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PubMed2004

Cardiovascular diseases in kidney transplant recipients: the role of anemia.

Cardiovascular diseases are among the leading causes of mortality and death associated graft loss in kidney transplant recipients. Recently, there has been an increased awareness of the potential role of nontraditional risk factors such as anemia in contributing to the increased burden of cardiovascular diseases in kidney transplant recipients. Studies that are primarily based on retrospective data analyses have shown an association between anemia and cardiovascular outcomes. These findings underscore the need for prospective studies to better understand these risks and to implement management strategies that would have a positive impact on patient and graft outcomes. On the basis of the available data, this article reviews the magnitude of cardiovascular diseases and anemia in kidney transplant recipients with a focus on the role of anemia on cardiovascular outcomes in these patients.

Anemia↗
PubMed1993

Association of hemostatic variables with prevalent cardiovascular disease and asymptomatic carotid artery atherosclerosis. The Atherosclerosis Risk in Communities (ARIC) Study Investigators.

The relation of hemostatic factor levels to the occurrence of cardiovascular disease is incompletely established. The Atherosclerosis Risk in Communities Study measured fibrinogen, factor VII, factor VIII, von Willebrand factor, antithrombin III, protein C, activated partial thromboplastin time, and other cardiovascular risk factors in nearly 15,000 men and women aged 45 to 64. This analysis assessed the relations of these hemostatic factors with prevalent cardiovascular disease and asymptomatic carotid artery intimal-medial thickness measured by B-mode ultrasound. Compared with participants without cardiovascular disease, those with cardiovascular disease had higher levels of fibrinogen, factor VIII, and von Willebrand factor in both sexes. The other hemostatic factors were less consistently associated with prevalent cardiovascular disease. Only fibrinogen was associated with carotid intimal-medial thickness. Adjusted for age, race, and field center, the odds ratio for carotid wall thickness in the 90th percentile or greater, compared with < 50th percentile, for each SD higher fibrinogen concentration (65 mg/dL) was 1.42 (95% confidence interval, 1.25, 1.62) in men and 1.43 (1.25, 1.64) in women. This population-based study provides further evidence that fibrinogen and possibly factor VIII and von Willebrand factor are risk factors for cardiovascular disease.

Arteriosclerosis↗
PubMed1998

Epidemiology of oral contraceptives and cardiovascular disease.

PURPOSE: To review the association between combined oral contraceptives and cardiovascular disease, with emphasis on oral contraceptives containing low doses of estrogen (low-dose oral contraceptives). DATA SOURCES: A systematic search of the MEDLINE database was done for all relevant articles published between 1967 (when low-dose oral contraceptives were introduced in the United States) and June 1997. Textbooks, meeting proceedings, and reference lists were also searched. STUDY SELECTION: All English-language human epidemiology studies of oral contraceptives that used cardiovascular disease as an end point were reviewed. Animal and metabolic studies were reviewed only if they were especially relevant to the mechanism of action of oral contraceptives. DATA EXTRACTION: Descriptive and analytic data from each study were collected. DATA SYNTHESIS: Data were organized by cardiovascular end point, study design, estrogen dose, and type of progestogen. Data on relative and absolute risk are presented to address current prescription guidelines. CONCLUSIONS: The risk for cardiovascular disease is lower with current preparations of oral contraceptives, including those that contain the new progestogens, than with older oral contraceptives containing high doses of estrogen. Among users of low-dose oral contraceptives, cardiovascular diseases occur mainly in smokers and women with predisposing factors. Every effort should be made to encourage smoking cessation among potential users of oral contraceptives.

Animals↗
PubMed1990

Diabetes, fibrinogen, and risk of cardiovascular disease: the Framingham experience.

The influence of fibrinogen on the risk of cardiovascular disease is examined over 16 years of follow-up in 1314 subjects who were initially free of cardiovascular disease in the Framingham Study. Of these subjects, 46 men and 43 women developed diabetes, and 56 men and 53 women had blood sugar levels that exceeded 120 mg/dl. Diabetes predisposed subjects to all of the 408 major cardiovascular disease outcomes. Diabetics had higher levels of fibrinogen, hypertension, hypertriglyceridemia, and obesity, but lower HDL cholesterol values. The influence of diabetes on cardiovascular disease was greatly dependent on these coexistent risk factors, but there was a substantial independent effect of glucose intolerance when all the standard risk factors had been taken into account. There was a rise in fibrinogen values throughout the range of blood sugar levels, which suggests a thrombogenic explanation for the unique diabetic effect. However, multivariate analysis indicates no further reduction in diabetic cardiovascular risk ratios after adjustment for fibrinogen; thus, there is a residual effect for glucose intolerance after all of the standard risk factors and fibrinogen have been taken into account.

