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PubMed2004

Fetal and childhood onset of adult cardiovascular diseases.

Childhood onset of adult cardiovascular disease has become a significant public health problem. Whether genetic, environmental, or fetal influences are the primary culprits in the epidemic of the cardiovascular disease seen today remains unknown. The benefits of an overall physically active lifestyle that includes weight control, lower blood pressure, avoidance of tobacco use, and consistent exercise are clear and can impact the overall health of children and adolescents. Physicians who care for children and adolescents must begin to incorporate screening of adult cardiovascular disorders into their practice. Better understanding of the etiology of these disease states will bring with it enhanced preventive and targeted therapies.

Adolescent↗

PubMed2000

[Genetic predisposition to cardiovascular diseases].

The development of cardiovascular system disorders depends on both environmental and genetic factors. Precise mechanism by which genetic factors may promote atherosclerotic lesion formation is still under investigation. From multiple candidate genes for cardiovascular disorders the special attention should be paid to that which control synthesis of molecules involved in atherosclerosis process. For now lots of experiments have been done to test specific genes speculated to be crucial for the onset and progression of atherosclerosis, including genes of lipoprotein metabolism, coagulation and fibrinolysis system, renin-angiotensin system and substances influencing the metabolism of arterial wall. Many of them showed the association between tested polymorphisms and pathogenesis of cardiovascular diseases.

Blood Coagulation↗

PubMed1996

Economic impact of cardiovascular disease in Canada.

OBJECTIVE: To estimate the total cost of cardiovascular disease in Canada. DESIGN: Prevalence-based study estimating disease-related costs generated by individuals with cardiovascular disease in 1994, from a societal viewpoint. The human capital approach was used to estimate the value of lost productivity due to illness. SETTING: Canada. OUTCOME MEASURES: First, direct costs, in terms of expenditures on hospital care, other institutions, physician services, other health professionals, drugs, research and other items; and second, indirect costs, in terms of lost productivity due to premature mortality or disability. MAIN RESULTS: The total cost of cardiovascular disease was $18.0 billion in 1994, with direct and indirect cost components at $10.4 and $7.6 billion, respectively. Based on the sensitivity analysis, the lower and upper bounds were $14.1 and $20.4 billion, respectively. CONCLUSIONS: This study highlights the scope and magnitude of cardiovascular disease through its economic consequences. While the figures calculated herein do not give an indication of the appropriateness of current health expenditures on cardiovascular disease, they provide guidance in the setting of national priorities for research and prevention activities.

Canada↗

PubMed1993

The changing pattern of cardiovascular diseases in China.

In China, morbidity and mortality attributable to cardiovascular disease increased rapidly from the 1950s to the 1980s due to an increased life expectancy and changes in lifestyle. Cardiovascular disease has become the leading cause of death in the country. There is a high incidence of stroke, which is the commonest or second commonest cause of death. Hypertension, the main risk factor for stroke and an important risk factor for coronary heart disease, is the most prevalent cardiovascular disease, and should be given first priority in control programmes. Smoking, a common habit in males, is to be a principal focus of preventive activities over the next few years. Between 1970 and 1990, several community programmes for the prevention and control of cardiovascular diseases were established. The WHO MONICA Project has developed standardized methodologies that are used to establish systems for monitoring and evaluating control programmes. There is an urgent need to develop a long-term national strategy for the management and control of cardiovascular diseases.

Adult↗

PubMed1996

[Prevention of cardiovascular diseases by hormone replacement in postmenopause].

Cardiovascular disease is the most important cause of death even among women. After menopause there is a steep increase in risk factors like LDL-cholesterol and lipoprotein (a) as well as the incidence of hypertension and diabetes mellitus. This is followed by a rise especially in coronary artery disease. Therefore women too have to be included in prevention programs for cardiovascular disease by normalizing risk factors. One means is hormone replacement therapy. Estrogens lower LDL-cholesterol by up to 20% and increase HDL-cholesterol up to 30%. This effect remains even after addition of a suitable progestin. Numerous large scale studies indicate that every other cardiovascular death can be prohibited by the simple measure of hormone replacement therapy. Because of the high rate of cardiovascular disease low incidences of adverse events cannot prevent the marked decrease in total mortality.

Adult↗

PubMed2003

Depression and cardiovascular disease: mechanisms of interaction.

