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PubMed2004

Management and prevention of cardiovascular disease in women.

Cardiovascular disease, including coronary artery disease, hypertension, and stroke, is the number one killer of men and women in the United States and Canada. In the United States, cardiovascular disease accounts for more deaths in women, compared with men, every year since 1984. Unfortunately, many women are unaware of their risk for developing cardiovascular disease. This article reviews the statistics of this disease, identifies the risk factors, and reviews the evidence-based guidelines for prevention of cardiovascular disease in women.

Cardiovascular Diseases↗
PubMedDate not supplied

Gender differences in the link between depression and cardiovascular disease.

OBJECTIVES: Cardiovascular disease is the leading cause of mortality in women costing more than 500,000 lives each year in the United States alone. Major depression in healthy subjects increases cardiovascular mortality in both men and women. The presence of major depression in patients with recent acute myocardial infarction (AMI) or unstable angina more than doubles the risk of cardiac death in both men and women. In the presence of depression, lack of social integration has an additive effect on cardiac events. Depression is more prevalent in women with coronary heart disease (CHD) than in men. Psychologic counseling as well as cognitive behavioral treatment in women post-AMI seems to adversely affect prognosis, whereas it has neutral effects in men. Pharmacologic treatment of depression with serotonin reuptake inhibitors is safe in men and women post-AMI and is particularly effective in patients with recurrent depression. Whether effective treatment of depression lowers cardiac mortality remains to be proven.

Antidepressive Agents↗
PubMed1999

Resistance Exercise in the Elderly Person with Cardiovascular Disease.

Elderly cardiovascular disease patients are not aggressively referred to cardiac rehabilitation programs due to concerns regarding orthopedic fragility, hemodynamic risk, and life expectancy. However, there is a growing consensus that older cardiovascular patients enrolled in rehabilitation programs will derive the same magnitude of improvement in functional capacity as their younger counterparts. Further, resistance exercise training may be necessary, as a part of a comprehensive cardiac rehabilitation program, to elicit optimal benefits in elderly cardiovascular patients. In this article, we briefly review orthopedic and hemodynamic risks associated with resistance training, the efficacy of resistance training, and the recommended guidelines for resistance exercise prescription. (c)1999 by CVRR, Inc.

Journal Article↗
PubMed2006

Periodontitis and cardiovascular disease: a review of shared risk factors and new findings supporting a causality hypothesis.

Periodontitis is a common chronic disease worldwide. It is a major cause of tooth loss among adults and recently has been suggested to increase the risk for developing several systemic diseases, including cardiovascular disease. Populations are not equally affected by periodontal disease because there are several environmental and host factors modulating susceptibility. Cardiovascular disease shares many of the same susceptibility factors. The purpose of this report is to identify risk factors and indicators common to periodontitis and cardiovascular disease, and also to discuss their possible interrelationship in this association. Recent findings to support a causal association between the 2 conditions are also presented.

Cardiovascular Diseases↗
PubMed2004

Two-year statin therapy does not alter the progression of intima-media thickness in patients with type 2 diabetes without manifest cardiovascular disease.

OBJECTIVE: Cardiovascular disease (CVD) is the most important cause of mortality in patients with type 2 diabetes. We aimed to determine the effect of statin therapy versus placebo on the progression of carotid intima-media thickness (IMT) in type 2 diabetic patients without manifest CVD. RESEARCH DESIGN AND METHODS: A randomized, placebo-controlled, double-blind clinical trial was performed in 250 patients with type 2 diabetes. Patients were given either 0.4 mg cerivastatin or placebo daily. In August 2001, when cerivastatin was withdrawn from the market, 0.4 mg cerivastatin was replaced by 20 mg simvastatin without deblinding the study. The primary end point was the change of mean common carotid IMT, as measured by B-mode ultrasound, over 2 years. RESULTS: Common carotid IMT at baseline was 0.780 mm in the placebo group and 0.763 mm in the statin group and did not change significantly after 2 years. There was no significant difference in IMT change in any carotid segment between the groups. LDL cholesterol was reduced by 25% in the statin group and increased by 8% in the placebo group (P <0.001). Cardiovascular events occurred in 12 patients in the placebo group and two patients in the statin group (P=0.006). CONCLUSIONS: There was no effect of 2 years' statin therapy on carotid IMT in type 2 diabetic subjects. The natural history of IMT in our patients was milder than anticipated. In contrast, we observed a significantly lower cardiovascular event rate on statin therapy. Prognostic tools other than IMT should be explored in this patient group.

