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[Anxiety and depressive disorders in cardiovascular diseases].

Cardiovascular diseases are often associated with anxiety and depression. The literature gives different interpretations of this comorbidity. Psychopathological factors have been successively studied as risk factors, comorbid disorders and factors influencing the prognostic. The authors describe the incidence and the prevalence of anxiety and depression, first in coronary heart disease and secondly before cardiac surgery. The prognostic significance of these psychological factors is also reviewed. Physiopathological hypothesis and practical application in clinical practice are proposed.

Adaptation, Psychological↗

Why the workplace and cardiovascular disease?

Cardiovascular disease (CVD) remains the major cause of morbidity and mortality in the industrialized world. Current approaches to managing the CVD epidemic are based on powerful engineering models and advanced medical techniques. Innovative research has identified a number of risk factors for hypertension and CVD. However, our understanding of these disorders and our ability to manage the epidemic remain limited. A social epidemiologic paradigm suggests that essential hypertension and CVD are diseases of industrialized society of rather recent historical origins. To better understand and manage the CVD epidemic, current models need to incorporate a heretofore relatively neglected realm of social life in the workplace.

Cardiovascular Diseases↗

Historical perspective on garlic and cardiovascular disease.

Cardiovascular disease is a complex and multifactorial disease characterized by such factors as high cholesterol, hypertension, reduced fibrinolysis, increase in blood-clotting time and increased platelet aggregation. Dietary therapy is the first step in the treatment of hyperlipidemia; garlic has been used medicinally for centuries and is still included in the traditional medicine of many cultures. Historically, there has been great interest in the role of garlic in reducing cardiovascular risk factors. Evidence from numerous studies points to the fact that garlic can bring about the normalization of plasma lipids, enhancement of fibrinolytic activity, inhibition of platelet aggregation and reduction of blood pressure and glucose. However, some contradictory results have also emerged as a result of methodological shortcomings, the use of different formulations/preparations of garlic and different time scales of the studies. Accordingly, further clinical studies are required in which standardized formulations of garlic with known compositions can be used. Such formulations (e.g., Aged Garlic Extract) are now available and are being investigated. Evidence obtained from these studies indicates that garlic has potential in the prevention and control of cardiovascular disorders and is beneficial when taken as a dietary supplement.

Arteriosclerosis↗

Vitamin D and cardiovascular disease.

Cardiovascular disease (CVD) is the leading cause of death among patients with end-stage renal disease (ESRD). Vitamin D deficiency accompanies the loss of kidney function and is extremely common. Treatment with active vitamin D has improved survival rate in dialysis patients. The relationship between vitamin D and CVD has been reported in the literature. Genetic factors have been known to cause both vitamin D deficiency and CVD. Vitamin D receptor is found in the heart muscle. Vitamin D is reported to be involved in the pathogenesis of many cardiovascular problems. Certainly, vitamin D has an important role in modulating CVD.

Cardiovascular Diseases↗

Hormone replacement therapy and the prevention of cardiovascular disease.

Cardiovascular disease (CVD) is the primary killer of both men and women in Western societies. The implementation of preventive strategies has led to a fall in the rate of CVD, but there is still much to be achieved. Proven interventional strategies are largely under-utilized, and the search continues for further promising interventions. HRT appears to reduce CVD in post-menopausal women, based on observational data supported by plethora of evidence for the beneficial cardiovascular effects of estrogen. However, a recent controlled trial in post-menopausal women with established CVD has shown that a specific combined oral HRT regimen did not reduce, and may even contribute to, an early increase in cardiovascular events, suggesting that HRT is inappropriate in secondary prevention. HRT may be useful in the primary prevention of CVD, yet observational data that suggested cardiovascular benefit with HRT also suggests that 80% of CVD in women could be eliminated by lifestyle modification, without the attendant risks of HRT including thrombosis and (potentially) breast cancer. At present, it is arguable that the evidence is inadequate to recommend HRT solely for the purpose of CVD prevention, and that the challenge for the health professional should be appropriate utilization of established preventative therapies, with further research into the potential role of HRT and estrogen-receptor modulators.

Animals↗

The impact of anemia correction on cardiovascular disease in end-stage renal disease.