This article explores the relationship between depression and cardiovascular disease from a mechanistic standpoint. Depression and cardiovascular disease are two of the most prevalent health problems in the United States and are the two leading causes of disability both in the United States and worldwide. Although depression is a known risk factor for the development of cardiovascular disease, as well as an independent predictor of poor prognosis following a cardiac event, the mechanistic relationship between the two remains unclear. Depression is associated with changes in an individual's health status that may influence the development and course of cardiovascular disease, including noncompliance with medical recommendations, as well as the presence of cardiovascular risk factors such as smoking and hypertension. In addition, depression is associated with physiologic changes, including nervous system activation, cardiac rhythm disturbances, systemic and localized inflammation, and hypercoagulability, that negatively influence the cardiovascular system. Further, stress may be an underlying trigger that leads to the development of both depression and cardiovascular disease. This article reviews seven potential mechanisms for the relationship between depression and cardiovascular disease and presents the available evidence surrounding each mechanism. Finally, future directions for research are discussed.

Adrenal Glands↗

PubMed1988

[Cardiovascular diseases: a medical and social problem].

Cardiovascular diseases are still the most important cause of death in industrialized countries. In spite of enormous progress regarding prevention, diagnostic and therapeutic procedures, coronary heart disease remains the most important cardiovascular cause for early invalidity, professional inactivity and premature death. The direct and indirect costs of cardiovascular diseases amount to 14.8% of total disease related costs. The future challenges are clear: this disease group is to a large extent preventable; efficient intervention models both on an individual and on a community level are available. Still, some more research on etiology, e.g. in relation to social class gradients is needed. In addition, the disease and its role within society and the health care structure should also be subject to research.

Cardiovascular Diseases↗

PubMed1992

Approaches to gene therapy of complex multigenic diseases: cancer as a model and implications for cardiovascular disease and diabetes.

The general concept of gene therapy is now well established and accepted by the medical, scientific and public policy communities, and is rapidly being implemented in human experimental studies. In addition to the initial models of single gene defects, target diseases have now come to include multigenic and multifactorial diseases such as human cancer, neurodegenerative diseases such as Parkinson's disease and firms of cardiovascular disease. While many conceptual and technical obstacles must still be overcome before therapy for disorders such as coronary artery disease and diabetes mellitus will easily be approached at the genetic level, the early results with several multigenic disease models gives some cause for optimism that gene therapies for even those complicated disorders will eventually become available.

Animals↗

PubMedDate not supplied

Evaluating South Carolina's community cardiovascular disease prevention project.

A community cardiovascular disease prevention program was undertaken as a cooperative effort of the South Carolina Department of Health and Environmental Control and the Centers for Disease Control of the Public Health Service. As part of the evaluation of the project, a large scale community health survey was conducted by the State and Federal agencies. The successful design and implementation of the survey, which included telephone and in-home interviews as well as clinical assessments of participants, is described. Interview response rates were adequate, although physical assessments were completed on only 61 percent of those interviewed. Households without telephones were difficult and costly to identify, and young adults were difficult to locate for survey participation. The survey produced baseline data for program planning and for measuring the success of ongoing intervention efforts. Survey data also have been used to estimate the prevalence of selected cardiovascular disease risk factors.

Adolescent↗

PubMed1985

[Statistical study of the risk of cardiovascular disease in hysterectomized patients].

The risk of atherosclerotic or hypertensive cardiovascular disease increases after physiological or surgical menopause, irrespective of whether or not the ovaries are removed. In order to evaluate the direct contribution of the uterus in cutting down the incidence of cardiovascular diseases, the clinical records of 1551 cardiovascular patients and 296 healthy women were examined. All subjects were divided into 8 different groups according to their age. The following data were considered: 1) the incidence of cardiovascular diseases; 2) the number of subjects in physiological or surgical menopause; 3) the number of women hysterectomised in premenopause; 4) the number of women who underwent hysterectomy and bilateral salpingo-oophorectomy in premenopause; 5) the number of women who underwent either operation before or after the menopause. It was found that both in hysterectomised and not hysterectomised women the hypertensive and ischaemic cardiovascular pathologies prevailed in the younger and older groups respectively. Among the patients with cardiovascular diseases the percentage of subjects who had undergone hysterectomy or hysterectomy with bilateral oophorectomy was significantly higher (p less than 0.05) than in the controls. The difference was particularly marked in the younger groups. These data indicate that when the uterus is properly stimulated by the oestrogens, is able to produce a protective factor against cardiovascular diseases. It has been suggested that this factor may be prostacyclin, a potent vasodilator and the most potent inhibitor of platelet aggregation yet discovered. The epidemiological evidence alone that premenopausal hysterectomy increases the risk of cardiovascular disease should be an important consideration in weighing the risks and benefits of the procedure. If the epidemiological data can be supported by a definite mechanism of action via prostacyclin, then current indications for hysterectomy must be carefully reconsidered.