Body Mass Index↗
PubMed2006

Screening for asymptomatic cardiovascular disease with noninvasive imaging in patients at high-risk and low-risk according to the European Guidelines on Cardiovascular Disease Prevention: the SMART study.

OBJECTIVE: To assess the prevalence of atherosclerotic risk factors and to investigate the added value of noninvasive imaging in detecting asymptomatic cardiovascular diseases in patients at low risk and high risk according to the European Guidelines on Cardiovascular Disease Prevention. METHODS: In the vascular screening program of the University Medical Center Utrecht, patients aged 18 to 79 years who had recently received a diagnosis of manifest vascular disease (coronary heart disease, cerebrovascular disease, abdominal aortic aneurysm, or peripheral arterial disease [PAD]) or had a risk factor (hypertension, hyperlipidemia, or diabetes mellitus) were assessed for atherosclerotic risk factors and (other) arterial diseases by noninvasive means. The European guidelines were applied to quantify the number of high-risk patients. RESULTS: Eighty-eight percent of 3950 patients were considered to be at high-risk. More than 80% had hyperlipidemia, approximately 50% had hypertension, 21% had diabetes mellitus, and 31% were current smokers. An asymptomatic reduced ankle-brachial index (< or = 0.90) was most frequently observed in patients with cerebrovascular disease (21%); an asymptomatic abdominal aortic aneurysm (> or = 3.0 cm) in patients with PAD (5%) or cerebrovascular disease (5%); and an asymptomatic carotid stenosis (> or = 50%) in patients with PAD (15%). On the basis of noninvasive measurements, 73 (13%) of 545 patients initially considered as low risk were reclassified as high risk. CONCLUSIONS: This study confirmed a high prevalence and clustering of modifiable atherosclerotic risk factors in high-risk patients. The yield of noninvasive vascular measurements was relatively low but identified a sizable number of high-risk patients. Standard screening for asymptomatic atherosclerotic disease identified a limited number of vascular abnormalities that necessitated immediate medical attention in patients already identified as high-risk patients.

Adolescent↗
PubMed2005

The effect of statin therapy on endothelial function in type 2 diabetes without manifest cardiovascular disease.

OBJECTIVE: Cardiovascular disease (CVD) is the most important cause of mortality in patients with type 2 diabetes and is preceded by endothelial dysfunction. Flow-mediated dilation (FMD) is a noninvasive technique for measuring endothelial dysfunction. We aimed to determine the effect of long-term statin therapy versus placebo on FMD in patients with type 2 diabetes without manifest CVD. RESEARCH DESIGN AND METHODS: A randomized, placebo-controlled, double-blind trial was performed with 250 type 2 diabetic patients. Patients were given 0.4 mg cerivastatin or placebo daily. In August 2001, when cerivastatin was withdrawn from the market, the 0.4 mg cerivastatin was replaced by 20 mg simvastatin, without deblinding the study. The primary end point was the change in FMD, measured by B-mode ultrasound, after 2 years. RESULTS: Determinants of baseline FMD were diabetes duration, common carotid intima-media thickness, and brachial artery diameter. FMD at baseline was 1.51% in the placebo group and 1.66% in the statin group and did not change significantly after 2 years. CONCLUSIONS: The 2-year statin therapy had no effect on FMD in type 2 diabetes. Statin-induced improvement of cardiovascular risk in patients with type 2 diabetes may be mediated through mechanisms other than increased nitric oxide availability.

Blood Flow Velocity↗
PubMed2003

A functional variant of the myeloperoxidase gene is associated with cardiovascular disease in end-stage renal disease patients.

