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At least 433 records · Page 24Linked to original sources
PubMed1993

Lipid abnormalities and end-stage renal disease: implications for atherosclerotic cardiovascular disease?

Disorders of lipoprotein metabolism may have clinical implications as determinants of cardiovascular risk in patients with end-stage renal disease (ESRD). However, the role of hypertriglyceridemia or other parameters of lipoprotein metabolism as predictors of clinical measures of outcome during ESRD treatment is currently unknown. We determined the relationship between blood lipid, lipoprotein-cholesterol, apoprotein levels and the risk of cardiovascular death during 48 months of hemodialysis treatment in a prospective study of 129 patients with ESRD. Although serum triglyceride levels were increased in patients with preexisting cardiovascular disease, they were unrelated to clinical outcome during the period of follow-up. In contrast, lipoprotein(a) was an independent predictor of the risk of deaths attributable to cardiovascular disease during the prospective period of follow-up. Although these findings do not exclude the possibility that hypertriglyceridemic hemodialysis patients have atherogenic lipoproteins or associated metabolic conditions that predispose to cardiovascular death, our findings suggest that measurements of serum triglyceride concentration may not improve the cardiovascular risk assessment of hemodialysis patients.

Apolipoproteins A↗
PubMed2002

Angiotensin converting enzyme gene insertion/deletion polymorphism and cardiovascular disease: therapeutic implications.

Cardiovascular disease is the major cause of morbidity and mortality in Westernised societies. It is well known that the aetiology of this devastating disorder involves both genetic and environmental factors. Sequence variants of the components of the renin-angiotensin-aldosterone system and the kallikrein-kinin system are suggested to have significant influences on cardiovascular homeostasis. Both gene targeting and transgenic studies in mice have clearly suggested a critical role of the angiotensin converting enzyme (ACE) gene in blood pressure regulation. Furthermore, an up-regulation of myocardial ACE gene expression has been observed in patients with heart failure. Thus, the ACE gene has been recognised as a top candidate gene for cardiovascular research. Over the past decade, the insertion/deletion (I/D) polymorphism of a 287-bp Alu element in intron 16 of the ACE gene has attracted significant attention and has been extensively investigated in a spectrum of cardiovascular phenotypes, because of its correlation with serum ACE activity. A large majority of previous studies have shown a positive association between the DD genotype and an increased risk of myocardial infarction, but results in hypertension, left ventricular hypertrophy, cardiomyopathy and restenosis after percutaneous transluminal coronary angioplasty remain quite controversial. Since ACE inhibitors are widely used in hypertension and congestive heart failure, we also review the literature on the relationship of ACE I/D polymorphism with ACE inhibitor response. It appears that this polymorphism has some moderate impact on the cardiovascular response to ACE inhibitors but there is no consensus as to which allele confers a more pronounced effect. In addition, previous data are suggestive of an association between the ACE I allele and a greater risk of increased occurrence of ACE inhibitor-induced cough, but such a relationship needs further confirmation. Overall, since ACE I/D is only an intronic marker, the true locus that controls the ACE enzyme activity remains to be identified, and could be located within either the ACE gene or another nearby gene such as the human growth hormone gene. We note that since associations tend to vary across different gender or ethnic groups, or across different socio-ecological settings, consideration of potential gene-gene and gene-environment interactions should be made. Furthermore, the dissection of the genetic underpinning of cardiovascular disease needs delineation of all molecular variants of the key physiological pathways that influence cardiovascular function.

Angiotensin-Converting Enzyme Inhibitors↗
PubMed1997

Effects of dietary fatty acids on lipoproteins and cardiovascular disease risk: summary.

Cardiovascular disease is the leading cause of death and disability in the United States and other countries. To reduce the risk of cardiovascular disease, dietary saturated fat and cholesterol should be reduced. This section of the workshop included a discussion of pragmatic issues associated with translating complex scientific information on the fat and fatty acid content of foods for the public; an overview of and a theoretical framework for cholesterol and lipoprotein metabolism; information on the role of cholesterol in the control of low-density-lipoprotein cholesterol (from animal studies); epidemiologic studies on the association between dietary fat and fatty acids and lipids and lipoproteins; the appropriate experimental design for fatty acid studies; and clinical studies evaluating the effects of individual fatty acids on plasma lipids and lipoproteins. The evidence to date indicates that the individual fatty acids elicit distinctly different physiologic effects. There is still much to be learned about the effects of individual fatty acids on lipids and lipoproteins, their metabolic fate, and the responsible biological mechanisms.