Adult↗

PubMed1998

[Molecular genetics of cardiovascular diseases].

This review introduces recent progress in molecular genetics of cardiovascular diseases. Many genes and their mutations causing familial cardiovascular diseases have been discovered, including familial hypertrophic cardiomyopathy which is caused by mutated cardiac beta myosin heavy chain, light chains, troponin T, troponin I, or alpha-tropomyosin, and long QT syndrome by KvLQT1, HERG, minK or cardiac voltage-dependent Na channel mutation. The mutations in causative genes can affect clinical courses of diseases; amino acid substitutions of cardiac beta myosin heavy chain with charge changes seem to cause poorer prognosis of hypertrophic cardiomyopathy. Besides monogenic diseases, there are many cardiovascular diseases affected with genetic polymorphisms, such as hypertension, ischemic heart disease and atherosclerosis. Specific amino acid mutations or polymorphisms in the promoter region of the genes are known to become a risk factor of these diseases. Polymorphisms of genes encoding apolipoprotein E, angiotensin converting enzyme, angiotensinogen and endothelial NO synthase (ecNOS) have been well characterized as an important risk factor of cardiovascular diseases. We recently found a novel gene which seems to affect human aging phenotype and vascular endothelial function. It is important as a future study to clarify the regulatory mechanisms of the klotho gene in the cardiovascular system and the clinical significance of klotho gene polymorphisms.

Amino Acids↗

PubMed2005

Cardiovascular diseases in Croatia and other transitional countries: comparative study of publications, clinical interventions, and burden of disease.

AIM: To determine the number of publications on cardiovascular diseases in the MEDLINE database, the rate of medical doctors and clinical interventions in cardiology, and health and socioeconomic indicators for Croatia, and to compare them with those for Slovenia, Hungary, the Czech Republic, and Austria. METHODS: PubMed was used in search for publications on cardiovascular diseases published in 1991-2004. Rates per million population and proportions of publications on cardiovascular diseases in the MEDLINE database were calculated. Gross domestic product (GDP) per capita was used as a socioeconomic indicator, whereas human resources in medicine were presented as the rate of medical doctors per million population. Standardized death rates from cardiovascular diseases and ischemic heart disease were used as indicators of cardiovascular health. Clinical interventions in cardiology, such as coronary angiograms, percutaneous transluminal coronary angioplasties (PTCA), and coronary bypass surgeries (CABG) were expressed per million population per year. RESULTS: Croatia had the lowest GDP per capita among the analyzed countries. The standardized death rate from cardiovascular diseases in Croatia was 91.7 per 100,000 population aged 0-64 in 2001, which was higher than that in Slovenia and Austria (P<0.001), similar to that in the Czech Republic, and lower than that in Hungary (P<0.001). Cardiovascular scientific output in Croatia was the lowest among investigated countries, ie, 1.1 per million population in 2003 (P<0.001). Despite a significantly lower number of medical doctors in comparison with Hungary and the Czech Republic (P<0.001), Croatia experienced a similar increment in the amount of clinical interventions in cardiology. CONCLUSION: In contrast to high cardiovascular mortality rates, cardiovascular scientific production in Croatia was significantly lower than in other investigated countries. A positive trend in cardiovascular medicine was recorded in clinical practice, but has yet to be followed by scientific production.

Adolescent↗

PubMed2000

Atherosclerotic cardiovascular disease risks in chronic hemodialysis patients.

