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PubMed2001

Interstitial lung diseases in collagen vascular diseases.

In this review, a clinical update is presented of the most important collagen vascular diseases (CVDs) and the different types of interstitial lung disease (ILD) encountered in these CVDs. These CVDs represent a heterogenous group of immunologically mediated inflammatory disorders with a large variety of affected organs besides the lungs. The frequency, clinical presentation, prognosis and response to therapy vary depending on the histological pattern (usual interstitial pneumonia, desquamative interstitial pneumonia, organising pneumonia, diffuse alveolar damage, nodular lesions, etc.), as well as on the underlying CVD (scleroderma, rheumatoid arthritis, systemic lupus erythematosus, dermatopolymyositis, Sjogren's syndrome or mixed connective tissue disease). The diagnosis of most of these CVDs is based on a number of criteria; in several of these, however, lung involvement is not part of the diagnostic criteria. In addition, there may be overlaps between several of these CVDs. Optimal treatment varies depending on the type of collagen vascular disease and the presence of interstitial lung disease, although in many cases, a combination of corticosteroids and cytostatic drugs are given.

Arthritis, Rheumatoid↗
PubMed1992

Has antihypertensive treatment prevented vascular disease or vascular events?

Our current knowledge of the effects of antihypertensive therapy is based on a large number of therapeutic trials based on mortal and morbid cardiovascular events. Although these events are indeed "hard" data, extrapolations from the results of trials based on events cannot be applied to possible effects on the underlying cardiovascular disease, particularly coronary artery disease, as the mechanisms responsible for the precipitation of events are often different from the mechanisms leading to disease. Once a distinction between prevention of disease and prevention of events is made, then both must be considered to be different, but essential, goals of antihypertensive therapy. The prevention of events is a short-term goal for patients who already have disease, and can be easily appreciated by traditional event-based trials; the prevention of disease, however, is a long-term goal that can be appreciated clinically only after years of treatment, but can be assessed within a shorter time frame by measuring plaque development, as in new types of randomized trials. Studies of the potential actions of antihypertensive drugs on the mechanisms precipitating events, particularly thrombotic factors, may further supplement our current knowledge in our search for the most appropriate treatment of the hypertensive patient.

Antihypertensive Agents↗
PubMed2005

Coronary artery disease and peripheral vascular disease in chronic kidney disease: an epidemiological perspective.

The enormous burden of CAD and PVD inpatients who have CKD contributes substantially to increased morbidity and mortality. The increased risk of vascular disease observed in CKD patients is likely to be multifactorial, with contributions from traditional and nontraditional cardiovascular factors. Given the overwhelming evidence on the known benefits of cardioprotective medications, their underuse remains puzzling in a population at enormous risk. During the past 5 years, the research community and national interest groups have made significant progress in organizing a concerted approach to improve the management of patients who have CKD and vascular disease. Much work remains to be done. The development of national guidelines in the management of these patients at high risk for future cardiovascular events will be a welcome step. The evaluation of multitargeted interventions for reduction of cardiovascular risk through randomized clinical trials is desperately needed. Finally, the low use of known cardioprotective strategies in this high-risk group is a serious issue and warrants immediate attention at local and national levels.

Chronic Disease↗
PubMed1992

Serotonin, histamine and platelets in vascular disease with special reference to peripheral vascular disease.

Cardiovascular disease is a major cause of death. There is evidence that this disease is predicted and its progression influenced by various factors (e.g. hyperlipidaemia). In this review, we consider aspects of platelet structure and function which may explain how this cell type contributes to the pathogenesis of vascular disease. The platelet also contains bioamines (serotonin, 5-HT; histamine) which are potent vasoactive substances. Studies involving patients with peripheral vascular disease (PVD) where abnormalities in platelet function (platelet aggregation and platelet shape change) and in bioamine status (vascular, platelet and plasma bioamine concentrations) are reviewed. We also discuss how platelet activation (in vitro) and plasma lipids influence intraplatelet bioamine status. Finally, we report in vitro evidence of the effect of two drugs prescribed to PVD patients: aspirin and naftidrofuryl. Aspirin is an ineffective inhibitor of 5-HT-induced whole blood platelet aggregation whereas naftidrofuryl is effective in the presence or absence of aspirin. By identifying and altering the factors which contribute to the pathogenesis of atherosclerosis we will be better equipped to prevent, reverse or retard this process.