Animals↗
PubMed2005

Usefulness of low-density lipoprotein particle size measurement in cardiovascular disease prevention.

BACKGROUND: Cardiovascular disease is largely explained by the traditional risk factors, but there are several novel risk factors that have been shown to predict cardiovascular morbidity. The measurement of low-density lipoprotein particle size (LDLPS) is a novel cardiovascular risk factor, yet it is unknown whether this measurement provides additional information that may influence the subsequent medical treatment of patients. HYPOTHESIS: The measurement of LDLPS provides additional information that may influence preventive treatment for cardiovascular disease. METHODS: In an observational study of 82 patients referred to a tertiary care preventive cardiology clinic, LDLPS was dichotomized as either small or large and was determined by either the NMR LipoProfile test, the Vertical Auto Profile (VAP) cholesterol test, or gradient gel electrophoresis. Lipid profiles were obtained and Framingham risk scores were calculated. Patients were stratified by Adult Treatment Panel guidelines as being at low, intermediate, or high risk. RESULTS: The study included 56 men and 26 women with a mean age of 54 +/- 11 years. In the entire cohort of 82 patients, only 31 (38%) were at non-high-density lipoprotein (HDL) goal, only 21 (26%) were at goals for both non-HDL and HDL, and only 18 (22%) were at goal for non-HDL, HDL, and triglycerides. When considering each of the risk factor strata, 19 of 43 (44%) low-risk patients were at non-HDL goal and 12 of these also had a small LDLPS. Only 8 of 18 (44%) intermediate-risk patients were at non-HDL goal and 7 of these (88%) had small LDLPS. Finally, only four high-risk patients were at non-HDL goal and three of these (75%) had small LDLPS. CONCLUSIONS: Knowing the LDLPS could alter subsequent therapeutic recommendations for most patients who have reached target lipid values.

Adult↗
PubMed1998

Risk factors for cardiovascular disease in Latina women.

Cardiovascular disease is the leading cause of death for Latina women in the United States. Nevertheless, the literature available about the risk factors for cardiovascular disease is inconsistent and hampered by issues related to race and ethnic identification and the exclusion of Latina women from major population-based studies. Compared with white women, Latina women have more of the major and contributing factors for cardiovascular disease, including hypertension, diabetes, overweight/obesity and physical inactivity. This article presents an overview of the literature on cardiovascular disease in Latina women. Literature on mortality, as well as key risk factors (hypertension, cigarette smoking, elevated serum lipids, overweight and obesity, diabetes mellitus and physical inactivity) are reviewed. Issues related to the sociocultural environment of Latina women are also discussed. The article concludes with the implications for clinical practice and further nursing research. The information provided in this article may help nurse clinicians, educators and researchers design and implement nursing interventions that can promote heart health and prevent cardiovascular disease in Latina women.

Acculturation↗
PubMed2003

Effectiveness and costs of interventions to lower systolic blood pressure and cholesterol: a global and regional analysis on reduction of cardiovascular-disease risk.

BACKGROUND: Cardiovascular disease accounts for much morbidity and mortality in developed countries and is becoming increasingly important in less developed regions. Systolic blood pressure above 115 mm Hg accounts for two-thirds of strokes and almost half of ischaemic heart disease cases, and cholesterol concentrations exceeding 3.8 mmol/L for 18% and 55%, respectively. We report estimates of the population health effects, and costs of selected interventions to reduce the risks associated with high cholesterol concentrations and blood pressure in areas of the world with differing epidemiological profiles. METHODS: Effect sizes were derived from systematic reviews or meta-analyses, and the effect on health outcomes projected over time for populations with differing age, sex, and epidemiological profiles. Incidence data from estimates of burden of disease were used in a four-state longitudinal population model to calculate disability-adjusted life years (DALYs) averted and patients treated. Costs were taken from previous publications, or estimated by local experts, in 14 regions. FINDINGS: Non-personal health interventions, including government action to stimulate a reduction in the salt content of processed foods, are cost-effective ways to limit cardiovascular disease and could avert over 21 million DALYs per year worldwide. Combination treatment for people whose risk of a cardiovascular event over the next 10 years is above 35% is also cost effective leading to substantial additional health benefits by averting an additional 63 million DALYs per year worldwide. INTERPRETATION: The combination of personal and non-personal health interventions evaluated here could lower the global incidence of cardiovascular events by as much as 50%.

Adolescent↗
PubMed1999

Fasting and post-methionine homocysteine levels in NIDDM. Determinants and correlations with retinopathy, albuminuria, and cardiovascular disease.