Cardiovascular disease (CVD) is the leading cause of mortality in end-stage renal disease (ESRD) patients and there is emerging evidence that genetic factors may contribute to the development of atherosclerosis. Myeloperoxidase (MPO) is an abundant enzyme involved in the production of free radicals. A functional G-->A single nucleotide polymorphism (SNP) has been identified at position -463, where the A allele is associated with lower MPO expression. To analyze the association between this SNP and inflammation, oxidative stress, and CVD, we studied a cohort of 155 ESRD patients (52 +/- 1 years, 62% males, 22% diabetics) shortly before the initiation of dialysis treatment. CVD was defined by medical history criteria; plasma interleukin-6 (IL-6) was used as a marker of inflammation, and plasma pentosidine as an estimation of oxidative protein damage. DNA from leukocytes was used for genotyping, performed by the pyrosequencing reaction. Only five patients (3%) had the genotype AA at the -463 position, whereas 38 (25%) had the GA and 112 (72%) had the GG genotype. No differences were noted in plasma IL-6 levels between the genotype groups, whereas the pentosidine levels were higher in the GG group (28.4 pmol/mg albumin [range, 8.5 to 123 pmol/mg albumin]) compared to the other two groups (21.4 pmol/mg albumin [range, 7.6 to 384 pmol/mg albumin; P < 0.05]). Patients with the GG genotype had a higher prevalence of positive serology for Chlamydia pneumoniae (51%) when compared to the carriers of the A allele (24%) (P < 0.05). The prevalence of CVD was lower in the AA (0%) and GA genotypes (18%), compared to the GG genotype (35%). The GG genotype was still associated with CVD after correction for age, diabetes, smoking, malnutrition, and inflammation. Our findings suggest that the -463 G-->A SNP, which supposedly results in lower MPO activity, is associated with a lower prevalence of CVD in ESRD patients. It could be speculated that this effect is mediated by a decreased oxidative stress due to lower production of free radicals.

Arginine↗
PubMed1999

Impact of nondigestible carbohydrates on serum lipoproteins and risk for cardiovascular disease.

Atherosclerotic cardiovascular disease (ASCVD) is the leading cause of death in the U.S. and in most developed countries. Many nutritional factors contribute to risk for ASCVD including total and saturated fat consumption, fruits and vegetables in the diet and dietary fiber intake. This review will focus on the relationship of dietary fiber intake to risk for coronary heart disease (CHD) and ASCVD (which includes, principally, CHD, cerebral vascular disease and peripheral vascular disease). Fiber-rich foods such as vegetables, fruits, whole-grain cereals and legumes are rich sources of nutrients, phytochemicals and antioxidants. For example, most high fiber foods contain soluble and insoluble fiber, minerals, vitamins, other micronutrients and phytochemicals. Cereals and legumes also contain complex carbohydrates and unsaturated fatty acids. Some high fiber foods are rich in monounsaturated fatty acids, whereas others provide (n-3) fatty acids. Legumes and certain vegetables provide oligosaccharides. When assessing the health benefits of dietary fiber, one should consider the potential effects of associated nutrients, micronutrients and phytochemicals. These interactions will be reviewed as we discuss relationships of dietary fiber to ASCVD.

Animals↗
PubMed1993

Prospects for the prevention of free radical disease, regarding cancer and cardiovascular disease.

Free radicals may be involved in the aetiology of cancer and cardiovascular diseases. In epidemiological studies poor plasma levels of all essential antioxidants are associated with increased relative risks; in particular, low levels of carotene and vitamin E with the risk of cancer and ischemic heart disease, respectively. The studies suggest that for optimal synergistic protection the plasma antioxidant levels should simultaneously exceed the threshold values of 28-30 mumol/l lipid-standardized vitamin E, 40-50 mumol/l vitamin C, 0.4-0.5 mumol/l carotene and 2.2-2.8 mumol/l lipid-standardized vitamin A. However the preventive efficacy of an optional antioxidant status is still to be proven in randomized intervention trials. Although these antioxidant micronutrients may be the primary protective components of vegetable-rich 'preventive' diets, the potentials of other plant components await exploration, eg carotenoids other than beta-carotene, bioflavonoids and oxygen-sensitive B-vitamins.

Adult↗