Cardiovascular disease is a major cause of mortality and morbidity in patients with end-stage renal disease. Anemia, a result of erythropoietin deficiency, is associated with increased all-cause and cardiovascular mortality in this population, and predisposes patients to the development of symptomatic heart disease. Anemia is also associated with the development and progression of left ventricular echocardiographic disorders, which strongly predict cardiac failure and death. Left ventricular dilatation with compensatory hypertrophy, the major pattern of echocardiographic disease progression in hemodialysis patients, is a particularly strong predictor of late mortality. Partial correction of anemia with recombinant human erythropoietin likely reduces left ventricular mass and volume. Complete correction of anemia may prevent progressive left ventricular dilatation in patients with normal left ventricular volumes. A recent trial, however, reports excess mortality and vascular access loss in patients with preexisting symptomatic heart disease when anemia was completely corrected. Consequently, hematocrit target ranges above 32% to 36% cannot be recommended in this population. In patients without symptomatic heart disease, it is not possible to conclude that potential benefits derived from a normalized hematocrit will outweigh potential risks.

Anemia, Iron-Deficiency↗

The role of data-driven planning and coalition development in preventing cardiovascular disease.

Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in the United States. Effective programs for the prevention and control of CVD need to include data-based planning and evaluation at the State and local levels. The authors describe the development of data-driven planning and intervention strategies in Missouri. Statewide planning activities have resulted in the formation of an advisory committee and development of a State plan, a resource directory, and training courses. Analysis of mortality data revealed an unusual concentration of CVD deaths in the southeast portion of the State. Local coalitions are being developed in each of six counties in this region to reduce the prevalence of CVD risk factors. A regional behavioral risk factor survey of 1,006 adults identified key risk factors that will be addressed by the coalitions. These data suggested that physical inactivity, obesity, and hypertension are especially acute problems in the area. Key components of the local coalition development included providing localized data and obtaining the strong commitment of the local health departments. Expanded use of chronic disease surveillance data for planning and evaluation will increase the probability that localities, States, and the nation will achieve Year 2000 Health Objectives. The data-based planning process is described as a possible model for use by other States and localities.

Cardiovascular Diseases↗

C-reactive protein, but not homocysteine, is related to cognitive dysfunction in older adults with cardiovascular disease.

Cardiovascular disease (CVD) is a risk factor for cognitive impairment and dementia. Recent studies implicate homocysteine (HCY) and C-reactive protein (CRP) in this increased risk, as both are associated with cognitive dysfunction in demented and non-demented patients. However, it remains unclear whether they confer added risk in older adults with CVD. A total of 126 older CVD patients underwent blood and neuropsychological evaluation as part of a prospective examination of the neurocognitive consequences of CVD. A subset of these participants (n=37) also underwent neuroimaging to quantify the degree of white matter disease. After adjusting for demographic and medical factors, no significant relationship emerged between HCY and cognitive performance. In contrast, CRP showed significant independent relationships to test performance, including global cognitive performance, attention/psychomotor function, executive function, memory, and visuospatial abilities. Neither HCY nor CRP was related to extent of white matter disease or whole brain volume on magnetic resonance imaging. Further study is needed to identify mechanisms by which inflammatory processes impact on cognitive function and to determine whether reducing circulating levels of inflammatory markers results in improved cognition.

Aged↗

Blood pressure and the global burden of cardiovascular disease.

Cardiovascular disease is responsible for a large and increasing proportion of death and disability worldwide. Half of this burden occurs in Asia. This study assessed the possible effects of population-wide (2% lower DBP for all) and targeted (7% lower DBP for those with usual DBP > or = 95 mmHg) BP interventions in Asia, using data from surveys of blood pressure levels, the Global Burden of Disease Project, Eastern Asian cohort studies and randomised trials of blood pressure lowering. Overall each of the two interventions would be expected to avert about one million deaths per year throughout Asia in 2020. These benefits would be approximately additive. About half a million deaths might be averted annually by each intervention in China alone, with about four-fifths of this benefit due to averted stroke. The relative benefits of these two strategies are similar to estimates made for US and UK populations. However, the absolute benefits are many times greater due to the size of the predicted CVD burden in Asia.

Blood Pressure↗

Dietary intake of fruits and vegetables and risk of cardiovascular disease.

Cardiovascular disease (CVD) remains the leading cause of morbidity and mortality in the United States and worldwide. In this review, we examine the scientific evidence in support of current dietary recommendations to increase fruit and vegetable intake for CVD prevention. Available evidence indicates that persons who consume more fruits and vegetables often have lower prevalence of important risk factors for CVD, including hypertension, obesity, and type 2 diabetes mellitus. Recent large, prospective studies also show a direct inverse association between fruit and vegetable intake and the development of CVD incidents such as coronary heart disease and stroke. However, the biologic mechanisms whereby fruits and vegetables may exert their effects are not entirely clear and are likely to be multiple. Many nutrients and phytochemicals in fruits and vegetables, including fiber, potassium, and folate, could be independently or jointly responsible for the apparent reduction in CVD risk. Functional aspects of fruits and vegetables, such as their low dietary glycemic load and energy density, may also play a significant role. Although it is important to continue our quest for mechanistic insights, given the great potential for benefits already known, greater efforts and resources are needed to support dietary changes that encourage increased fruit and vegetable intake.