Aged↗
PubMed2002

Prevention of cardiovascular diseases. Coronary artery disease, congestive heart failure, and stroke.

Cardiovascular disease leads to significant morbidity and mortality in the older population. Results of risk reduction can be dramatic in terms of patient survival and quality of life. This article reviews evidence for cardiovascular risk factors and disease prevention in older adults. Interventions which reduce morbidity and mortality from coronary artery disease, heart failure, and cerebrovascular disease in the elderly population are examined. Attention is given to the role of cardiovascular disease in older women and in minorities, subsets not well-represented in many studies.

Aged↗
PubMed2002

Platelets and cardiovascular disease.

Platelets play an important, but often under-recognized role in cardiovascular disease. For example, the normal response of the platelet can be altered, either by increased pro-aggregatory stimuli or by diminished anti-aggregatory substances to produce conditions of increased platelet activation/aggregation and occur in active cardiovascular disease states both on a chronic (e.g. stable angina pectoris) and acute basis (e.g. acute myocardial infarction). In addition, platelet hyperaggregability is also associated with the risk factors for coronary artery disease (e.g. smoking, hypertension, and hypercholesterolaemia). Finally, the utility of an increasing range of anti-platelet therapies in the management of the above disease states further emphasizes the pivotal role platelets play in the pathogenesis of cardiovascular disease. This paper provides a comprehensive overview of the normal physiologic role of platelets in maintain homeostasis, the pathophysiologic processes that contribute to platelet dysfunction in cardiovascular disease and the associated role and benefits of anti-platelet therapies.

Blood Platelets↗
PubMed2003

[The genetics of multifactorial cardiovascular disease. How significant for the cardiologist?].

Cardiovascular disease represents the prime cause of mortality and morbidity in many countries. The occurrence is affected by pre-existing risk factors of which the best known at the moment are the environmental risk factors. However, for the same level of environmental risk, two individuals do not necessarily have the same probabilities of developing a cardiovascular event. In effect, the constitutional component, accounted for by details in everyone's genetic makeup, can significantly alter this risk. The characterisation and identification of the mutations responsible for this variation in individual susceptibility are complex in the case of multifactorial diseases such as cardiovascular disease. Several studies now allow a glimpse at the expected benefits of understanding this genetic component, as far as diagnosis, prognosis and pharmacogenetics are concerned. The current explosion in high capacity genome techniques will herald new therapeutic approaches likely to further improve the survival and quality of life for our patients.

Cardiology↗
PubMed2005

[Particles in the outside air increase the risk of cardiovascular diseases].

Evidence accumulated during the mid-1990 s that ambient particulate air pollution aerosol particles may not only exacerbate respiratory diseases but also be a risk factor for cardiovascular disease exacerbation. The aim of the studies described here was to assess the impact of the 1985 smog episode on the risk factor profile in the randomly selected population-based sample of the MONICA survey 1984/85 (S1). During a 13-day period in January 1985 sulphur dioxide concentrations increased four times and concentrations of total suspended atmospheric particles doubled. The impact of this time period on plasma viscosity, plasma C-reactive protein concentrations, heart rate and blood pressure was investigated. Regression models were used to assess these associations adjusting for individual risk factors such as gender, age, body mass index, serum total cholesterol and HDL-cholesterol, smoking, physical activity and medication for cardiovascular diseases and for weather conditions during the survey period. An increase in plasma viscosity, C-reactive protein and heart rate was estimated during the air pollution episode. There was also an increase in blood pressure, but this appeared to be attributable to the weather conditions during the air pollution episode. All the four outcomes were associated with the sulphur dioxide concentrations and the total suspended particle concentrations during the survey. These results indicate that ambient air pollution, particularly ambient particulate air pollution may induce systemic inflammation and modulate the autonomic function of the heart. These pathomechanisms may contribute to the observed associations between ambient air pollution concentrations and cardiovascular disease exacerbation such as hospitalisation and mortality due to cardiovascular diseases.

