Cardiovascular risk factors in children are increasing at an alarming rate in the western world. However, there is limited information regarding these in the South Asian children. This review attempts at summarizing such evidence. South Asians are remarkable for the earlier onset of adult cardiovascular disease (CVD) by almost a decade compared to the Caucasians. We identified published literature, mainly on PubMed, Embase and Cochrane library using specific search terms such as lipid abnormalities, high blood pressure, hyperglycemia, tobacco use, obesity, physical inactivity, and unhealthy dietary practices. Atherosclerotic CVD processes begin early in childhood and are influenced over the life course by genetic and potentially modifiable risk factors and environmental exposure. 80% of adult CVD burden will fall on the developing nations by 2020. The concept of primordial prevention is fast emerging as a necessary prevention tool to curb adult CVD epidemic. Established guidelines and proven preventive strategies on cardiovascular health exist; however, are always implemented half-heartedly. Composite screening and prediction tools for adults can be adapted and validated in children tailored to South Asian population. South Asian children could be at a greater risk of developing cardiovascular risk factors at an earlier stage, thus, timely interventions are imperative.
Prasad, Duggirala Sivaram; Kabir, Zubair; Dash, Ashok Kumar; Das, Bhagabati Charan
The chemotherapy of epidemic diseases in tropical countries poses important practical problems which tend to be underestimated in those western countries where patients can be admitted to a hospital, precisely diagnosed and given the drug appropriate to t...
D. A. Warrell P. L. Perine D. W. Krause
This study was designed to assess students' perceptions of the obstacles to positive dietary practices and increased physical activity and to solicit the students' recommendations for addressing and possibly reducing the negative practices that are associated with the rise in obesity and the development of cardiovascular diseases. Data for the study were obtained from the administration of the 2005 Project Health High School Survey (PHHSS) which measured the students' perceptions regarding obstacles to eating more nutritious, healthier foods and obstacles to participating in daily physical activity. The reasons for students' lack of interest in practicing more life-healthy behaviors are ranked and recorded. Some of the students indicated that they usually ate what they liked to eat, and the decision about what to eat was made because of the taste of the food without regard for any health consequence or negative health outcomes. Finding ways to reach these students at their young ages is the key to successfully combating the high prevalence of obesity and the development of other chronic diseases in childhood, as well as in adulthood. PMID:16968973
Addison, Clifton C; White, Monique S; Jenkins, Brenda W; Young, Lavon
This model can be used to create a virtual population to observe how different factors might affect the spread of a disease. Scientists often use computer models to study complicated phenomena like epidemics. This model is a simplified simulation of any disease that is spread through human contact.
Cardiovascular disease (CVD) is the most frequent and costly complication of type 2 diabetes. In this review, we examine the\\u000a impact of diabetes on CVD. Shedding some light on the diabetes\\/CVD relationship are epidemiologic studies, which focused on\\u000a Native Americans, who collectively experienced little or no diabetes or CVD in the past, but experience both conditions in\\u000a epidemic proportions today.
Barbara V. Howard; Michelle F. Magee
As a manifestation of the epidemiologic transition being experienced throughout the developing world, the prevalence of diabetes mellitus (DM) is increasing. However, whether an individual's risk of cardiovascular diseases as a consequence of DM is also higher in these countries is unknown. We conducted a case-control study at the medical center in the state of Qatar comparing the prevalence of DM in 512 patients who were admitted with acute myocardial infarctions (MI) and 262 cases of cerebrovascular accidents (CVA) to 382 hospital and outpatient controls to calculate the odds ratios (OR) associated with DM for MI and CVA. The OR for MI was estimated to be 4.01 compared to 2.92 for other countries in the Middle East and 1.75 for North America. The OR was even higher for Qatari natives. Understanding the reasons for this increase, including genetic differences, lifestyle, and medical management issues, is critical for the design and prioritization of effective interventions.
