended for those with sustained pressure elevation. Adverse effects of antihypertensive drugs may be minimized by starting with lower doses and by checking blood pressure in the upright position.

Aged↗
PubMedDate not supplied

Aging-associated changes in vascular activity: a potential link to geriatric cardiovascular disease.

Ischemic cardiovascular disease is a common cause of morbidity and mortality in the United States population over the age of 65. Prior clinical studies have demonstrated that the severity of cardiovascular pathophysiology is increased in older individuals. Both in vitro and in vivo experimental studies have shown that age-associated clinical events parallel changes in vascular function. Aging is associated with systemic as well as cardiac alterations in three basic vascular regulatory functions: vascular tone, hemostasis, and vascular repair/angiogenesis. This article reviews the molecular and cellular events that may contribute to senescent cardiac pathology. Indeed, a better understanding of the biology of aging-associated vascular dysfunction is fundamental for the development of therapeutics targeted for the treatment of cardiovascular disease in older individuals.

Age Factors↗
PubMed2002

The cholesterol mobilizing transporter ABCA1 as a new therapeutic target for cardiovascular disease.

Atherosclerotic cardiovascular disease remains the leading cause of morbidity and mortality in Western societies. A hallmark of the developing atherosclerotic lesion is the appearance of cholesterol-laden macrophages in the artery wall. A cell membrane transporter called ABCA1 mediates the removal of excess cholesterol from macrophages into the lipoprotein pathway. This makes ABCA1 a promising new therapeutic target for reducing cholesterol deposits in tissues, eliminating excess cholesterol from the body, and preventing cardiovascular disease.

ATP Binding Cassette Transporter 1↗
PubMed1998

[Application of chronotherapy to cardiovascular diseases].

Among cardiovascular diseases, hypertension, angina pectoris, acute myocardial infarction and ischemic stroke present a circadian pattern with a greater incidence of unfavourable events between awakening and noon. Chronotherapy aims to use drugs that release their active principles at different times during the day, according to biological needs. In chronotherapy of cardiovascular diseases, a particular attention has been paid to slow-release drugs that assure a 24 hours therapeutic effect with once a day administration. In primary hypertension well controlled by monotherapy (dipper hypertensives), the morning administration of long-acting beta-blockers and calcium antagonists has shown to control blood pressure over 24 hours, whereas ACE-inhibitors have proved more effective when administered at evening. In secondary hypertension (non dipper hypertensives) the administration of calcium antagonists is more effective at evening. Patients with severe hypertension need polytherapy. In that case, at least one of the antihypertensive drugs should be given at evening to lower night blood pressure values, which are particularly elevated also during sleep, and so to prevent an excessive blood pressure rise on awakening. In chronic monotherapy of ischemic heart disease, long-acting beta-blockers and calcium antagonists have shown to be equally effective when they are administered at morning, whereas slow-release nitrates, which need a nitrate-free interval, are to be administered either at morning or at evening, according to the expected time of onset of anginal pain. ASA seems to reduce the morning incidence of acute myocardial infarction, while tissue-type plasminogen activator presents a circadian variation of its thrombolytic activity with a higher efficacy between noon and midnight.

Cardiovascular Agents↗
PubMed1983

[Age-dependent adjustment to disease in patients with cardiovascular diseases].

During their rehabilitation treatment 61 inpatients with different cardiovascular diseases or disorders were investigated with structured interviews, questionnaires about anamnesis and psychological tests in order to determine the individual coping strategies. The mean results show that three of four pts with functional heart and circulatory disorders don't know anything or something wrong about the pathology of their symptoms. Pts with coronary heart disease without myocardial infarction don't have any or any right information in 45%, but coronary infarction-pts don't have any right pathogenetic knowledge in only 12% (differences: p less than .05). The pathogenetic knowledge is not statistically correlated with the age of the pts. In total 54% can't give any reasons for the incidence, 18% are accusing their own health behaviour, 15% say that it is fate and 13% are believing that primarily environmental factors are the best conception about the etiology of their disease. The subjective illness-related psycho-physical irritation show a moderate to average strength and does not depend on pts' age. The main actual cognitive and emotional reaction to illness is in 40% denial, 30% are trying to adept actively to the given situation, 22% show acute mourning and anxiety and 8% respond with rebellion, aggressiveness or anger (differences: p less than .01). There is a tendency growing with increasing life-age to accept the event of illness as a chance for an active change to a better style of life in future. Pts with cardiovascular diseases design an overall optimistic development for their own future: they expect an age of 66.2 years, male pts believe to grow older than female (p less than .01). The prospected satisfaction with life doesn't show any significant differences depending on diagnosis or age. All in all the results lead to the conclusion that the factor "age of life" does not play a dominant role in the process of managing with cardiovascular diseases compared with psychological factors of coping with the illness.