Adult↗
PubMed1999

Role of arginine, taurine and homocysteine in cardiovascular diseases.

Arginine, taurine and homocysteine are amino acids which have been shown to affect the risk factors of cardiovascular diseases in humans. Arginine and taurine may protect against cardiovascular diseases while homocysteine may be a risk factor for them. Both arginine and taurine seem to lower blood pressure, arginine may also inhibit atherogenesis, and taurine may have antioxidant properties. However, the evidence of the beneficial effects of arginine and taurine supplementation from human studies is insufficient. Elevated levels of plasma homocysteine may be associated with atherosclerotic and thromboembolic cardiovascular diseases. Supplementation with folic acid seems to be effective in reducing hyperhomocysteinaemia, but there is an insufficient number of studies showing that lowering of homocysteine levels with vitamin supplementation will reduce the risk of cardiovascular diseases. In conclusion, further research is needed to determine the optimal levels for taurine and arginine in the human diet in order to decrease the risk factors for cardiovascular diseases, and to whom supplementation with folic acid should possibly be recommended to reduce hyperhomocysteinaemia. Even though the use of arginine and taurine supplements to reduce cardiovascular risk factors is an interesting possibility, the reported health-promoting effects and the safety of such a supplementation should first be confirmed.

Animals↗
PubMed2006

Hypothesis: dietary iodine intake in the etiology of cardiovascular disease.

This paper reviews evidence suggesting that iodine deficiency can have deleterious effects on the cardiovascular system, and correspondingly, that a higher iodine intake may benefit cardiovascular function. In recent years, public health bodies have aggressively promoted sodium restriction as a means of reducing hypertension and the risk of cardiovascular disease. These inducements have led to a general decline in iodine intake in many developed countries. For example, a United States national health survey conducted in the early 1970s observed that 1 in 40 individuals had urinary iodine levels suggestive of moderate or greater iodine deficiency; twenty years later, moderate to severe iodine deficiency was observed in 1 in 9 participants. Regional iodine intake has been shown to be associated with the prevalence of hypothyroidism and hyperthyroidism, where autoimmune hypothyroidism is the more common of the two in regions with moderate to high iodine intake. Both of these thyroid abnormalities have been shown to negatively affect cardiovascular function. Selenium, an important antioxidant in the thyroid and involved in the metabolism of iodine-containing thyroid hormones, may play an interactive role in the development of these thyroid irregularities, and in turn, cardiovascular disease. Iodine and iodine-rich foods have long been used as a treatment for hypertension and cardiovascular disease; yet, modern randomized studies examining the effects of iodine on cardiovascular disease have not been carried out. The time has come for investigations of sodium, hypertension, and cardiovascular disease to also consider the adverse effects that may result from mild or greater iodine deficiency.

Cardiovascular Diseases↗
PubMed2006

Pediatric precursors of adult cardiovascular disease: noninvasive assessment of early vascular changes in children and adolescents.

BACKGROUND: Until recently, our understanding of the childhood antecedents of adult cardiovascular disease was limited mainly to autopsy studies and pathologic findings in teens and young adults who died from accidental causes. Recent advances in the understanding of atherosclerosis and new technologies allowing detection of early events have made it possible to observe anatomic and physiologic evidence of cardiovascular disease in young adults and children. OBJECTIVES: The goal of this article was to introduce pediatricians to new methods for noninvasive measurement of cardiovascular disease and its precursors, to describe the potential application of these techniques in detecting childhood precursors of adult cardiovascular disease, and to summarize knowledge gained from this approach. METHODS: We conducted a computerized search of peer-reviewed articles listed in PubMed and Medline from 1980 to April 2006. We reviewed 63 and 84 articles from the adult and pediatric literature, respectively. RESULTS: Reviewing the research on childhood antecedents of adult cardiovascular disease is sobering. Vascular alterations in anatomy, physiology, mechanical properties, and proinflammatory and prothrombotic changes are present from a very early age of childhood and are associated with the risk factors common in adult cardiovascular disease. At the same time, this body of research supports the concept that the vascular impairment from childhood may improve over time with appropriate intervention. CONCLUSIONS: The measurement tools and concepts described in this article offer diagnostic and therapeutic opportunities for collaboration between clinical pediatricians and pediatric researchers. These partnerships will enable pediatricians to contribute in an effort to reduce the burdens of cardiovascular disease to individuals, families, and society.

