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PubMed1985

Magnesium and certain other elements and cardiovascular disease.

Cardiovascular disease (CVD) continues to be the major cause of mortality in developed countries. For the past two-and-a-half decades the inverse relationship between water hardness and CVD mortality has stimulated interest among epidemiologists, clinicians and experimental researchers. Much progress has been made in elucidating which element in the water may account for this situation. After reviewing those elements found to have a role in cardiovascular function the authors present the epidemiological evidence and its consistency with recent findings: aside from various trace elements emphasis is placed on magnesium which is recognized as having a vital role.

Adult↗
PubMed2005

Chronic kidney disease and cardiovascular disease in a general Japanese population: the Hisayama Study.

BACKGROUND: Chronic kidney disease has been shown to be an independent risk factor for cardiovascular disease in high-risk populations. However, this relationship is inconclusive in community-based populations. METHODS: To clarify this issue, we followed 2634 community-dwelling individuals without cardiovascular disease, aged 40 years or older, for 12 years and examined the relationship between chronic kidney disease and the incidence of cardiovascular disease. RESULTS: During the follow-up period, 99 subjects (56 men and 43 women) experienced coronary heart disease, 137 subjects (60 men and 77 women) ischemic stroke, and 60 subjects (26 men and 34 women) hemorrhagic stroke. In men, the age-adjusted incidence of coronary heart disease was significantly higher in subjects with chronic kidney disease than in those without it (6.2 vs. 2.9 per 1000 person-years) (P < 0.05), but such a relationship was not observed with ischemic stroke. In contrast, in women, the age-adjusted incidence of ischemic stroke was significantly higher in subjects with chronic kidney disease than in those without it (3.4 vs. 2.5) (P < 0.05), while that of coronary heart disease was not. Chronic kidney disease was not found to be associated with the incidence of hemorrhagic stroke. In multivariate analysis, even after adjustments for traditional and nontraditional cardiovascular disease risk factors, chronic kidney disease was found to be an independent risk factor for the occurrence of coronary heart disease in men [hazard ratio (HR), 2.26; 95% CI, 1.06-4.79], and for the occurrence of ischemic stroke in women (HR, 1.91; 95% CI, 1.15-3.15). CONCLUSION: Our findings suggest that chronic kidney disease is an independent risk factor for the occurrence of cardiovascular disease in the general Japanese population.

Adult↗
PubMed1994

Socioeconomic aspects of ACE inhibition in the secondary prevention in cardiovascular diseases.

Cardiovascular diseases are the leading causes of morbidity and mortality in the industrialized world and have become a major economic burden. Therefore, not only ethical and medical but also economic reasons suggest more intense efforts in primary and secondary prevention of cardiovascular and, especially, coronary artery disease. The prevention of the progression of heart failure and of the risks inherent in left ventricular dysfunction, including development of heart failure, reinfarctions, and death, are major cornerstones in the ambitious but economically balanced use of our resources. Major trials in chronic heart failure as well as the angiotensin-converting enzyme inhibitor pooling project in heart failure of all major studies have shown almost uniformly a reduction in hospitalizations attributable to slowing of the progression of the disease. In the Munich Mild Heart Failure Trial (MHFT) socioeconomic analysis confirmed the high economic burden of progression to the end-stages of disease: Patients with progressive heart failure had a four- to fivefold increase in hospital costs. The blunting of the progressive course of heart failure was effective enough to offset the costs of drug treatment with captopril in an analysis extrapolating the results of the socioeconomic analysis to the total trial population. Favorable results in preventive treatment of patients with asymptomatic left ventricular dysfunction, hypertension, and diabetic nephropathy also suggest that part of the additional costs of medication is outweighed by fewer hospitalizations and interventions. Thus in many cardiovascular diseases angiotensin-converting enzyme inhibitors have a favorable cost-benefit ratio and can be recommended for broader use.

Angiotensin-Converting Enzyme Inhibitors↗
PubMed2006

Vascular biomarkers and surrogates in cardiovascular disease.

Cardiovascular biomarker research efforts have resulted in the identification of new risk factors and novel drug targets, as well as the establishment of treatment guidelines. Government agencies, academic research institutions, diagnostic industries, and pharmaceutical companies all recognize the importance of biomarkers in advancing therapies to improve public health. In drug development, biomarkers are used to evaluate early signals of efficacy and safety, to select dose, and to identify the target population. The United States Food and Drug Administration has relied on biomarkers to support clinical applications in many therapeutic fields, including cardiovascular disease. The appropriate application of cardiovascular biomarkers requires an understanding of disease natural history, the mechanism of the intervention, and the characteristics and limitations of the biomarker. Channels of communication among researcher, developer, and regulator must remain open to maximize the success of future biomarker efforts. In 2003, 2004, and 2005, an international panel of cardiovascular biomarker experts convened at the "Cardiovascular Biomarker and Surrogate Endpoints Symposia" held in Bethesda, Md, to discuss the use of biomarkers in the development of improved cardiovascular diagnostics and therapeutics. The information presented in the present report summarizes the authors' perspective distilled from these proceedings.