OBJECTIVE: The increased cardiovascular risk in subjects with NIDDM is partly explained by an association with established risk factors like hypertension, dyslipidemia, and obesity. Mild hyperhomocysteinemia has emerged as a new risk factor for cardiovascular disease. The purpose of this study was to assess its role in NIDDM. RESEARCH DESIGN AND METHODS: We studied predictors of homocysteine levels and correlations between homocysteine and (micro-)albuminuria, retinopathy, and history of cardiovascular disease in normotensive NIDDM subjects under stable metabolic control. This was done in 85 NIDDM subjects by measuring fasting and post-methionine-loading homocysteine levels together with blood pressure, BMI, serum cholesterol, triglyceride, HDL cholesterol, folate, vitamin B12, pyridoxal-5-phosphate, HbA1c, and (micro-)albuminuria and creatinine clearance in triplicate 24-h urine samples. The relationship between micro- and macrovascular complications and fasting homocysteine only was studied in an additional 65 subjects, giving a total of 150 subjects. RESULTS: In multiple regression analysis, significant (P < 0.05) predictors of fasting homocysteine were low-normal values of creatinine clearance (threshold effect at < 80 ml.min-1 .1.73 m-2), folate (< 20 nmol/l), and vitamin B12 (< 350 pmol/l), and postmenopausal status in women. Determinants of post-methionine homocysteine were pyridoxal-5-phosphate levels < 80 nmol/l, creatinine clearance, and sex (higher levels in women). Hyperhomocysteinemia did not cluster with other cardiovascular risk factors, like hypertension, obesity, or dyslipidemia. Regarding cardiovascular complications, fasting homocysteine, but not post-methionine homocysteine, was higher in subjects with a history of cardiovascular disease. There was a stepwise increase in the prevalence of subjects with cardiovascular disease with increasing fasting homocysteine. The prevalence of cardiovascular disease was 19.4% in the bottom quartile of fasting homocysteine, versus 55.0% in the top quartile (P for trend < 0.01). Neither fasting homocysteine nor post-methionine homocysteine correlated with (micro-)albuminuria or with retinopathy. CONCLUSIONS: The findings suggest that homocysteine levels in NIDDM rise even with modest deterioration of renal function and when vitamin status is in the low to low-normal range. Fasting homocysteine correlates with macrovascular disease, but we found no evidence of a correlation with retinopathy or (micro-)albuminuria. Post-methionine homocysteine levels do not show a correlation with micro- or macrovascular complications.

Administration, Oral↗
PubMed2001

Gene therapy in cardiovascular disease. Current status.

Cardiovascular disease is the leading cause of mortality and morbidity in developed countries. Most conventional therapy is often inefficacious and tends to treat the symptoms rather than the underlying causes of the disorder. Gene therapy offers a novel approach for prevention and treatment of cardiovascular diseases. Technical advances in viral vector systems and the development of fusigenic liposome vectors have been crucial to the development of effective gene therapy strategies directed at the vasculature and myocardium in animal models. Gene transfer techniques are being evaluated as potential treatment alternatives for both genetic (familial hypercholesterolemia) and acquired occlusive vascular diseases (atherosclerosis, restenosis, arterial thrombosis) as well as for cardiac disorders including heart failure, myocardial ischemia, graft coronary arteriosclerosis and hypertension. Continued technologic advances in vector systems and promising results in human and animal gene transfer studies make the use of gene therapy a promising strategy for the treatment of cardiovascular disorders.

Animals↗
PubMed1996

Asthma and its association with cardiovascular disease in the elderly. The Cardiovascular Health Study Research Group.

Cardiovascular disease (CVD) is more prevalent in elderly than in middle-aged patients. Symptoms such as intermittent wheezing with dyspnea may then be due to either CVD or asthma. The objective of this study was to determine the prevalence and correlates of asthma in the elderly and their associations with CVD and CVD risk factors. A community sample of 5201 elderly persons from the Cardiovascular Health Study was asked if they had a physician diagnosis of asthma, and multiple cardiovascular risk and disease variables were measured. Six percent of the participants (309) recalled a history of asthma, and half of these were never smokers. Thirty percent of those with asthma were currently taking a bronchodilator, 14% inhaled steroids, and 10% oral prednisone. Men and women with asthma who were cigarette smokers were more likely to report a concurrent diagnosis of congestive heart failure than smokers without asthma (p = .04). However, when we determined the independent CVD correlates of asthma in this cohort, controlling for smoking status, age, gender, and diagnoses of chronic bronchitis and emphysema, only higher levels of high-density lipoprotein cholesterol (HDL-C) and higher plasma fibrinogen levels were significantly associated with asthma. It was concluded that asthma is as prevalent in the elderly as in middle-aged persons and is associated with higher HDL-C and higher fibrinogen levels, but not with prevalent cardiovascular disease.

