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PubMed2006

Hypertensive renal vascular disease and cardiovascular endpoints.

PURPOSE OF REVIEW: Hypertension involves the entire cardiovascular system, and hypertensive vascular disease may promote and exacerbate cardiac and renal dysfunction. We discuss the coexistence of cardiorenal disease as a manifestation of vascular involvement in hypertension, and the relationship of biomarkers of renal vascular involvement in hypertension with cardiovascular endpoints. RECENT FINDINGS: Markers of renal dysfunction, especially microalbuminuria, have been considered recently as potent predictors of cardiovascular morbidity and mortality in all explored populations, including hypertensive individuals. Microalbuminuria, per se, is related to vascular injury and to the increased glomerular permeability of albumin as a direct manifestation of renal vascular involvement in hypertension, a systemic vascular disease. Left ventricular hypertrophy in hypertension develops even before proteinuria or impairment of renal function. Factors including anemia, inflammation and hyperuricemia are either induced or exacerbated by renal vascular disease, and each of these may exert additional influence in determining the increased incidence of cardiovascular events with progressive renal dysfunction. SUMMARY: The development and progression of vascular disease is the primary determinant in the progressive cardiac and renal dysfunction observed in hypertension and, therefore, is the underlying mechanism of the overall clinical manifestations of cardiorenal disease. Commonly used biomarkers of renal and vascular function are important tools for determination of the progression and, hence, management of hypertensive disease and its complications.

Albuminuria↗
PubMed2005

Self-efficacy in patients with clinical manifestations of vascular diseases.

OBJECTIVE: Patients with established cardiovascular disease are at high risk of developing new vascular events or death. This risk can be reduced by lifelong treatment of risk factors and by permanent changes in lifestyle. Self-efficacy is important for achieving behavior change by self-management. The self-efficacy of different vascular risk factors subgroups in patients with clinical manifestations of atherosclerotic vascular diseases was investigated. METHODS: From January 2001 to September 2003, 192 patients with recently established clinically manifest atherosclerotic disease with > or = 2 modifiable vascular risk factors were selected for the study. The mean self-efficacy scores were calculated for vascular risk factors (age, sex, vascular disease, weight, diabetes mellitus, smoking behavior, hypercholesterolemia, hypertension, and hyperhomocysteinemia). RESULTS: Diabetes, overweight, and smoking, but none of the other risk factors, were significantly associated with the level of self-efficacy in these patients. CONCLUSIONS: Patients with vascular diseases appear to have high levels of self-efficacy regarding medication use, exercise, and controlling weight. In patients with diabetes, overweight, and in smokers, self-efficacy levels were lower. PRACTICE IMPLICATIONS: In nursing care and research on developing self-efficacy based interventions, lower self-efficacy levels can be taken into account for specific vascular patient groups.

Aged↗
PubMed2003

Novel aspects on RANK ligand and osteoprotegerin in osteoporosis and vascular disease.

The clinical coincidence of osteoporosis and vascular disease has long indicated that common mediators may adversely affect bone metabolism and vascular integrity alike. Receptor activator of NF-kappaB ligand (RANKL) is an important cytokine for bone resorption that acts through its osteoclastic receptor, receptor activator of NF-kappaB (RANK), while osteoprotegerin serves as a decoy receptor that binds RANKL and prevents activation of RANK. Skeletal and vascular cells are sources and targets of RANKL and OPG both in vitro and in vivo. Modulation of the RANKL/RANK/OPG system in animals results in a skeletal and vascular phenotype, and administration of OPG may prevent osteoporosis and vascular calcification. Recent studies on OPG serum levels and gene polymorphisms also suggest an important role of this cytokine system in skeletal and vascular diseases. In summary, there is increasing evidence that RANKL and OPG may link the skeletal with the vascular system.

Animals↗
PubMed2004

[Summary of the practice guideline 'Peripheral vascular disease' (first revision) from the Dutch College of General Practitioners].

Peripheral vascular disease is a manifestation of atherosclerosis and may occur with or without signs or symptoms. The local prognosis is worse with signs or symptoms. The concomitant atherosclerosis in heart and brain is responsible for long-term morbidity and mortality. Absence of signs and symptoms almost excludes peripheral vascular disease, but for the diagnosis an ankle-brachial index is mandatory. This implies a protocol in general practice. Treatment of peripheral vascular disease consists of advice on cardiovascular risk factors, stopping smoking, walking exercises, and foot care. For peripheral vascular disease, anti-thrombotic medication is advised.