Adaptation, Psychological↗
PubMed2006

10-year follow-up of subclinical cardiovascular disease and risk of coronary heart disease in the Cardiovascular Health Study.

BACKGROUND: The incidence of coronary heart disease (CHD) is very high among individuals 65 years or older. METHODS: We evaluated the relationships between measurements of subclinical disease at baseline (1989-1990) and at the third-year follow-up examination (1992-1993) and subsequent incidence of cardiovascular disease and total mortality as of June 2001. Approximately 61% of the participants without clinical cardiovascular disease at baseline had subclinical disease based on our previously described criteria from the Cardiovascular Health Study. RESULTS: The incidence of CHD was substantially increased for participants with subclinical disease compared with those who had no subclinical disease: 30.5 per 1000 person-years with and 16.3 per 1000 person-years without for white individuals, and 31.2 per 1000 person-years with and 12.5 per 1000 person-years without for black individuals. The risk persisted over the entire follow-up period. Incidence rates were higher for men than for women with or without subclinical disease, but there was little difference in rates for black individuals and white individuals. CONCLUSIONS: In multivariable models, subclinical disease at baseline remained a significant predictor of CHD in both men and women; the hazard ratios (95% confidence intervals) of their relative risks were 1.64 (1.30-2.06) and 1.49 (1.21-1.84), respectively. The presence of subclinical disease substantially increased the risk of subsequent CHD for participants with hypertension, diabetes mellitus, or elevated C-reactive protein. In summary, subclinical disease is very prevalent among older individuals, is independently associated with risk of CHD even over a 10-year follow-up period, and substantially increases the risk of CHD among participants with hypertension or diabetes mellitus.

Aged↗
PubMed2001

Candidate genes as potential links between periodontal and cardiovascular diseases.

Recent epidemiological associations between periodontal disease and cardiovascular disease have led to a search for biological mechanisms that explain the associations. Genetic factors that influence biological processes involved in both diseases represent one of the potential mechanisms that may link periodontitis and cardiovascular disease. At present, several candidate genes have been investigated in one of the diseases but not the other. Although there are limited data to support a specific candidate gene as the explanation for observed associations between the 2 diseases, a few candidates look promising. One candidate that influences inflammation, interleukin-1 gene polymorphisms, has been associated with periodontal disease and cardiovascular disease. This review will consider biological mechanisms and genes that may be reasonable candidates for an etiological mechanism that influences the clinical characteristics of both periodontal disease and cardiovascular disease.

Alleles↗
PubMed2004

Omega-3 (n-3) fatty acids in health and disease: Part 1--cardiovascular disease and cancer.

The omega-3 (n-3) polyunsaturated fatty acids have a wide range of beneficial effects in several human health conditions. Animal and in vitro studies have indicated that omega-3 fatty acids affect blood lipid profiles, cardiovascular health, membrane lipid composition, eicosanoid biosynthesis, cell signaling cascades, and gene expression. Findings from epidemiological studies suggest that intake of omega-3 fatty acids from natural sources or supplements may influence the onset and progression of several disease states, including cardiovascular disease and cancer. This review highlights some recent research findings that help advance our understanding of how omega-3 fatty acids influence cardiovascular disease and cancer.

Animals↗
PubMed1998

[Cognitive impairment and cardiovascular disease risk factors. Project CASCADE Kraków. I. Project to test exposure to risk factors for cardiovascular disease in the studied sample].