Aged↗
PubMedDate not supplied

[Morbidity in cardiovascular diseases in Vojvodina].

Cardiovascular diseases in Vojvodina are characterised by high morbidity, mortality, apsenteism and invalidism. This epidemiological picture has been present for a very long time, showing the trend to constant increase. The follow-up of absolute values of out-patients' morbidity from cardiovascular diseases in general, and especially from ischaemic heart disease, over the period from 1971 to 1985, it was established that there was a certain regular development which could be identified by a logistic curve, i.e. the highest values dominated in the middle-of the period and the lower at the beginning and the end of the study. This presumption was also confirmed by regression analysis of morbidity oscillations in the period from 1961 and 1969 to 1985.

Cardiovascular Diseases↗
PubMed1998

Cardiovascular disease and use of oral and injectable progestogen-only contraceptives and combined injectable contraceptives. Results of an international, multicenter, case-control study. World Health Organization Collaborative Study of Cardiovascular Disease and Steroid Hormone Contraception.

This report describes the first study to evaluate the risks of cardiovascular disease (CVD) associated with the use of oral and injectable progestogen-only and combined injectable contraceptives. Based on combined data from Africa, Asia, Europe, and Latin America collected in the World Health Organization (WHO) Collaborative Study, odds ratios (OR) for CVD combined, strokes, venous thromboembolism (VTE), and acute myocardial infarction (AMI) were calculated. Among 3697 CVD cases (59% stroke, 31% VTE, and 10% AMI), 53, 37, and 13 women, respectively, were current users of oral and injectable progestogen-only and combined injectable contraceptives. Overall, the adjusted OR for all CVD combined compared with nonusers of any type of steroid hormone contraceptive (SHC) associated with current use of oral and injectable progestogen-only contraceptives and combined injectable contraceptives, respectively, were 1.14 (95% CI: 0.79-1.63), 1.02 (0.68-1.54), and 0.95 (0.49-1.86). No significant changes in OR were apparent for strokes, VTE, or AMI in association with any of these types of contraception. However, a small, nonsignificant increase in OR for VTE was apparent in association with oral and injectable progestogen-only contraceptives. Among women with a history of hypertension, OR for stroke, as compared with that for nonusers of any type of SHC with no history of hypertension, rose from 7.2 (6.1-8.5) among nonusers of any type of SHC to 12.4 (4.1-37.6) among current users of all oral progestogens. Although limited by the small number of cases and control subjects using the types of contraceptives under investigation, these data suggest that there is little or no increased risk of stroke, VTE, or AMI associated with the use of oral or injectable progestogen-only or combined injectable contraceptives. However, further investigation into a possible adverse effect on stroke risk of progestogen-only contraceptives used by women with a history of high blood pressure are indicated.

Adolescent↗
PubMed2001

The treatment of coronary heart disease: an update. Part 1: An overview of the risk factors for cardiovascular disease.

Cardiovascular disease (CVD) is the main cause of death. Atherosclerosis of coronary arteries is responsible for almost all cases of CVD. The term 'risk factor' describes all those characteristics found in healthy individuals that are independently related to subsequent development of CVD. It includes modifiable biochemical and physiological characteristics, such as hypercholesterolaemia, hypertension, cigarette smoking, diabetes mellitus, obesity and low HDL cholesterol levels, as well as non-modifiable personal characteristics, such as age, gender and family or personal history of early onset CVD. In addition to the 'classic' risk factors mentioned above, several other variables have been implicated as predictors of CVD: left ventricular hypertrophy; infectious agents; markers of inflammation; oxidative stress; and increased levels of fibrinogen, triglycerides, homocysteine and Lp(a)]. However, controversy exists regarding the exact role of these variables in the pathogenesis of atherosclerosis. Furthermore, there are no conclusive data showing that the modification of these variables is associated with a decrease in the incidence of cardiovascular events. Nevertheless, these 'new' risk factors should be taken into account in patients with CVD without established risk factors.

Biomarkers↗
PubMed2003

Cardiovascular disease in postmenopausal women.