Fibrinolytic Agents↗
PubMed2005

Immunosuppression related to collagen-vascular disease or its treatment.

Collagen-vascular diseases are associated with immune dysregulation and inflammation, leading to tissue destruction or compromise. Immunosuppression is more commonly associated with the drugs used to treat these disorders than with the diseases themselves. The newest agents being used to treat collagen-vascular diseases are the tumor necrosis factor (TNF)-alpha inhibitors. U.S. Food and Drug Administration-approved TNF-alpha inhibitors have differing effects on the immune system, reflecting their potency and mechanisms of action. They are particularly effective in breaking down granulomatous inflammation, which makes them effective treatment for sarcoidosis and Wegener's granulomatosis. This same property makes them likely to break down the host defense mechanism that normally contains pathogens such as mycobacteria and fungi in a dormant state, namely the physical and immunologic barrier formed by granulomas in the lung and elsewhere. The most common infection reported with the TNF-alpha inhibitors has been tuberculosis, which may manifest as pulmonary and/or extrapulmonary disease, with the latter being more common and severe than usual. Histoplasma capsulatum, Aspergillus, Cryptococcus neoformans, and Listeria monocytogenes have also been described in a number of cases, and their frequency is discussed.

Collagen Diseases↗
PubMed1995

A quantitative assessment of plasma homocysteine as a risk factor for vascular disease. Probable benefits of increasing folic acid intakes.

OBJECTIVES: To determine the risk of elevated total homocysteine (tHcy) levels for arteriosclerotic vascular disease, estimate the reduction of tHcy by folic acid, and calculate the potential reduction of coronary artery disease (CAD) mortality by increasing folic acid intake. DATA SOURCES: MEDLINE search for meta-analysis of 27 studies relating homocysteine to arteriosclerotic vascular disease and 11 studies of folic acid effects on tHcy levels. STUDY SELECTION AND DATA EXTRACTION: Studies dealing with CAD, cerebrovascular disease, and peripheral arterial vascular disease were selected. Three prospective and six population-based case-control studies were considered of high quality. Five cross-sectional and 13 other case-control studies were also included. Causality of tHcy's role in the pathogenesis of vascular disease was inferred because of consistency across studies by different investigators using different methods in different populations. DATA SYNTHESIS: Elevations in tHcy were considered an independent graded risk factor for arteriosclerotic vascular diseases. The odds ratio (OR) for CAD of a 5-mumol/L tHcy increment is 1.6 (95% confidence interval [CI], 1.4 to 1.7) for men and 1.8 (95% CI, 1.3 to 1.9) for women. A total of 10% of the population's CAD risk appears attributable to tHcy. The OR for cerebrovascular disease (5-mumol/L tHcy increment) is 1.5 (95% CI, 1.3 to 1.9). Peripheral arterial disease also showed a strong association. Increased folic acid intake (approximately 200 micrograms/d) reduces tHcy levels by approximately 4 mumol/L. Assuming that lower tHcy levels decrease CAD mortality, we calculated the effect of (1) increased dietary folate, (2) supplementation by tablets, and (3) grain fortification. Under different assumptions, 13,500 to 50,000 CAD deaths annually could be avoided; fortification of food had the largest impact. CONCLUSIONS: A 5-mumol/L tHcy increment elevates CAD risk by as much as cholesterol increases of 0.5 mmol/L (20 mg/dL). Higher folic acid intake by reducing tHcy levels promises to prevent arteriosclerotic vascular disease. Clinical trials are urgently needed. Concerns about masking cobalamin deficiency by folic acid could be lessened by adding 1 mg of cobalamin to folic acid supplements.

Arteriosclerosis↗
PubMed2006

History of vascular disease and mild parkinsonian signs in community-dwelling elderly individuals.