Atherosclerosis↗
PubMed2005

Homocysteine, renal disease and cardiovascular disease in a remote Australian Aboriginal community.

BACKGROUND: Rates of renal and cardiovascular disease are high among Aboriginal Australians living in remote communities. Nutritional problems, in particular low folate levels, are also common. This suggests that increased homocysteine concentrations might be widespread, and a possible contributor to the high rates of cardiovascular disease. AIMS: To examine homocysteine concentrations, and their relationships to folate levels, and to markers of renal disease and cardiovascular disease in a remote Aboriginal Australian community METHODS: As part of a cross-sectional survey among adults in one community, homocysteine concentrations, concentrations of the crucial determinants (red blood cell (RBC) folate, vitamin B(12) and the C677T methylene tetrahydrofolate reductase polymorphism) and cardiovascular risk factors were examined. RESULTS: Among 221 people, geometric mean homocysteine concentration was 11.8 micromol/L (range: 11.1-12.5 micromol/L), with 57/221 (26%) values > or =15.0 micromol/L. Higher concentrations were associated with older age, male gender, lower RBC folate and lower vitamin B(12) concentrations and homozygosity for C677T. Homocysteine concentrations were not related to the presence of albuminuria, other than over the overt albuminuria range. Homocysteine concentrations were inversely correlated with calculated glomerular filtration rate (GFR). Carotid intima-media thickness, however, was not related to homocysteine concentration. In multivariate analyses, age, male gender, lower RBC folate concentrations, lower vitamin B(12) concentrations, lower calculated GFR and the C677T polymorphism were all associated with homocysteine concentrations. CONCLUSIONS: Homocysteine concentrations were consistent with previous limited reports in Aboriginal communities. Although superficially they are similar to reports from non-Aboriginal settings, the younger age of this cohort and the association of homocysteine concentrations with age suggest that age-specific concentrations are higher among Aboriginal Australians. In addition to dietary determinants, the high prevalence of apparently reduced renal function renal disease appears to be an important determinant of homocysteine concentrations in remote Aboriginal communities. The role of homocysteine concentrations as a potential mediator of the high rates of cardiovascular disease remains to be determined.

Adult↗
PubMed2006

The relationship of periodontal disease to cardiovascular diseases--review of literature.

Association of Oral and Systemic diseases has gained importance because the high occurrence of oral diseases is an extremely common source of infection. Epidemiological Studies have presented periodontal diseases as a risk factor for development of cardiovascular diseases. A chronic oral infection such as periodontitis is a constant potential source of infection and has now been considered as a separate risk factor for cardiovascular diseases, cerebrovascular diseases, peripheral arterial disease and respiratory diseases as well as delivery of low-birth-weight infants. The possible pathways linking oral infections to systemic diseases are metastatic infections, bacterial endotoxins, and systemic vascular injury. People with a history of periodontal disease and/or tooth loss were found at higher risk for Peripheral arterial disease (PAD) as compared to those without periodontal disease and/or tooth loss. All studies on the relationship of periodontal diseases to cardiovascular diseases are inconclusive and most of the data is based on epidemiological studies.

Cardiovascular Diseases↗
PubMed2003

Chronic kidney disease and cardiovascular disease in the Medicare population.

BACKGROUND: The extent of diabetes, chronic kidney disease (CKD), and cardiovascular disease (CVD) in the Medicare population is relatively unknown. Also unknown is the effect of these diseases on patient survival before end-stage renal disease (ESRD). METHODS: Prevalent cohorts of Medicare enrollees from 1996 to 2000 were assessed for diabetes and CKD, presence of CVD, and probability of death versus ESRD in the follow-up period. Hospitalization rates and, in diabetics, lipid testing and glycemic control monitoring were also assessed. RESULTS: The prevalence of diabetes in the Medicare population increased at 4.4% per year, reaching 18.9% in the 1999-2000 cohort. Approximately 726,000 elderly Medicare enrollees carry a diagnosis code for CKD. Those with CKD are 5 to 10 times more likely to die before reaching ESRD than the non-CKD group. In CKD patients, CVD is twice as common and advances at twice the rate. Cardiovascular disease advances at a similarly higher rate in CKD patients who die and those who survive to ESRD. Heart failure hospitalizations are 5 times greater in CKD patients and only 30% less than those in dialysis patients. Only half of the CKD patients with diabetes who advance to ESRD had a lipid or glycosylated hemoglobin test done in the year before or after dialysis initiation. CONCLUSION: Diabetes, the leading cause of ESRD, is increasing in the general Medicare population at 4.4% per year. Cardiovascular disease is common, progresses at twice the rate, is associated with death before ESRD, and patients receive suboptimal risk factor monitoring. Active identification and treatment of CKD patients is needed.