Animals↗

Advanced glycoxidation. A new risk factor for cardiovascular disease?

Cardiovascular disease (CVD) is the leading cause of mortality worldwide. A large body of evidence both in vitro and in vivo suggests an important role for advanced glycoxidation end products (AGE) in the development or progression of CVD. AGE are a heterogenous group of molecules formed within the body during aging and, at an accelerated rate, in diabetes. AGE result from the nonenzymatic reaction of reducing sugars with proteins, lipids, and nucleic acids. Diet is considered an important exogenous source of highly reactive AGE. Recent studies have suggested a relationship between AGE and features of CVD. These findings together with the cardioprotective effects of anti-AGE agents demonstrate the causal relationship of AGE to the development and progression of CVD. Prospective outcome and controlled studies are needed to further support this relationship.

Cardiovascular Diseases↗

Combination pharmacotherapy for cardiovascular disease.

Cardiovascular disease (CVD) is the major cause of death in developed countries and is rapidly becoming the major cause of death in the developing world. The increasing rates of obesity and type 2 diabetes, however, may slow the current favorable trends for deaths attributable to CVD in many developed countries. To improve control of risk factors for CVD, Wald and Law proposed a "polypill," containing a statin, a diuretic, a beta-blocker, an angiotensin-converting enzyme inhibitor, aspirin, and folic acid. This combination pharmacotherapy (CP) could be made widely available without treating specific risk factors or individuals. A workshop sponsored by the Centers for Disease Control and Prevention reviewed the concept of CP for both primary and secondary prevention. Combination pharmacotherapy may prove to be efficacious but may also have side effects and poor adherence, which may be greater than or less than that of other preventive approaches. Randomized trials are needed to study these issues, although the design for such trials is uncertain. The ability of CP to prevent CVD in a cost-effective manner must be demonstrated. Minority groups and people with low socioeconomic status in the United States have an increased risk for CVD, and the effectiveness of such pharmacotherapy must be considered for these populations. Combination pharmacotherapy may prove especially effective in the developing world, where studies of CP may precede those done in wealthier countries. Combination pharmacotherapy may have tremendous potential, but additional study and detailed evaluation are necessary.

Cardiovascular Agents↗

Traditional and non-traditional risk factors as contributors to atherosclerotic cardiovascular disease in end-stage renal disease.

Cardiovascular disease (CVD) remains the main cause of morbidity and mortality in patients with end-stage renal disease (ESRD). Although traditional risk factors, such as diabetes mellitus, hypertension, dyslipidemia and advanced age, are prevalent in ESRD patients they may not be sufficient by themselves to account for the high prevalence of CVD in patients with this condition. Thus, the search for other, non-traditional, risk factors that may be involved in the pathogenesis of uremic CVD has been an area of intense study. Data suggest that the accelerated atherosclerotic process of ESRD may involve several interrelated processes, such as oxidative stress, endothelial dysfunction and vascular calcification, in a milieu of constant low-grade inflammation. The cause(s) of inflammation in ESRD are multifactorial and, while it may reflect underlying CVD, an acute-phase reaction may also be a direct cause of vascular injury via several pathogenetic mechanisms. Available data suggest that pro-inflammatory cytokines play a central role in the genesis of both malnutrition and CVD in ESRD. Thus, it could be speculated that suppression of the vicious cycle of malnutrition, inflammation and atherosclerosis (MIA syndrome) would improve survival in dialysis patients. Recent evidence has demonstrated strong associations between inflammation and both increased oxidative stress and endothelial dysfunction in ESRD patients. As there is not yet any recognized, or even proposed, treatment for ESRD patients with chronic inflammation it would be of obvious interest to study the long-term effect of various anti-inflammatory treatment strategies on the nutritional and cardiovascular status as well as outcome of these patients.

Adult↗

Postmenopausal hormone replacement therapy and cardiovascular disease.

Cardiovascular disease is the leading cause of mortality in postmenopausal women in developed countries. A possible cardioprotective role of hormone replacement therapy (HRT) is suggested by epidemiologic studies of HRT and reduced risk of coronary heart disease, as well as by randomized trials of HRT and lipid subfractions. Estrogen has beneficial effects on the lipid profile, raising high-density lipoprotein cholesterol levels and reducing low-density lipoprotein cholesterol levels each by approximately 10%. Other possible biologic mechanisms include beneficial effects on vascular function, oxidative status, endothelial-dependent vasodilation, intimal hyperplasia and insulin sensitivity. Estrogen's net effects on coagulation and fibrinolysis are less clear. Estrogen replacement therapy is associated with decreased atherosclerosis in several animal models. However, most of the available data on HRT derive from observational studies or small randomized trials assessing biologic intermediates rather than clinical events. Further research, including large-scale randomized clinical trials, are required to evaluate definitively the role of estrogen replacement therapy, especially given uncertainties about the effects of combined estrogen-progestin therapy and the balance of benefits and risk of this common intervention in postmenopausal women.