BACKGROUND: Cardiovascular diseases are the most common causes of death among chronic hemodialysis patients, yet the risk factors for these events have not been well established. METHODS: In this cross-sectional study, we examined the relationship between several traditional cardiovascular disease risk factors and the presence or history of cardiovascular events in 936 hemodialysis patients enrolled in the baseline phase of the Hemodialysis Study sponsored by the U.S. National Institutes of Health. The adjusted odds ratios for each of the selected risk factors were estimated using a multivariable logistic regression model, controlling for the remaining risk factors, clinical center, and years on dialysis. RESULTS: Forty percent of the patients had coronary heart disease. Nineteen percent had cerebrovascular disease, and 23% had peripheral vascular disease. As expected, diabetes and smoking were strongly associated with cardiovascular diseases. Increasing age was also an important contributor, especially in the group less than 55 years and in nondiabetic patients. Black race was associated with a lower risk of cardiovascular diseases than non-blacks. Interestingly, neither serum total cholesterol nor predialysis systolic blood pressure was associated with coronary heart disease, cerebrovascular disease, or peripheral vascular disease. Further estimation of the coronary risks in our cohort using the Framingham coronary point score suggests that traditional risk factors are inadequate predictors of coronary heart disease in hemodialysis patients. CONCLUSIONS: Some of the traditional coronary risk factors in the general population appear to be also applicable to the hemodialysis population, while other factors did not correlate with atherosclerotic cardiovascular diseases in this cross-sectional study. Nontraditional risk factors, including the uremic milieu and perhaps the hemodialysis procedure itself, are likely to be contributory. Further studies are necessary to define the cardiovascular risk factors in order to devise preventive and interventional strategies for the chronic hemodialysis population.

Adult↗

PubMed2002

Hemoglobin levels, cardiovascular disease, and left ventricular hypertrophy in patients with chronic kidney disease. Case study of the anemic patient.

Cardiovascular disease is the primary cause of morbidity and mortality in patients with chronic kidney disease. Anemia, a well-defined risk factor for cardiovascular disease, has been shown to contribute to the development of angina pectoris, ischemic events, and left ventricular hypertrophy. Data indicate that these cardiovascular-related disorders are often ameliorated or reversed in patients who maintain hemoglobin (Hb) levels in the 11 to 12 g/dL range recommended by NKF-K/DOQI. Conversely, Hb levels below 11 g/dL result in an increase in cardiovascular disorders and a 2.9-fold increased risk of death. Nephrology nurses should understand the interplay between Hb levels and cardiovascular disease, and how their efforts to maintain Hb levels > or = 11 g/dL can positively affect patient outcomes.

Anemia↗

PubMedDate not supplied

Small animal models of cardiovascular disease: tools for the study of the roles of metabolic syndrome, dyslipidemia, and atherosclerosis.

INTRODUCTION: Cardiovascular disease, the leading cause of death in much of the modern world, is the common symptomatic end stage of a number of distinct diseases and, therefore, is multifactorial and polygenetic in character. The two major underlying causes are disorders of lipid metabolism and metabolic syndrome. The ability to develop preventative and ameliorative treatments will depend on animal models that mimic human disease processes. The focus of this review is to identify suitable animal models and insights into cardiovascular disease achieved to date using such models. CRITERIA FOR ANIMAL MODELS: The ideal animal model of cardiovascular disease will mimic the human subject metabolically and pathophysiologically, will be large enough to permit physiological and metabolic studies, and will develop end-stage disease comparable to those in humans. Given the complex multifactorial nature of cardiovascular disease, no one species will be suitable for all studies. AVAILABLE MODELS: Potential larger animal models are problematic due to cost, ethical considerations, or poor pathophysiological comparability to humans. Rabbits require high-cholesterol diets to develop cardiovascular disease, and there are no rabbit models of metabolic syndrome. Spontaneous mutations in rats provide several complementary models of obesity, hyperlipidemia, insulin resistance, and type 2 diabetes, one of which spontaneously develops cardiovascular disease and ischemic lesions. The mouse, like normal rats, is characteristically resistant to cardiovascular disease, although genetically altered strains respond to cholesterol feeding with atherosclerosis, but not with end-stage ischemic lesions. CONCLUSIONS: The most useful and valid species/strains for the study of cardiovascular disease appear to be small rodents, rats, and mice. This fragmented field would benefit from a consensus on well-characterized appropriate models for the study of different aspects of cardiovascular disease and a renewed emphasis on the biology of underlying diseases.

Animals↗

PubMed2002

Stress in cardiovascular diseases.

