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At least 577 records · Page 32Linked to original sources
PubMed2004

Kidney transplantation halts cardiovascular disease progression in patients with end-stage renal disease.

Morbidity and mortality from cardiovascular disease have a devastating impact on patients with chronic kidney disease (CKD) and end-stage renal disease. Renal function decline in itself is thought to be a strong risk factor for cardiovascular disease (CVD). In this study, we investigated the hypothesis that the elevated CV mortality in kidney transplant patients is due to the preexisting CVD burden and that restoring renal function by a kidney transplant might over time lower the risk for CVD. We analyzed 60,141 first-kidney-transplant patients registered in the USRDS from 1995 to 2000 for the primary endpoint of cardiac death by transplant vintage and compared these rates to all 66813 adult kidney wait listed patients by wait listing vintage, covering the same time period. The CVD rates peaked during the first 3 months following transplantation and decreased subsequently by transplant vintage when censoring for transplant loss. This trend could be shown in living and deceased donor transplants and even in patients with end-stage renal disease secondary to diabetes. In contrast, the CVD rates on the transplant waiting list increased sharply and progressively by wait listing vintage. Despite the many mechanisms that may be in play, the enduring theme underlying rapid progression of atherosclerosis and cardiovascular disease in renal failure is the loss of renal function. The data presented in this paper thus suggest that the development or progression of these lesions could be ameliorated by restoring renal function with a transplant.

Adolescent↗
PubMed2000

Dietary supplements and cardiovascular disease.

Consumer use of dietary supplements has increased considerably in recent years, and interest in using supplements to treat or prevent chronic diseases such as cardiovascular disease is particularly high. This review examines several popular dietary supplements used for cardiovascular disease, their likely points of intervention, and what is known to date about their efficacy and safety.

Cardiovascular Diseases↗
PubMedDate not supplied

Clinical epidemiology of cardiovascular disease in chronic kidney disease prior to dialysis.

Cardiovascular disease (CVD) remains the leading cause of morbidity and mortality in patients with end-stage renal disease (ESRD). Both in dialysis and in transplant patients, CVD remains the leading cause of death. There is accumulating evidence that the increase in CVD burden is present in patients prior to dialysis, due to both conventional risk factors as well as those specific to kidney disease. Of importance is that even in patients with mild kidney disease, the risk of cardiovascular events and death is increased relative to patients without evidence of kidney disease. The new classification system proposed by the National Kidney Foundation as part of the Dialysis Outcomes Quality Initiative (DOQI) process describes the five stages of kidney disease, as well as those complications associated with chronic kidney disease (CKD), in particular cardiovascular risk factors and disease. Patients with kidney disease are deemed to be at highest cardiovascular risk. CVD, defined as the presence of either congestive heart failure (CHF), ischemic heart disease (IHD), or left ventricular hypertrophy (LVH), is prevalent in cohorts with established CKD (8-40%). The prevalence of hypertension, a major risk factor for coronary artery disease (CAD) and LVH is high in patients with CKD (87-90%). At least 35% of patients with CKD have evidence of an ischemic event (myocardial infarction or angina) at the time of presentation to a nephrologist. The prevalence of LVH increases at each stage of CKD, reaching 75% at the time of dialysis initiation, and the modifiable risk factors for LVH include anemia and systolic blood pressure, which are also worse at each stage of kidney disease. Even under the care of nephrologists, a change in cardiac status (worsening of heart failure or anginal symptoms) occurs in 20% of patients. The presence of CVD predicts a faster decline of kidney function and the need for dialysis, after controlling for all other factors including glomerular filtration rate (GFR), age, and the presence of LVH. This article describes the new classification system for staging of CKD, defines and describes CVD in CKD, and reviews the evidence and its limitations with respect to the current understanding of CKD and CVD. Specifically, methodologic issues related to survival and referral bias limit our current understanding of the complex interaction of conventional and nonconventional kidney disease-specific risk factors. We identify the importance of well-conducted studies of patient groups with and without CVD, with and without CKD, in order to better understand the complex physiology so that treatment strategies can be appropriately applied.

Cardiovascular Diseases↗
PubMed2006

Postmenopausal hormone therapy and cardiovascular disease: an overview of main findings.

Cardiovascular disease has emerged as a leading cause of death in women. In recent years, significant attention has been paid to the potential benefits of hormone therapy on chronic diseases such as cardiovascular disease. Large prevention trials failed to confirm the cardioprotective effect of estrogen. The divergent findings from observational and randomized clinical studies are summarized and reasons for the different results are postulated. Use of estrogen alone or estrogen opposed with progestins is not indicated for the prevention of cardiovascular disease and may even increase the risk of stroke. Oral estrogen increases venous thromboembolism events. Recent data suggest that transdermal estrogens are safe with respect to venous thromboembolism. Current data have limited ability to investigate the wide variety of hormone treatments available. Clinical research should be continued to assist patients and clinicians in making treatment decisions on the basis of an individual's benefits and risks.