BACKGROUND: Mild parkinsonian signs (MPS) are commonly found during the clinical examination of older people. These signs could reflect the accumulation of vascular pathological changes in the brain. If the etiology were vascular, one could hypothesize that individuals with MPS would be more likely to have systemic vascular disease than would their counterparts without these signs. OBJECTIVES: To examine whether MPS are associated with a history of vascular disease and whether certain MPS (rigidity, changes in axial function) are more strongly associated with a history of vascular disease than are other MPS (tremor). METHODS: Evaluation of older people without dementia in Washington Heights-Inwood, northern Manhattan, NY. The presence of vascular diseases was assessed with a structured health interview. RESULTS: Mild parkinsonian signs were present in 375 (16.4%) of 2286 participants without dementia. Diabetes mellitus, heart disease, peripheral vascular disease, and stroke were more prevalent in participants with MPS than without MPS, whereas nonvascular diseases (cancer, thyroid disease) were not. In a logistic regression analysis that adjusted for age, sex, education, and depressive symptoms, the number of vascular diseases was associated with MPS (odds ratio, 1.31 [95% confidence interval, 1.18-1.46]; P<.001). The combination of diabetes mellitus and heart disease increased the odds of MPS by 70% and the combination of these with stroke increased the odds by 332%. CONCLUSIONS: The presence of MPS in elderly individuals might reflect, in part, the accumulation of vascular pathological changes in the basal ganglia or white matter regions caused by preventable vascular diseases. Prospective and pathological studies are needed to further explore this finding.

Aged↗
PubMed1998

Homocysteinemia: new information about an old risk factor for vascular disease.

OBJECTIVE: To determine the importance of homocysteinemia as a risk factor for atherosclerotic vascular disease. DESIGN: Literature review of published studies homocysteine as risk factor for atherosclerotic vascular disease. METHODS: MEDLINE search from 1969 to 1998 using homocysteine and vascular disease as search terms, from which 13 articles were selected for review. RESULTS: Homocysteine is a sulfur containing amino acid derivative formed during methionine metabolism. Inherited deficiencies of cystathionine B synthase or MTHF reductase result in markedly elevated plasma homocysteine levels and homocystinuria. Although rare, hereditary homocystinuria results in a variety of life threatening vascular complications occurring at a young age. Lesser degrees of homocysteinemia may result from vitamin B12, folate and pyridoxine deficiencies as well as a recently described mutation of the MTHF reductase gene. Homocysteinemia from these causes has been shown to increase the risk of coronary artery disease, peripheral artery disease, stroke, and venous thrombosis. Postulated mechanisms for this association are discussed. CONCLUSION: Homocysteinemia is a risk factor for premature vascular disease. The strength of this association is similar to that due to hyperlipidemia and tobacco use. Although vitamin supplementation with folic acid, B12, and B6 is able to reduce homocysteine levels in many persons, proof of the effectiveness of vitamin treatment in preventing or halting the progression of vascular disease is not yet available.

Aged↗
PubMed1986

Pathophysiology related to peripheral vascular disease.

The problems of peripheral vascular diseases are varied and sometimes complex. The major and most common disease is arteriosclerosis obliterans. This problem will continue as the life expectancy increases. The severity of the disease compromises the quality of life. An understanding of the pathophysiologic process is necessary to enhance the quality of life and prevent the terrible and disfiguring complications which can arise as a result of insufficient knowledge.

Adult↗
PubMed1998

Premature peripheral vascular disease: clinical profile and abnormal lipid peroxidation.

The aim of this study was to determine any biochemical differences between early-onset peripheral vascular disease and typical onset atherosclerosis, and age-matched controls. A subset of patients present at a young age ( < 50 years) with peripheral vascular disease which pursues an aggressive course. As lipid oxidation seems important in atherosclerosis, total lipid peroxides, oxidized subfractions, and Trolox equivalent antioxidant capacity (TEAC) were studied in patients with premature peripheral vascular disease. Charts were reviewed of patients operated on for vascular occlusive disease over a 5-year period. Patients with early-onset peripheral vascular disease (group I) were evaluated for biochemical abnormalities and compared with typical onset atherosclerotics (group II) and age-matched controls (group III). Sixteen patients with early-onset peripheral vascular disease underwent biochemical evaluation. Conventional lipid profiles did not differ statistically from those of age-matched controls, except for mild elevations in LDL and VLDL in patients with vascular occlusive disease (207 and 195 mg/dl in groups I and 11 versus 157 mg/dl in group III). Total oxidative potential was significantly elevated (P = 0.006) 3.04, 2.15 and 2.04 nmol/ml in groups I, II and III, respectively. Levels of oxidized LDL and VLDL were even more significantly elevated (P = 0.0009) for premature peripheral vascular disease, (1.2, 0.58 and 0.47 nmol/ml in groups I-II). TEAC values did not differ significantly between groups (0.83, 0.82, 0.82 nmol/ml) and did not correlate with total lipid peroxide values for individual patients. In conclusion, lipid peroxides were significantly elevated in patients with premature peripheral vascular disease, the most marked changes being seen in oxidized LDL and VLDL subfractions. Lipid peroxides were elevated when standard lipid profiles were only mildly abnormal. The poor long-term prognosis in these patients suggests the need for aggressive evaluation and treatment of lipid abnormalities.