OBJECTIVE: Evidence for a connection between stress and selected cardiovascular diseases is analyzed. Does stress cause or exacerbate cardiovascular diseases? METHOD: The stress phenomenon is illustrated and the impact of stress on the circulatory system is examined. In particular, the pathophysiological significance of stress in hypertension, atherosclerosis, coronary artery disease, myocardial infarction (and others) is described. RESULTS: Stress plays a major role in various (patho)physiological processes associated with the circulatory system. Thereby, it potentially has ameliorating or detrimental capacities. However, with regard to cardiovascular diseases, stress most often is related to deleterious results. The specific outcome depends on multiple variables (amount of stress, duration of its influence, patient's history/predisposition, genetic components -- as they all may alter functions of the basic stress response components: the hypothalamic-pituitary-adrenal axis and the sympathoadrenal medullary system). CONCLUSIONS: Stress has a major impact upon the circulatory system. It plays a significant role in susceptibility, progress, and outcome of cardiovascular diseases. Subjective or individual differences have also to be taken into account. Stress, especially 'adequate' acute stress - stress that is not 'overwhelming' - may improve performance and thus be beneficial in certain cases. The close relationship between stress and cardiovascular diseases may represent an important aspect of modern medicine. New therapeutic strategies have to be set in place.

Arteriosclerosis↗

PubMed1995

Fibrinogen and factor VIII, but not factor VII, are associated with measures of subclinical cardiovascular disease in the elderly. Results from The Cardiovascular Health Study.

No studies have examined the associations of coagulation factor levels with measures of subclinical cardiovascular disease (CVD) in the elderly. The Cardiovascular Health Study (CHS) is a prospective, population-based cohort study of CVD in persons older than 65 years. At the baseline examination, we measured fibrinogen, factor VII, and factor VIII levels in 5024 of the 5201 participants of the CHS and examined the associations of these coagulation factors with measures of subclinical CVD in a cross-sectional analysis. Subclinical CVD measures were based on electrocardiography, carotid ultrasonography, echocardiography, and ankle-arm blood pressure measurements (AAI). For analyses, we used the full cohort as well as two mutually exclusive subgroups: those with prevalent clinical CVD at baseline and those without. Fibrinogen and to a lesser extent factor VIII showed positive associations with a variety of subclinical CVD measures. In age-adjusted analyses, fibrinogen and factor VIII were significantly associated with 8 of 10 measures. In multivariate analyses, fibrinogen was significantly associated with carotid artery stenosis, internal (but not common) carotid artery wall thickness, and AAI. Factor VIII was associated with abnormal wall motion and AAI in the full cohort only. Factor VII was not consistently associated with subclinical disease measures. In bivariate analyses that included data from all three groups, there were 5 positive subclinical disease associations and 5 negative associations for factor VII. In multivariate analyses, there were no significant associations between factor VII and subclinical CVD in the full cohort or in either subgroup. We conclude that in these cross-sectional analyses, fibrinogen and to a lesser extent factor VIII are associated with subclinical CVD in the elderly, even in those without symptoms or a history of clinical CVD. Factor VII, however, was not associated with subclinical CVD in the elderly.

Aged↗

PubMed1999

[Epidemiology and prevention of cardiovascular diseases after 1989].

During the past 30 years the geographical distribution of cardiovascular diseases in Europe has substantially changed. The highest rates that were reported in the mid sixties in Finland occurred in 1990/91 occurred in central and eastern Europe. The reasons for such different development of cardiovascular mortality have not been explained yet. The epidemy of cardiovascular diseases in post-socialist countries may be only partially associated with high prevalence of the three classical risk factors (hypercholesterolemia, smoking, hypertension). Presumably other, yet unrecognized risk factors have potentiated the classical ones (psychosocial stress, specific nutritional deficiencies). A decrease in mortality from cardiovascular diseases can be attributed to improvements in care of patients with cardiovascular diseases, mainly with coronary heart disease including AMI, with favourable effects on survival and to a decline in risk factors prevalence or to a combination of both. Similar detailed information for Slovakia is lacking. Therefore it is difficult to predict the future incidence of cardiovascular diseases and AMI in Slovakia. The authors in the review article focused on some epidemiological and preventive aspects of cardiovascular diseases and their implementation at present. In order to achieve a reversal of the unfavourable trend of cardiovascular mortality it is insufficient only to answer the basic questions, as e.g., what was the reason for such differing trends in disease rates and mortality from cardiovascular diseases in our country (and in post-socialist countries of central and eastern Europe) and e.g. in Finland or in the U.S.A., where cardiovascular mortality decreased almost by half. For the appropriate formulation of prevention measures with a focus on cardiovascular diseases, detailed analysis of the current specific situation in our country is also necessary.

Cardiovascular Diseases↗