Arteries↗
PubMed1990

High density lipoprotein cholesterol as a predictor of cardiovascular disease mortality in men and women: the follow-up study of the Lipid Research Clinics Prevalence Study.

With data from the Lipid Research Clinics Prevalence Study used as a baseline, an average of 8.4 years of mortality follow-up has been completed for 8,825 male and female participants who were at least 30 years of age at the time of the study. The participants were examined at 10 North American sites during 1972-1976. Univariate findings for high density lipoprotein (HDL) cholesterol in the 7,569 persons initially free of coronary heart disease indicate an inverse relation with cardiovascular disease mortality for men and women. Controlling for age, low density lipoprotein (LDL) cholesterol, triglycerides, body mass index, systolic blood pressure, and smoking, multivariate analysis results indicate inverse relations between HDL cholesterol and cardiovascular disease mortality. In men, the cardiovascular disease mortality rate ratio for HDL cholesterol increments of 10 mg/dl was similar to the cardiovascular disease mortality rate ratio for LDL cholesterol increments of 30 mg/dl. In women, HDL cholesterol is more closely related to cardiovascular disease than is LDL cholesterol. HDL cholesterol is inversely related to both coronary heart disease and other cardiovascular disease mortality in both sexes, though the relation of HDL cholesterol with coronary heart disease mortality in women approached statistical significance only for the combined end point of suspect and definite cases. No relation was observed in either sex group between HDL cholesterol and noncardiovascular disease mortality. This study, only the second large prospective study evaluating the role of HDL cholesterol in women, confirms both the importance and the independence in both men and women of HDL cholesterol in the epidemiology of coronary heart disease and other cardiovascular disease mortality.

Adult↗
PubMed1998

Plasma triglyceride as a risk factor for cardiovascular disease.

OBJECTIVES: To determine whether cardiovascular disease can be predicted from plasma triglyceride levels independent of high density lipoprotein (HDL) cholesterol levels. DATA SOURCES AND STUDY SELECTION: Seventeen prospective population-based studies, ranging in publication date from 1965 to 1994, were selected based on uniform criteria. Among the studies, 16 were conducted in men, comprising data for more than 46,000 men, with an average follow-up period of more than eight years. The data from women came from five studies, including nearly 11,000 women with an 11-year average follow-up. DATA EXTRACTION: The meta-analysis protocol comprised the following steps: estimating the relative risk of triglyceride for each individual study; standardizing the relative risks to a 1 mmol/l increase; estimating the variance and weighting relative risks by the inverse of the variance, and estimating the summary relative risk by averaging the weighted relative risks. DATA SYNTHESIS: Among studies of men, relative risks ranged from 1.1 to 2.0, and the summary relative risk was 1.32 (P < 0.05). All five studies of women were statistically significant, with relative risks ranging from 1.7 to 2.0. The summary relative risk was 1.76, higher than that for men, indicating a 76% increase in risk for women. For the studies among men in which HDL cholesterol data were available, multivariate adjusted relative risk was attenuated to 1.14 but was still statistically significant. Although only two studies of women included HDL cholesterol adjustments, the summary relative risk for triglyceride remained statistically significant, with a value of 1.37. CONCLUSIONS: When all available data are taken into account, increased triglyceride level is a risk factor for cardiovascular disease, independent of HDL cholesterol level. Clinical trials are urgently needed to determine whether lowering plasma triglyceride levels reduces subsequent risk of cardiovascular disease.

Cardiovascular Diseases↗
PubMed1993

Risk factors for cardiovascular disease after renal transplantation.

The incidence of cardiovascular disease is high after renal transplantation. Risk factors include pretransplant cardiovascular disease, diabetes, male sex, serum cholesterol, hypertension, cigarette smoking, and allograft dysfunction. Prevention of cardiovascular disease can probably best be approached by modifying multiple risk factors. Thus, efforts should be made to identify and treat patients with severe coronary artery disease before transplantation. After transplantation, hypertension and hyperlipidemia should be treated, and efforts should be made to help patients abstain from smoking. Chronic immunosuppression protocols should attempt to balance the need to prevent allograft rejection with the known adverse effects of immunosuppressive agents on cardiovascular disease. Altogether, an aggressive, coordinated program to modify multiple risk factors is probably the best approach to the prevention of cardiovascular disease after renal transplantation.