Adult↗
PubMed1996

Prevalence of renal artery stenosis in patients with peripheral vascular disease and hypertension.

The aim of this study was to evaluate the prevalence of renal artery stenosis in patients with clinical signs of peripheral vascular disease and hypertension. One hundred patients, mean age 69 years (range 45-88) with symptoms and clinical signs of severe peripheral ischemia, underwent aortography to determine the degree of peripheral vascular disease and possible renal artery stenosis. History of claudication, and measurement of systolic distal blood pressure (BP) and calculation of the Ankle Brachial Index was used to define the severity of peripheral vascular disease. A total of 31% had renal artery stenosis (14% greater than 50% reduction in luminal diameter). In a subgroup of patients with hypertension and peripheral vascular disease (n = 74), 34% had renal artery stenosis. In the subgroup of patients with renal artery stenosis, 81% have hypertension. Patients with renal artery stenosis and lumen reduction of more than 50%, 93% have hypertension (P < or = 0.001). In conclusion this study shows that the combination of peripheral vascular disease and hypertension is an important clinical clue for renovascular disease. Examination for reno-vascular disease in this population should be considered, since the prevalence of the condition is high. Furthermore examination for renal vascular disease in this population is mandatory, before treatment with angiotensin converting enzyme (ACE) inhibitors is initiated, since treatment might lead to serious renal function impairment.

Aged↗
PubMed1991

Near-infrared spectroscopy in peripheral vascular disease.

Near-infrared spectroscopy has been performed on the calf muscles of 38 subjects, 21 normal controls without vascular disease and 17 patients with peripheral vascular disease. Oxygen consumption was measured in the calf by calculating the rate of conversion of oxyhaemoglobin to deoxyhaemoglobin during a period of tourniquet-induced ischaemia. Postischaemic reoxygenation was also measured. Median oxygen consumption in patients with peripheral vascular disease was 0.10 ml 100 g tissue-1 min-1, while in the control group it was 0.20 ml 100 g tissue-1 min-1 (P less than 0.03, Mann-Whitney U test). The median time taken to reach maximum oxyhaemoglobin levels after ischaemia was 40 s in patients with peripheral vascular disease and 20 s in controls (P less than 0.02). The results indicate that oxygen consumption is reduced in peripheral vascular disease. Near infrared spectroscopy is a non-invasive method for assessing metabolic improvement resulting from surgical or pharmacological treatment.

Adult↗
PubMed1993

Common peripheral vascular diseases.

Among the most common causes of morbidity and mortality in elderly individuals are the manifestations of the various peripheral vascular diseases. Many chronic degenerative diseases, which begin in middle age, are associated with peripheral vascular disease. Heart disease, hypertension, hyperlipidemia and diabetes are all risk factors for peripheral vascular diseases and also common degenerative conditions in our society. Other risk factors, such as diet, smoking, stress, lack of exercise, and obesity, are also closely associated with peripheral vascular disease. Aging itself is also a risk factor. Appropriate treatment for disease processes such as diabetes and hypertension and control of other preventable risk factors have been shown to reduce the morbidity and mortality seen in peripheral vascular disorders. Our rapidly aging population requires increasing amounts of medical resources, placing an enormous burden on society because the aged population are generally more dependent upon government-sponsored health care services. The podiatric practitioner is in a position as a primary care provider to influence the health practices of our aging population. The implementation of a health practice that stresses prevention and wellness as well as the appropriate management and a referral of patients with peripheral vascular disorders will limit the morbid results of peripheral vascular diseases.

Aged↗
PubMedDate not supplied

[Rapid effect of glucuronyl glucosamine glycan sulfate on the blood levels of HDL-cholesterol in vascular diseases].