Adolescent↗
PubMed1981

Change in health behaviour in relation to estimated coronary heart disease risk during a community-based cardiovascular disease prevention programme.

The relationship between change in one coronary heart disease risk factor and levels of other risk factors was investigated in independent pre-and post-intervention samples and in a cohort surveyed both before and after a community-based cardiovascular disease prevention programme. A risk score that did not include the factor being analysed for change was developed and used to estimate risk. In the independent samples generally neither change in smoking nor change in saturated fat intake was related to coronary heart disease risk estimated from other factors in either men or women. Only the intake of saturated fats reduced slightly more among the hypertensive than other men (p less than 0.05). In the cohort, only change in smoking by women was related to initial risk estimated from other factors (p less than 0.05). Since change in behaviour had no consistent relation to the preprogramme risk level, it was concluded that health behaviour change in the population was based on common lifestyle changes in th intervention community, and that either face-to-face counselling or new techniques of mass communication are needed to induce high-risk individuals to do more to change their risk-inducing behaviours.

Adult↗
PubMed1993

The pattern of cardiovascular disease in Indonesia.

As its socioeconomic situation is improving, Indonesia is now in epidemiological transition, having the double burden of infectious diseases and emerging noncommunicable, especially cardiovascular, diseases. A review of the data from recent community surveys indicates an increase in cardiovascular diseases, particularly ischaemic heart disease and hypertension and its sequelae, as causes of morbidity and mortality, most markedly among the elderly, while rheumatic heart disease and congenital heart disease continue to have much lower incidences. In response to this situation, Indonesia has joined the WHO MONICA Project as an associate member. The first population screening, completed in 1988 on 2,073 randomly selected subjects, disclosed important risk factors including hypertension, smoking and physical inactivity. Lipid values are low compared with Western figures but higher than Japanese values. The prevalence of hypertension ranged from 5 to 15% in all adults but reached over 20% in those aged 50 years and over. Primary and primordial prevention programmes are to receive higher priority, and health education is to be given special attention at all levels. It will be necessary for the government to work closely with nongovernmental organizations in order to accomplish the tasks in hand.

Adult↗
PubMed2003

Cardiovascular diseases in patients with high levels of plasma high density lipoprotein: association with increased plasma oxidative state.

BACKGROUND: Increased levels of high density lipoprotein (over 60 mg/dl) are considered to be a negative risk factor for ischemic heart disease. However, some patients with high HDL still develop cardiovascular diseases. OBJECTIVE: To explore why patients with very high HDL still suffer from cardiovascular diseases. METHODS: We analyzed several risk factors, such as increased lipid peroxidation, hyperhomocysteinemia and increased release of inflammatory molecules, that could be related to the development of vascular disease in patients with high serum HDL levels. Patients with HDL cholesterol levels above 75 mg/dl were selected for this study and were separated into two groups based on the presence of atherosclerotic vascular disease, i.e., those with vascular disease (patients) and those without (controls). RESULTS: Plasma isolated from the patient group exhibited significantly increased lipid peroxidation by 21% and decreased total antioxidant status by 17%, but there were no differences regarding their serum or their paraoxonase activity. Moreover, both groups exhibited similar levels of serum C-reactive protein, fibrinogen and homocysteine, enabling us to eliminate these risk factors in the etiology of cardiovascular disease in the patient group. CONCLUSION: Increased oxidative stress could be one of the factors leading to cardiovascular diseases in patients with high serum HDL levels.

Aged↗
PubMed2004

Secular trends in cardiovascular disease mortality, incidence, and case fatality rates in adults in the United States.