Cardiovascular Diseases↗
PubMed1978

CARDIOVASCULAR DISEASE: PREVENTION AND REHABILITATION.

Cardiovascular related diseases are the major cause of death in the United States. The primary goal of the physician should be prevention of these diseases; however, once problems occur, a definitive rehabilitation program must be instituted in addition to the medical and surgical treatment. Although risk factors for the development of cardiovascular disease are numerous, statistical reports suggest that control of these factors might delay or prevent such development. This presentation describes the recommended Physical Medicine and Rehabilitation Program for high-risk patients or those with existing cardiovascular disease. The basis of the physical fitness and rehabilitation program is controlled progression-of-energy-expenditure physical activity and exercise in metabolic equivalents (METS). Education plays a key role in decreasing the incidence of cardiovascular disease, and should start at an early age. Adults at high risk of developing cardiovascular disease should be offered medically supervised physical fitness exercise programs, with monitoring where necessary.

Journal Article↗
PubMed2000

Gene expression profiling of cardiovascular disease models.

Recent development of gene expression profiling technologies has enabled the large-scale analysis of gene expression changes during disease progression. Frequently, cardiovascular diseases involve complex interactions of multiple cell types over prolonged periods of time. A better understanding of the pathology of cardiovascular diseases and the potential identification of underlying genetic defects are currently being explored by using profiling methodologies in a number of animal and tissue-culture models.

Animals↗
PubMed1995

[Tricyclic antidepressants in depressed patients with cardiovascular diseases: a contraindication?].

Depressive disorder and cardiovascular diseases occur quite frequently together in the same patient, especially in older patients. On the one hand depressions can increase the risk of cardiovascular diseases, on the other hand cardiac disease can lead to depressive disorders in need of treatment. Thus the problem of prescribing tricyclics for patients with cardiovascular diseases is of great clinical relevance. In our review we summarize first of all the important cardiovascular effects of tricyclics in healthy persons and patients with cardiovascular diseases. Indications and (relative) contraindications for this medication with respect to cardiovascular disorders and proposals for diagnostic procedures in the beginning and during the course of antidepressant medication are following. Finally we present some recommendations for the treatment of tricyclic-induced side effects.

Antidepressive Agents, Tricyclic↗
PubMed1998

Plasma homocysteine is related to albumin excretion rate in patients with diabetes mellitus: a new link between diabetic nephropathy and cardiovascular disease?

The high risk of cardiovascular disease in patients with diabetes mellitus, particularly in those with nephropathy, is not completely explained by classical risk factors. A high plasma homocysteine concentration is an independent risk factor for cardiovascular disease but information on its association with diabetes is limited. Fasting homocysteine concentrations were measured in the plasma of 165 diabetic patients (75 with insulin-dependent [IDDM]; 90 with non-insulin-dependent diabetes [NIDDM]) and 56 non-diabetic control subjects. Other measurements included the prevalence of diabetic complications, glycaemic control, lipid and lipoprotein levels, vitamin status and renal function tests. Patients with NIDDM had higher homocysteine levels than control subjects, whereas IDDM patients did not (9.2 +/- 4.5 vs 7.7 +/- 2 micromol/l, p < 0.01; and 7.0 +/- 3 vs 7.4 +/- 2 micromol/l, NS). Univariate correlations and multiple regression analysis showed albumin excretion rate to be the parameter with the strongest independent association with homocysteine. Patients with both types of diabetes and nephropathy had higher plasma homocysteine concentrations than those without nephropathy. Increases of homocysteine in plasma were related to increases in the severity of the nephropathy. Fasting hyperhomocysteinaemia was considered as the mean of the plasma homocysteine for all control subjects (7.5 +/- 2.1 micromol/l) + 2 SD (cut-off = 11.7 micromol/l). Nephropathy was present in 80 % of diabetic patients with fasting hyperhomocysteinaemia. In conclusion, increases in fasting homocysteine in diabetic patients are associated with increased albumin excretion rate, especially in those with NIDDM, thus providing a potential new link between microalbuminuria, diabetic nephropathy and cardiovascular disease.

Adult↗
PubMedDate not supplied

Safety issues in pharmacotherapy for smoking in patients with cardiovascular disease.