The Authors investigated on the main lipidemic parameters in vascular diseases after acute administration of glucuronyl-glucosamine-glycan sulfate (3GS). The study was carried out in 48 subjects, aged 33 to 78, of whom 38 males and 10 females so divided: 6 metabolically healthy controls (N), 10 with vascular cerebral disease (VCD), 15 with coronary heart disease, 17 with peripheral vascular disease (PVD). Each subject, fasting and without drug treatment at least since 14 hours, after venous blood withdrawal, was given endovenous rapid bolus of 570 lipasemic units of glucuronyl-glucosamine-glycan sulfate (3GS); after 10', 20' and 30' other blood samples were taken; plasma NEFA (colorimetric method) triglycerides (TG), total cholesterol (TC) and HDL-cholesterol (C-HDL) (enzyme method) were assayed; C-HDL/TC ratio was calculated and LDL-cholesterol value (C-LDL) according to the Friedwald-Fredrickson's formula was obtained. In controls NEFA increase after 20' (+ 57%) and triglycerides drop (-49%) were detected; TC significant fall (-13%, P less than 0,05) after 20' was found, preceded by both C-HDL marked increase and C-HDL/TC ratio, and followed (30') by C-LDL slight rise. In the 3 groups of vascular patients a striking NEFA increase (respectively + 50%, + 43%, + 26%) was found; in subjects with PVD/TG blunted drop was observed, whereas in VCD and in CHD TG percentage fall -41 and -44%) did not differ from that one of controls. Evident remarked in control, drop of total cholesterolemia, lacked in the 3 groups of vascular diseases; in patients with VCD and PVD C-HDL and C-HDL/TC ratio increasing profile was like normal, while in CHD both progressive reduction of C-HDL (-19% after 30') and C-HDL/TC ratio with C-LDL increase were appreciated. On the basis of their results the Authors believed that in PVD a striking deficit of total plasma lipoprotein lipase (LPL), already in vitro documented, may occur, whereas LPL resulted normal in VCD and in CHD; on the contrary, in CHD an abnormally cholesterol-apo-VLDL affinity, like metabolic atherogenic derangement, was found; in the 3 groups of vascular diseases slow peripheral cholesterol removal was detectable.

Adult↗
PubMed1993

Risk of cardiac surgery in patients with peripheral vascular disease.

After reading these articles, I think the evidence is convincing that peripheral vascular disease clearly places the patient at a higher risk for coronary bypass surgery than is the case for patients without peripheral vascular disease. However, in some instances coronary bypass surgery must be performed before peripheral vascular surgery is performed. Perhaps the best way to leave it is to indicate that if there is a clear-cut indication for coronary bypass surgery it should be done independent of vascular disease elsewhere, but one must accept the fact that most reports indicate an increased morbidity and mortality. Thus, I would like to make a final point by quoting Gersh: "The protective shield of prior coronary artery bypass surgery [in patients with peripheral vascular disease] . . . has a price."

Coronary Artery Bypass↗
PubMed1995

Lipoprotein (a) and vascular disease in diabetic patients.

In order to assess the potential role of lipoprotein (a) as a risk factor for cardiovascular disease in diabetes mellitus, plasma concentrations were measured in a large group (n = 500) of non-insulin-dependent (NIDDM, n = 355) and insulin-dependent (IDDM, n = 145) patients. Concentrations of lipoprotein (a) were compared in diabetic patients with (n = 153) or without (347) documented vascular disease (ischaemic heart disease, peripheral vascular disease or macroangiopathy). They were significantly higher (p < 0.05) in patients with ischaemic heart disease (mean [interquartile range] 15.5 (5.0-38.0) vs 9.0 (4.5-26.0) mg/dl) or macroangiopathy (13.0 (5.0-38.0) vs 9.0 (4.0-25.0) mg/dl) compared to patients without manifestations of vascular disease. In addition, stepwise logistic regression analysis identified lipoprotein (a) levels > or = 30 mg/dl as being independently associated with the presence of cardiovascular disease. Lipoprotein (a) was an independent risk factor for ischaemic heart disease and macroangiopathy in this group of IDDM and NIDDM patients.

Adult↗
PubMed1991

Pregnancy complicated by collagen vascular disease.

Pregnancies complicated by collagen vascular diseases present a challenge to the obstetrician, internist, and other consulting physicians caring for the patient. Although most pregnancies complicated by these disorders result in satisfactory outcomes, a significant number develop manifestations sufficiently serious to require admission to an intensive care unit. Such manifestations include lupus nephritis, CNS lupus, ARDS, massive alveolar hemorrhage, scleroderma renal crisis, pulmonary hypertension, severe myositis, and diffuse vasculitis. Of the numerous therapeutic options available, many may be used to optimize maternal and perinatal outcome.

Autoimmune Diseases↗