Heart Failure↗
PubMedDate not supplied

Biofeedback applications in the treatment of cardiovascular diseases.

Cardiovascular diseases impair the lives of millions of Americans each year. Researchers have studied a variety of nonpharmacologic interventions in an attempt to discover their use as therapies for these diseases. Various methods of biofeedback have shown promise in the treatment or management of several cardiovascular disorders. The literature relating to the use of biofeedback therapies for hypertension, cardiac arrhythmias, angina pectoris, cardiac ischemia, myocardial infarction, and Raynaud's phenomenon is reviewed. The number and types of studies in each of these areas vary widely, but research to date suggests that biofeedback could be a useful alternative or adjunct to more conventional forms of treatment. Further research to clarify the appropriate uses of biofeedback in the management of these disorders is recommended.

Arrhythmias, Cardiac↗
PubMed2004

Genetics and cardiovascular disease.

Cardiovascular disease (CVD) is a designation for multiple clinical phenotypes that result from the interaction of genetic variants, lifestyle choices, and environmental exposures. This article points to the utility of assessing a person's family history of CVD, which is the sum of genetic factors, environment and common lifestyle influences, which may be shared among family members and provides information useful for estimating risk for CVD. It also presents several approaches utilized in attempts to identify variants in genes that are involved in the etiology of CVD. Specifically, examples of the candidate gene approach to identify genetic risk factors for coronary heart disease from our own research are presented. The utilization of genetic profiling to predict an individual's long-term prognosis, to target preventive strategies, and to select the most efficacious drug for treatment are discussed, as well as, the need to consider newer approaches to understanding complex diseases.

Cardiovascular Diseases↗
PubMed2002

Cardiovascular disease in patients with chronic kidney disease.

Cardiovascular disease (CVD) is the major cause of morbidity and mortality in patients with renal failure. Patients with chronic kidney disease have significant CVD, and carry a high cardiovascular burden by the time they commence renal replacement therapy (RRT). The severity of CVD that has been observed in dialysis patients lead to a growing body of research examining the pathogenesis and progression of CVD during the progression of chronic kidney disease (CKD) to end-stage renal disease (ESRD) (ie, predialysis phase). Multiple factors are involved in the development of CVD in CKD. More importantly, critical and key factors seem to develop early in the course of CKD, and result in preventable worsening of CVD in this patient population. Anemia is common in patients with CKD, and has been shown to have an independent role in the genesis of left ventricular hypertrophy (LVH) and subsequent CVD. Unfortunately, it is underdiagnosed and undertreated in patients with CKD. Early intervention, and better correction of anemia, seems to gain a great momentum in the prevention and management of CVD in CKD. Hypertension is another risk factor that has been targeted by the National Kidney Foundation Task Force on CVD in chronic kidney disease. This article reviews the different factors involved in the pathogenesis of CVD in CKD and the evidence supporting early and aggressive intervention.

Anemia↗
PubMed2005

Primary prevention trials: lessons learned about treating high-risk patients with dyslipidemia without known cardiovascular disease.

Cardiovascular disease (CVD) is the leading cause of death worldwide. Many serious cardiovascular (CV) events occur in individuals with no prior manifestation of the disease, and often result in death. Awareness of the contributions of various risk factors to the occurrence of CVD is growing. Asymptomatic individuals with multiple risk factors at low or moderate levels can be at greater risk for CVD than those with a single risk factor at a high level. Dyslipidemia and hypertension are two risk factors that commonly coexist and are modifiable through lifestyle changes and/or medications. Recent trials with hydroxymethyl-glutaryl coenzyme A (HMG-CoA) reductase inhibitors (statins) have demonstrated that aggressive cholesterol-lowering therapy in patients without known atherosclerotic disease, but at high risk for CVD with relatively normal low-density lipoprotein cholesterol (LDL-C) levels (< 130 mg/dL), can significantly reduce the number of coronary events experienced by these patients. This subset of at-risk patients is better served by this approach than by treatment solely based on degree of dyslipidemia.

Cardiovascular Diseases↗
PubMed2001

Phenotype-driven genetic approaches in mice: high-throughput phenotyping for discovering new models of cardiovascular disease.