Dementia is found in a small percent of general population but remains a significant problem in the elderly population. Little is known whether prevention of dementia in the elderly is possible. Some evidence exists that both vascular dementia and Alzheimer's type dementia are related to cardiovascular disease risk factors. The main goal of the CASCADE Kraków Project is to study the relation between the exposure to cardiovascular disease risk factors in the middle age and cognitive impairment and cerebral white matter lesions in old age. Project CASCADE Kraków is an independent part of the international project CASCADE, which is carried out in 11 research centres from 9 countries. Polish part of the study includes a longitudinal observation of the sample screened earlier in POL-MONICA Kraków Project, which was selected from population of residents of rural province (Tarnobrzeg Voivodship). Studied sample are 1318 persons, for whom cardiovascular disease risk factors were measured in 1983-84 and who completed at least 64 years in 1997. Two-stage examination was designed. In the first stage collection of the following data was designed: socio-economic factors, history of cardiovascular disease, perceived health, blood pressure and cognitive function assessment using Mini-Mental State Examination (MMSE) procedure. In the second stage (sub-sample of 300 persons included) the following procedures were designed: detailed neuro-psychological testing, neurolo-gical examination, MRI, determination of total- and HDL-cholesterol and determination of apoE isoforms. There were 625 (47%) men and 693 (53%) women selected for the first stage. Out of them 128 (43%) men and 172 (57%) women were selected for the second stage. There were no important differences in age, education, health status and exposure to cardiovascular disease risk factors between the studied groups in the baseline assessment. However, there were important differences between men and women. Compared to men, women had lower education (higher than elementary education in 17% and 9% respectively), more frequent obesity (respectively 12% and 36%), hypertension (respectively 57% and 71%) and hyperlipoproteinemia (respectively 17% and 30%) but lower smoking rate (respectively 53% and 4%). Integration of neuropsychological testing and neuroimaging with the epidemiological approach to risk factors could contribute to better understanding of the mechanisms on which the disease affects the brain morphology and functions. The results of CASCADE and CASCADE Kraków projects will contribute also to the development of the strategies of medical care and management of the cognitive impairment in the elderly.

Aged↗
PubMed1994

[Role of fibrinogen in cardiovascular diseases].

In cardiovascular diseases increased fibrinogen concentration is usually observed. Fibrinogen is involved in platelet aggregation, affects blood coagulation and has direct on the vascular wall. Epidemiological studies identify fibrinogen as a major independent risk factor for ischemic heart disease.

Cardiovascular Diseases↗
PubMedDate not supplied

[Association between clustering of cardiovascular risk factors and the risk of cardiovascular disease].

BACKGROUND: Cardiovascular diseases are the main cause of mortality in Spain. The aim of this work was to study the association between clustering of cardiovascular risk factors and the risk of suffering major cardiovascular events: ischemic cardiopathy, cerebrovascular disease and peripheral arteriopathy of the lower limbs. METHOD: A descriptive transversal study was carried out in a city health centre, with a total of 2248 patients selected by simple random sampling of the clinical records with a mean age of 15 years. The data were obtained by examining the clinical records and estimating Odds Ratios (OR) for any cardiovascular event (n = 224), ischemic cardiopathy (n = 123), cerebrovascular disease (n = 84) and peripheral arteriopathy (n = 55) in relation to the number of cardiovascular risk factors. The cardiovascular risk factors included in the study were smoking, arterial hypertension, hypercholesterolemia, hypertriglyceridemia, diabetes and obesity. The OR was adjusted for age and sex. RESULTS: The percentage of patients with 0, 1, 2, 3 and 4-6 cardiovascular risk factors was 39.1, 32.8, 17.5, 6.9 and 3.7 respectively. The OR for experiencing a cardiovascular event associated to 1, 2, 3 and 4-6 cardiovascular risk factors was 1.6 (CI95%: 0.9-2.7), 2.8 (CI95%: 1.7-4.7), 3.6 (CI95%: 1.9-6.5) and 5.6 (CI95%: 2.9-10.8), respectively. The OR for ischemic cardiopathy associated to the same risk levels were 2.3 (CI95%: 1.1-4.6), 2.5 (CI95%: 1.2-5.2), 5.3 (CI95%: 2.4-11.5) and 6.2 (CI95%: 2.7-14.3), respectively. For cardiovascular disease, the OR were 1.1 (CI95%: 0.5-2.5), 2.3 (CI95%: 1.2-5.3), 2.4 (CI95%: 1.0-5.9) and 5.6 (CI95%: 2.2-14.1), respectively. The OR for peripheral arteriopathy were 2.1 (CI95%: 0.8-5.9), 3.7 (CI95%: 1.3-10.5), 3.3 (CI95%: 1.0-11.1) and 6.1 (CI95%: 1.8-20.3), respectively. CONCLUSIONS: The addition of cardiovascular risk factors is associated with an increased risk of cardiovascular events. This finding emphasises the need for prevention of cardiovascular risk factors in primary care.

Adolescent↗