Animals↗
PubMed2005

Prevalence of valve calcium and association of valve calcium with coronary artery disease, atherosclerotic vascular disease, and all-cause mortality in 137 patients undergoing hemodialysis for chronic renal failure.

Of 137 patients (mean age 63 years) who underwent hemodialysis for chronic renal failure, 65 (47%) had mitral valve calcium, mitral annular calcium, or aortic valve calcium. Thirty-eight of 65 patients (59%) who had valve calcium died at 3.5-year follow-up versus 21 of 72 patients (29%) who did not have valve calcium and who died at 4.3-year follow-up (p = 0.0005).

Adult↗
PubMed1998

An association between periodontal disease and peripheral vascular disease.

BACKGROUND: Periodontal disease has been shown to be associated with increased risk of coronary heart disease. Because coronary heart disease and peripheral vascular disease (PVD) have similar pathophysiologies, we hypothesized that periodontal disease might be a risk factor for PVD. METHODS: Using the combined data from the Normative Aging Study and Dental Longitudinal Study of the US Department of Veterans Affairs, we examined the relationship between PVD and periodontal disease. Multivariate logistic regression analysis was used. RESULTS: Over the 25 to 30 years of follow-up, 80 of these initially healthy subjects developed PVD. Compared with controls (n = 1,030), subjects with clinically significant periodontal disease at baseline had a 2.27 increment in the risk of developing PVD (95% confidence interval 1.32 to 3.9, P value = 0.003). CONCLUSIONS: Periodontal disease emerged as a significant independent risk factor for PVD in a multivariate analysis that adjusted for other established risk factors.

Adult↗
PubMed2003

Cell cycle-related protein expression in Alzheimer's disease and vascular disease.

The link between Alzheimer's disease and cerebrovascular disease has been long recognized. However, the mechanisms that lead to the development of the two seemingly different pathologies are still elusive. Our studies concentrate on the understanding of the interaction between the two diseases and the deciphering of a possible common pathogenic mechanism. In this context the role of shared risk factors, such as ApoE and elevated plasma homocysteine, is also discussed.

Aged↗
PubMed1991

[An epidemiological study of ischemic heart disease, vascular brain diseases and their risk factors in an open population of 25- to 64-year olds in Novosibirsk].

To study the incidence of coronary heart disease (CHD), cerebrovascular diseases (CVD), combined pathology (CHD and CVD), and their risk factors such as arterial hypertension (AH), overweight (OW), hypercholesterolemia (HC), and tobacco smoking in the same population, a random representative sample of male and female populations were examined in three districts of Novosibirsk. AH and tobacco smoking were found predominant among men, whereas OW and HC among women. It turned out that almost every fourth person out of the men and almost every second woman suffered from cardiovascular diseases. In the men, the CHD/CVD ratio was 1:1, that in the women, was 1:7. In the men and women, suffering from combined pathology, AH occurred more frequently as compared to those with CHD or CVD alone. OW promoted the development of CVD and combined pathology in women to a greater degree, whereas HC favoured the development of CHD and CVD in men.

Adult↗
PubMed1990

Crohn's disease and retinal vascular disease.

Patients with Crohn's disease may manifest extraintestinal findings including ocular involvement. We treated two patients with Crohn's disease who manifested retinal vascular disease that may have been related to the immune nature of the underlying disease or possibly to changes in the vasculature or coagulation system. One patient had a central retinal vein occlusion and the other had retinal vasculitis involving retinal arteries and veins with an apparent branch retinal artery occlusion. Both patients were in excellent health except for Crohn's disease, which was confirmed by a biopsy specimen. In one patient, the diagnosis of retinal vasculitis preceded the clinical diagnosis of Crohn's disease, whereas for the second patient the symptomatology of the intestinal disease preceded the ocular manifestations. We suggest that inflammatory bowel disease should be considered in the differential diagnosis of retinal vascular occlusive disease, especially in a young patient.