Cardiovascular Diseases↗

The role of stem cells for treatment of cardiovascular disease.

Cardiovascular disease is a global cause of mortality and morbidity. Current treatments fail to address the underlying scarring and cell loss, which are the causes of ischaemic heart failure. Cellular transplantation can overcome these problems and new impetus has been injected into this field following the isolation of human embryonic and adult stem cells. These cells have shown remarkable ability to produce cardiomyocytes and vascular cells in vitro and in vivo. Initial transplantation studies have demonstrated functional benefits and it is hoped further randomised clinical trials will concur with initial findings. Much basic science remains to be unearthed, such as the signals for homing, differentiation and engraftment of transplanted cells. Further matters of concern are the role of cell fusion and the mechanisms by which transplanted cells improve cardiac function. In spite of initial progress made in stem cell therapy there is still much to be done and we are some way off from achieving the goal of effective cellular regeneration.

Adult↗

Don't lose heart--therapeutic value of apoptosis prevention in the treatment of cardiovascular disease.

Cardiovascular disease is a leading cause of death worldwide. Loss of function or death of cardiomyocytes is a major contributing factor to these diseases. Cell death in conditions such as heart failure and myocardial infarction is associated with apoptosis. Apoptotic pathways have been well studied in non-myocytes and it is thought that similar pathways exist in cardiomyocytes. These pathways include death initiated by ligation of membrane-bound death receptors, release of pro-apoptotic factors from mitochondria or stress at the endoplasmic reticulum. The key regulators of apoptosis include inhibitors of caspases (IAPs), the Bcl-2 family of proteins, growth factors, stress proteins, calcium and oxidants. The highly organized and predictive nature of apoptotic signaling means it is amenable to manipulation. A thorough understanding of the apoptotic process would facilitate intervention at the most suitable points, alleviating myocardium decline and dysfunction. This review summarizes the mechanisms underlying apoptosis and the mediators/regulators involved in these signaling pathways. We also discuss how the potential therapeutic value of these molecules could be harnessed.

Animals↗

Pharmaceutical thrombosis prevention in cardiovascular disease.

Cardiovascular diseases are a leading cause of morbidity and mortality in modern society. As a result of this, great efforts have been made to establish regimens for prophylaxis and treatment of such disorders. Pharmacological intervention is also a prerequisite for the success of other therapeutic approaches, e.g. coronary angioplasty. Prevention of platelet aggregation is a goal that can be achieved by counteracting various receptors on the platelet surface. The main attentions for such interventions are focused on inhibiting the glycoprotein IIb/IIIa receptor. So far, they are limited to intravenous usage. Adenosine diphosphate receptor inhibitors are available for intravenous and oral usage. Their effect is, at least partly, also exerted via the counteraction of adenosine diphosphate-mediated activation of the glycoprotein IIb/IIIa complex. An oral direct thrombin inhibitor is under clinical evaluation. This review focuses on atherothrombotic disorders, but recent advances within new fields of anticoagulation (i.e., treatment of severe septic shock and a novel approach to prevent thromboembolic disorder during surgery) should not be overlooked.

Cardiovascular Diseases↗

A legal framework for preventing cardiovascular diseases.

Cardiovascular diseases are major contributors to death, disability, disparities, and reduced quality of life in the United States. Successful prevention and control of these diseases requires a comprehensive approach applied across multiple public health settings and in all life stages. Individual lifestyle and behavior change, as well as the broader social, environmental, and policy changes that enable healthy lifestyles, are necessary. Legal strategies can be powerful tools in this endeavor. This review presents seven such strategies applicable at the federal, state, and local levels that can be employed by healthcare providers, public health practitioners, legislators, and other policymakers. They include direct regulation, economic incentives and disincentives, indirect regulation through private enforcement, government as information provider, government as direct provider of services, government as employer and landlord, and laws directed at other levels of government. These strategies may be accomplished through legislation or administrative changes in practices or procedures. Effective use of these strategies requires a broader understanding of the advantages and limitations of legal frameworks and the importance of tailoring strategies to local conditions and resources. Examples of key roles that health professionals can play in advancing such an understanding are presented.

Cardiovascular Diseases↗