Cardiovascular disease is a major cause of death in both sexes. Women suffer almost as many myocardial infarctions as men, although they tend to occur at a greater age. Prevention programs for heart disease have impacted more positively on men than women and relatively young women aged 35-54 years may have fared worse. Hypertension is more prevalent amongst younger men than women, but above 65 years of age it becomes more common in women. Adequate treatment of hypertension has many rewards, but is only received by a minority of hypertensives. Heart failure, too, is a major burden of cardiovascular disease, particularly in older women. Approximately 30% of all cardiac surgery is performed on women, who have a worse short-term postoperative prognosis than men, although the two sexes fare equally in long-term survival. Hypertension, heart failure and diabetes have been identified as key preoperative factors determining a poorer prognosis for cardiac surgery amongst women. The renin-angiotensin-aldosterone system is thought to be central to the development of cardiovascular disease, with elevated levels of angiotensin II hypothesized as the factor which stimulates the formation of large insulin-resistant adipocytes, en route to diabetes. At the cellular level, estrogens have many effects on cardiovascular cells capable of being interpreted as beneficial in terms of cardiovascular disease. New studies demonstrate that approximately 5% of proteins produced by human myocardial cells are modulated by estrogens, estrogens receptors are modulated by age and disease, and estrogens modulate expression of receptors for endothelin-1, a neurohormone implicated in cardiovascular disease.

Adult↗
PubMed2006

Implications of chronic kidney disease for dietary treatment in cardiovascular disease.

Chronic kidney disease (CKD) often accompanies cardiovascular disease (CVD). Trends foretelling a greater burden of CKD and CVD are largely a result of increasing frequencies of obesity, hypertension, and diabetes. Nutritional therapy occupies a critical role in reducing risk factors and preventing progressive damage to the kidneys and heart. Nutritional assessment and treatment should take into account both health concerns. This review examines several diet components and eating styles for efficacy in the treatment of these conditions. A variety of dietary regimens claim to provide health benefits, but rigorous scientific validation of long-term efficacy is frequently lacking. An urgent need exists for eating styles that reduce risk of chronic diseases and that are acceptable and achievable in free-living populations. We describe our ongoing study, a randomized controlled trial comparing the American Heart Association Step II diet and a Mediterranean diet, in survivors of a first myocardial infarction. The primary end point is a composite of mortality and major CVD events. Because many in this population have CKD, indicators of kidney damage and function are prespecified secondary end points. Results of this trial should provide insight into optimal dietary interventions for persons with both CVD and CKD.

Cardiovascular Diseases↗
PubMed2006

Molecular basis of obesity and the risk for cardiovascular disease.

Atherosclerosis and cardiovascular disease (CVD) are the main causes of death in the Western world, for both men and women. The onset and development of diseases of the cardiovascular and cerebrovascular system are strongly dependent on multiple risk factors that promote pathologic conditions like atherosclerosis, hypertension and thrombosis. Besides genetic factors also environmental influences such as diet composition are known to be closely related to CVD. In this context obesity has been postulated as an independent cardiovascular risk factor. Data from the Framingham Heart Study have consistently shown that increasing degrees of obesity are accompanied by greater rates of CVD. At present, obesity affects 10-35% of the European and US population and increases steadily. As obesity is a serious health problem which promotes metabolic abnormalities (insulin resistance, hyperinsulinemia and dyslipidemia) and dramatically increases the risk for CVD, this review will focus on the epidemiologic and genetic background of obesity. Furthermore, the molecular mechanisms involved in obesity development and their contribution to CVD will be discussed.

Adipose Tissue↗
PubMed1995

Methods of assessing prevalent cardiovascular disease in the Cardiovascular Health Study.

The objective of this article is to describe the methods of assessing cardiovascular conditions among older adults recruited to the Cardiovascular Health Study (CHS), a cohort study of risk factors for coronary disease and stroke. Medicare eligibility lists from four US communities were used to obtain a representative sample of 5201 community-dwelling elderly, who answered standardized questionnaires and underwent an extensive clinic examination at baseline. For each cardiovascular condition, self-reports were confirmed by components of the baseline examination or, if necessary, by a validation protocol that included either the review of medical records or surveys of treating physicians. Potential underreporting of a condition was detected either by the review of medical records at baseline for other self-reported conditions or, during prospective follow-up, by the investigation of potential incident events. For myocardial infarction, 75.5% of the self-reports in men and 60.6% in women were confirmed. Self-reported congestive heart failure was confirmed in 73.3% of men and 76.6% of women; stroke, in 59.6% of men and 53.8% of women; and transient ischemic attack, in 41.5% of men and 37.0% of women. Underreporting was also common. During prospective follow-up of an average of about 3 years per person, approximately 50% of men and 38% of women were hospitalized or investigated for at least one potential incident event; for each cardiovascular condition, about 1 to 4% of those investigated during prospective follow-up were found to have had the cardiovascular condition prior to entry into the cohort.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