Adult↗
PubMedDate not supplied

[Rehabilitation of diabetic patients, amputated because of vascular disease. Angiology and vascular surgery services, 1995].

A descriptive and retrospective study of 95 patients from the "Ambrosio Grillo" and "Saturnino Lora" Hospitals, in Santiago de Cuba, was conducted between January and December, 1995, aimed at showing the rehabilitation of the diabetic patients, who have had a limb amputated due to vascular disease. These patients are a sample of the universe of lower limb amputees as a results of vascular disease. Diabetes mellitus increased the affection of the distal arterial arbor, which explains its high incidence among amputeez. The amputation of a lower limb is very significant for a patient, and it is considered as the final stage of the treatment since the patient's life is in danger due to a severe generalized sepsis of the extremity. General data from the medical histories, variables of interest as clinical data, risk factors, socioeconomic data, occupational category, and foot care were taken into consideration. Most of the patients were 60-70. Females prevailed and the time of evolution of diabetes mellitus was over 10 years. The rehabilitation activities include the psychical, physical and social aspects, and are carried out by a specialized working group.

Adult↗
PubMed2002

Interstitial lung diseases associated with collagen vascular diseases: radiologic and histopathologic findings.

Collagen vascular diseases that demonstrate features of interstitial lung disease include systemic lupus erythematosus, rheumatoid arthritis, progressive systemic sclerosis, dermatomyositis and polymyositis, ankylosing spondylitis, Sjögren syndrome, and mixed connective tissue disease. At histopathologic analysis, interstitial lung diseases associated with collagen vascular diseases are diverse and include nonspecific interstitial pneumonia, usual interstitial pneumonia, bronchiolitis obliterans organizing pneumonia (BOOP), apical fibrosis, diffuse alveolar damage, and lymphocytic interstitial pneumonia. Although proportions of interstitial pneumonias vary, nonspecific interstitial pneumonia accounts for a large proportion, especially in progressive systemic sclerosis, dermatomyositis and polymyositis, and mixed connective tissue disease. The more favorable prognosis in interstitial pneumonia associated with collagen vascular diseases than in idiopathic interstitial pneumonias may be explained by the larger proportion of nonspecific interstitial pneumonia than of usual interstitial pneumonia. High-resolution computed tomography seems to help characterize and determine the extent of interstitial lung disease in collagen vascular diseases.

Arthritis, Rheumatoid↗
PubMed2004

Tetrahydrobiopterin: regulator of endothelial nitric oxide synthase in vascular disease.

In vascular disease states such as atherosclerosis and diabetes, endothelial nitric oxide (NO) bioactivity is reduced and oxidative stress is increased, resulting in endothelial dysfunction. Recent studies suggest that changes in the activity and regulation of endothelial NO synthase by its cofactor tetrahydrobiopterin (BH4) is an important contributor to endothelial dysfunction. Pharmacologic studies and more recent insights from genetically modified mouse models have improved the understanding of the mechanistic role and importance of BH4 in vascular disease pathogenesis. Targeting BH4 may provide new therapeutic strategies in vascular disease.

Animals↗
PubMed2005

A role for endothelin-1 in peripheral vascular disease.

Peripheral vascular disease can compromise the blood supply to the lower limb with amputation being necessary in severe cases. Reduced blood flow may be due to arterial occlusive disease or constriction of skeletal microvessels with the resultant ischaemia causing pain, tissue damage, ulceration and gangrene. These events are associated with endothelial damage or dysfunction: endothelin-1 is implicated as a mediator via its constrictor, proinflammatory and proliferative actions. Raised plasma and tissue levels of this peptide have been described in various ischaemic conditions, including peripheral vascular disease. Here, the possible role of endothelin-1 in peripheral vascular disease is discussed and potential therapeutic tools are considered.

Animals↗