Cardiovascular diseases such as hypertension, atherosclerosis, cardiac hypertrophy homocysteinemia and arrhythmias impose great health, social and financial costs. Some of these diseases are single gene traits that segregate in a simple Mendelian manner. Most are genetically complex, however, and result from combinations of large numbers of genes (polygenic and epistatic traits) or from interactions between genetic and environmental factors (multifactorial traits). Insights into the genetic control of these diseases could lead to improved diagnosis and treatment as well as a deeper understanding of basic physiological processes.

Animals↗
PubMedDate not supplied

Improving the prevention of cardiovascular disease.

Cardiovascular disease is the most common cause of death in the UK. This article discusses the most recent guidance and evidence on prevention, and outlines the implications for nurses.

Cardiovascular Diseases↗
PubMed2005

Traditional and emerging risk factors for cardiovascular disease.

Cardiovascular disease (CVD) is the leading cause of death in the United States and most western societies, further, approximately 50% of CVD is related to coronary heart disease (CHD). Most CVD results from an athero-thrombotic pathologic process in the body's arterial beds, and is largely preventable through risk factor reduction. Risk factors are diseases, physiologic states, biologic markers, or other identifiable factors associated with increased incidence of CVD. This article breaks down traditional, emerging,and possible risk factors for discussion.

Age Factors↗
PubMed2004

Insulin and insulin resistance: impact on blood pressure and cardiovascular disease.

Cardiovascular disease is a major cause of mortality in individuals with diabetes. Many factors, including hypertension, contribute to the high prevalence of CVD in this population. Hypertension occurs approximately twice as frequently in patients with diabetes compared with patients without diabetes. Conversely, recent data suggest that hypertensive persons are more likely to develop diabetes than normotensive persons. In addition, up to 75% of CVD in patients with diabetes may be attributed to hypertension, leading to recommendations for more aggressive blood pressure control (ie, < 130/85 mm Hg) in persons with coexistent diabetes and hypertension. Increasing obesity further contributes to both diabetes and hypertension and significantly increases CVD morbidity and mortality. Other important risk factors for CVD in these patients include atherosclerosis, dyslipidemia, microalbuminuria, endothelial dysfunction, platelet hyperaggregability, coagulation abnormalities, and diabetic cardiomyopathy. The current knowledge regarding these risk factors has been reviewed, placing special emphasis on the metabolic syndrome, hypertension, microalbuminuria, and the role of obesity in these disorders. Although not discussed in detail, it is acknowledged that both hygienic measures (weight loss and aerobic exercise) and treatment strategies that include aspirin, statins, INS sensitizers, and antihypertensive agents that reduce renin-angiotensin-aldosterone system activity have been shown to reduce inflammation, coagulation abnormalities, endothelial function, proteinuria, and in some cases reduce CVD and renal disease progression. Additional therapeutic agents are currently being developed specifically to improve INS sensitivity and other CVD risk factors that are components of the cardiometabolic syndrome.

Angiotensin II↗
PubMed2006

Cardiovascular disease in end stage renal disease.

Cardiovascular disease is common and is the major cause of mortality and morbidity in end stage renal disease (ESRD). This article explores some of the many factors responsible for the high prevalence and mortality of cardiac disease in patients with ESRD. The mechanisms for cardiotoxicity in ESRD are multiple and include coronary artery disease, cardiomyopathy, microvascular disease, arrhythmia, valvular disease, cardiac calcification, pericarditis, aortic stiffness, malnutrition, inflammation, abnormal myocardial metabolism. Identifying high-risk patients remains a challenge as many traditional risk factors and screening tools are less predictive of cardiac disease in ESRD. At present, the treatment of high-risk patients is largely based on data from the general population and observational studies of patients with ESRD.

Cardiovascular Diseases↗
PubMedDate not supplied

Gene polymorphism association studies in dialysis: cardiovascular disease.

Cardiovascular disease (CVD) is the most important cause of morbidity and mortality in dialysis patients. The high prevalence of CVD is due to the cumulative effects of multiple risk factors from the early stages of chronic kidney disease (CKD). Familial predispositions to CVD, CKD, and their respective risk factors are well known, and it is likely that genetic factors determine the interindividual variability in risks for disease. Advances in genomic technology have facilitated the study of genetic variation--most commonly single nucleotide polymorphisms (SNPs) in candidate genes--and their associations with disease. This review examines CVD in dialysis patients as a model of a complex disease, discusses the approach to gene polymorphism association studies, including the roles of gene-environment and gene-gene interactions and provides an overview of available studies.

Cardiovascular Diseases↗