Twenty percent of patients with cardiovascular disease smoke, and smoking cessation results in a dramatic decline in the relative risk of future cardiovascular events. Questions regarding the safety of nicotine-replacement therapy and bupropion SR for smoking cessation in patients with cardiovascular disease have arisen, in particular because of potential hemodynamic effects of these agents. There have been several randomized, controlled, clinical trials testing the safety of transdermal nicotine in patients with cardiovascular disease that failed to show an increased risk for cardiac events in active treatment conditions compared with placebo. Efficacy trials conducted in other patient populations also support the safety of nicotine-replacement use in cardiac disease patients. To date there is one randomized controlled trial to test bupropion for smoking cessation conducted in this population. Studies to test the efficacy of bupropion for smoking cessation and depression suggest it is safe to use in cardiac disease patients despite recent case reports of adverse events associated with bupropion use. Nicotine-replacement therapy and bupropion significantly increase long-term smoking cessation rates, and the benefits of cessation exceed the risks for pharmacotherapy in patients with cardiovascular disease.

Antidepressive Agents, Second-Generation↗
PubMed1984

Trends in cardiovascular diseases mortality in the Philippines.

Cardiovascular disease mortality in the Philippines was studied from the existing vital statistics for 1963-76. Death rates from rheumatic fever and rheumatic heart disease remained unchanged, those for cerebrovascular diseases decreased, whereas mortality rates of ischaemic heart disease (IHD) and hypertensive disease (HPN) increased enormously both in men and women. This increase in IHD and HPN mortality was seen in all age groups. The age-standardized IHD mortality rate in men rose from 33.3 in 1964 to 78.0 in 1976, and that of women from 15.4 to 34.5. The age-standardized HPN mortality rate in men rose from 21.0 in 1964 to 45.6 in 1976, and that of women from 15.6 to 25.5. The male to female ratios in the age-standardized death rates for IHD, HPN and also for all causes increased during this 12-year period. Age-standardized all causes mortality increased clearly in the male population but decreased in the female population of the Philippines. This excess mortality in males is mostly due to the increased cardiovascular disease death rate. This is a clear example of how chronic non-communicable diseases are becoming major health problems in countries where they previously have not been prevalent. Immediate preventive measures are needed in order to control cardiovascular diseases in these countries where disease rates are rapidly increasing.

Adult↗
PubMed1998

[Iodine deficiency in cardiovascular diseases].

The thyroid hormone deficiency on cardiovascular function can be characterized with decreased myocardial contractility and increased peripheral vascular resistance as well as with the changes in lipid metabolism. 42 patients with cardiovascular disease (mean age 65 +/- 13 yr, 16 males) were investigated if iodine insufficiency can play a role as a risk factor for the cardiovascular diseases. The patients were divided in 5 subgroups on the ground of the presence of hypertension, congestive heart failure, cardiomyopathy, coronary disfunction and arrhythmia. Urine iodine concentration (5.29 +/- 4.52 micrograms/dl) was detected with Sandell-Kolthoff colorimetric reaction. The most decreased urine iodine concentration was detected in the subgroups with arrhythmia and congestive heart failure (4.7 +/- 4.94 micrograms/dl and 4.9 +/- 4.81 micrograms/dl, respectively). An elevated TSH level was found by 3 patients (5.3 +/- 1.4 mlU/l). An elevation in lipid metabolism (cholesterol, triglyceride) associated with all subgroups without arrhythmia. In conclusion, the occurrence of iodine deficiency in cardiovascular disease is frequent. Iodine supplementation might prevent the worsing effect of iodine deficiency on cardiovascular disease.

Aged↗
PubMed2003

[Serum homocysteine in children and adolescents. Relation with family history of cardiovascular disease].

BACKGROUND: Hyperhomocysteinemia is an independent cardiovascular risk factor that depends on folate and vitamin B12 nutrition. AIM: To measure homocysteine, folic acid and vitamin B12 serum levels in healthy children with and without a family history of cardiovascular disease. SUBJECTS AND METHODS: Forty children aged 6 to 15 years with a family history of cardiovascular disease, and 40 age and sex matched children without such history were studied. Serum homocysteine, folic acid and vitamin B12 were measured in a fasting blood sample. Homocysteine was measured by a fluorescence polarization immunoassay (FPIA), vitamin B12 by enzymatic microparticle assay, covered with intrinsic factor and folic acid by ionic capture, using commercial kits. RESULTS: Children with family history of cardiovascular disease had higher homocysteine levels than their counterparts without family history (7.9 +/- 3 and 5.8 +/- 2 mumol/l respectively, p < 0.03), but similar folic acid (5.2 +/- 1.8 and 5.5 +/- 1.4 pg/ml respectively) and vitamin B12 levels (431 +/- 213 and 445 +/- 209 ng/ml respectively). There was a negative and significant correlation between homocysteine and folic acid and vitamin B12 levels. CONCLUSIONS: Children with a family history of cardiovascular disease have higher levels of serum homocysteine than those without such history, despite having similar levels of folic acid and vitamin B12.

Adolescent↗