PURPOSE: To assess the effects of changes in cardiovascular disease incidence and case fatality rates on secular trends in mortality in the U.S. population between 1971-1982 and 1982-1992. METHODS: Using data from the first National Health and Nutrition Examination Survey Epidemiologic Follow-up Study, two cohorts (10,869 subjects in the 1971-1982 cohort and 9774 in the 1982-1992 cohort) of participants aged 35 to 74 years were created. Baseline medical history questionnaires were administered in 1971-1975 and 1982-1984, with follow-up interviews, hospital record reviews, and death certificate searches conducted in 1982-1984, 1986, 1987, and 1992. RESULTS: Between 1971-1982 and 1982-1992, age-standardized cardiovascular disease mortality declined from 79.1 (95% confidence interval [CI]: 75.2 to 83.0) to 53.0 (95% CI: 49.5 to 56.5) per 10,000 person-years, while cardiovascular disease incidence rates decreased from 293.5 (95% CI: 284.5 to 302.4) to 225.1 (95% CI: 216.6 to 233.5) per 10,000 person-years. The 28-day case fatality rate for cardiovascular disease declined from 15.7% (95% CI: 14.5% to 16.8%) to 11.7% (95% CI: 10.3% to 13.0%). After adjustment for age, sex, and race, rates were 31% lower for cardiovascular disease mortality, 21% lower for incidence, and 28% lower for 28-day case fatality in the 1982-1992 cohort than in the 1971-1982 cohort (each P <0.001). CONCLUSION: The decrease in cardiovascular disease mortality between 1971-1982 and 1982-1992 was due to declines in both the incidence and case fatality rates in this national sample. These findings suggest that both primary and secondary prevention and treatment contributed to the decline in cardiovascular disease mortality in the United States.

Adult↗
PubMed2004

The role of chronic inflammation in cardiovascular disease and its regulation by nutrients.

Multiple risk markers for atherosclerosis and cardiovascular disease act in a synergistic way through inflammatory pathways. This article discusses some of the key inflammatory biochemical risk markers for cardiovascular disease; in particular, the role of three basic cell types affected by these risk markers (endothelial cells, smooth muscle cells, and immune cells), the crucial role of inflammatory mediators, nitric oxide balance in cardiovascular pathology, and the use of nutrients to circumvent several of these inflammatory pathways. Most risk markers for cardiovascular disease have a pro-inflammatory component, which stimulates the release of a number of active molecules such as inflammatory mediators, reactive oxygen species, nitric oxide, and peroxynitrite from endothelial, vascular smooth muscle, and immune cells in response to injury. Nitric oxide plays a pivotal role in preventing the progression of atherosclerosis through its ability to induce vasodilation, suppress vascular smooth muscle proliferation, and reduce vascular lesion formation. Nutrients such as arginine, antioxidants (vitamins C and E, lipoic acid, glutathione), and enzyme cofactors (vitamins B2 and B3, folate, and tetrahydrobiopterin) help to elevate nitric oxide levels and may play an important role in the management of cardiovascular disease. Other dietary components such as DHA/EPA from fish oil, tocotrienols, vitamins B6 and B12, and quercetin contribute further to mitigating the inflammatory process.

Arteriosclerosis↗
PubMed2000

Oral microorganisms and cardiovascular disease.

The list of etiological factors for cardiovascular disease is long, complicated, intertwined, and yet to be completed. This paper will evaluate the current evidence for the pathogenic role of certain microorganisms, including those of the oral cavity, in the etiology of cardiovascular disease.

Bacterial Infections↗
PubMed1994

Prevalence of subclinical atherosclerosis and cardiovascular disease and association with risk factors in the Cardiovascular Health Study.

The prevalence of subclinical atherosclerosis and cardiovascular disease was evaluated among the 5,201 adults aged > or = 65 years in four communities participating in the Cardiovascular Health Study from June 1989 through May 1990. A combined index based on electrocardiogram and echocardiogram abnormalities, carotid artery wall thickness and stenosis based on carotid ultrasound, decreased ankle-brachial blood pressure, and positive response to a Rose Questionnaire for angina or intermittent claudication defined subclinical disease. The prevalence of subclinical disease was 36% in women and 38.7% in men and increased with age. Among women, low-density lipoprotein cholesterol, systolic blood pressure, blood glucose, and cigarette smoking were positively associated, and high-density lipoprotein cholesterol negatively associated, with subclinical disease. In men, systolic blood pressure, blood glucose, and cigarette smoking were independent risk factors in multiple logistic regression analyses. The risk factors for subclinical disease are, therefore, similar to those for clinical disease at younger ages, especially among women. It is possible that older individuals with subclinical disease are at very high risk of developing clinical disease and that more aggressive interventions to prevent clinical disease should be oriented to individuals with subclinical disease.

Aged↗