Mushlin, Alvin I.; Christos, Paul J.; Abu-Raddad, Laith; Chemaitelly, Hiam; Deleu, Dirk; Gehani, Abdul Razak
This special issue of International Journal of Environmental Research and Public Health is dedicated to leptospirosis, an endemic zoonotic disease that is a cause of many acute undifferentiated fevers, especially in tropical countries. While it can be debated whether leptospirosis is an emerging disease, it is evident that it is becoming an emerging public health problem. It is recognized as a disease of epidemic potential that has a significant health impact in many parts of the world. PMID:24351743
Schneider, Maria Cristina; Jancloes, Michel; Buss, Daniel F; Aldighieri, Sylvain; Bertherat, Eric; Najera, Patricia; Galan, Deise I; Durski, Kara; Espinal, Marcos A
Hyperhomocysteinemia is an independent risk factor for cardiovascular disease. Despite the well-known effectiveness of vitamin supplementation in reducing homocysteine levels, it is not known whether lowering of homocysteine levels is associated with a reduction in cardiovascular morbidity and mortality. The aim of this review is to discuss the epidemiologic evidence about the relation between homocysteine and cardiovascular disease, the pathophysiologic
Arduino A Mangoni; Stephen H. D Jackson
Summary. The burden of cardiovascular disease (CVD), especially ischemic heart disease and stroke, varies remarkably between regions of the world, with declining rates in Europe, North America, and Australia\\/New Zealand, burgeoning epidemics in the former socialist economies and India, and relatively lower impact in developing regions such as sub-Saharan Africa. The basis for a prediction of a global CVD epidemic
Thomas A. Pearson
There is a looming global epidemic of obesity and diabetes. Of all the end-organ effects caused by diabetes, the cardiovascular system is particularly susceptible to the biologic perturbations caused by this disease, and many patients may die from diabetes-related cardiovascular complications. Substantial progress has been made in understanding the pathobiology of the diabetic vasculature and heart. Clinical studies have illuminated the optimal way to treat patients with cardiovascular manifestations of this disease. This article reviews these aspects of diabetes and the cardiovascular system, broadly classified into diabetic vascular disease, diabetic cardiomyopathy, and the clinical management of the diabetic cardiovascular disease patient. PMID:24582091
Kovacic, Jason C; Castellano, Jose M; Farkouh, Michael E; Fuster, Valentin
Hyperphosphatemia is a major risk factor for death, cardiovascular events and vascular calcification among patients with and without kidney disease. Even serum phosphate levels within the “normal laboratory range” associate with a greater risk of death and cardiovascular events. Potential mechanisms by which increased phosphate results in adverse outcomes are incompletely understood but current evidence suggests a direct effect of phosphate on vascular calcification and modulation of key hormones fibroblast growth factor-23 and calcitriol. Despite convincing epidemiologic connections between phosphate excess and cardiovascular disease, no clinical trials have been conducted to establish a causal relationship and large, randomized trials with hard endpoints are urgently needed to prove or disprove the benefits and risks of therapy.
Kendrick, Jessica; Kestenbaum, Brian; Chonchol, Michel
Despite advances in the prevention and management of cardiovascular disease (CVD), this group of multifactorial disorders remains a leading cause of mortality worldwide. CVD is associated with multiple genetic and modifiable risk factors; however, known environmental and genetic influences can only explain a small part of the variability in CVD risk, which is a major obstacle for its prevention and
Caren E. Smith; José M. Ordovás
THIS PAPER REVIEW SEASONAL PATTERNS ACROSS TWELVE CARDIOVASCULAR DISEASES: Deep venous thrombosis, pulmonary embolism, aortic dissection and rupture, stroke, intracerebral hemorrhage, hypertension, heart failure, angina pectoris, myocardial infarction, sudden cardiac death, venricular arrythmia and atrial fibrillation, and discuss a possible cause of the occurrence of these diseases. There is a clear seasonal trend of cardiovascular diseases, with the highest incidence occurring during the colder winter months, which have been described in many countries. This phenomenon likely contributes to the numbers of deaths occurring in winter. The implications of this finding are important for testing the relative importance of the proposed mechanisms. Understanding the influence of season and other factors is essential when seeking to implement effective public health measures. PMID:23724401
Aim: The aim of the study was to study the abnormalities in the cardiovascular profile in postmenopausal Indian women and to compare the same with the cardiovascular profile of pre menopausal Indian women belonging to the same age group; taken as controls. The goal was to throw some light on the cardiovascular risk in postmenopausal women of the Indian population as this population is thought to be at higher risk than their western counterparts and significant studies of the same kind in this population have been few. Materials and Methods: A cross-sectional comparative study on 100 women who were either postmenopausal or premenopausal and were between the age group of 40 to 55 years was carried out over a period of ten months at our hospital. The variations in the cardiovascular profile between both groups were studied. All the women were subjected to a detailed history, thorough examination, investigations and imaging studies. Results: The evaluation revealed that Coronary Artery Disease (CAD), hypertension, abnormal Body Mass Index (BMI) and abnormal Waist Hip Ratio (WHR) were significantly higher in the postmenopausal group as compared to the premenopausal group. The post menopausal women had significantly higher prevalence of abnormal lipid profiles as compared to their premenopausal counterparts. The postmenopausal women with a normal lipid profile also had increased prevalence of CAD and SAHT, which emphasizes the non-lipid cardiovascular benefits of estrogen. Conclusion: Thus, we can conclude that cardiovascular disease was more common in postmenopausal women of age group 40-55 years as compared to those not yet achieved menopause in a population of western Indian women. And this risk was significantly associated with central obesity, an abnormal lipid profile and the postmenopausal state in itself. PMID:24701484
Dosi, Rupal; Bhatt, Nikita; Shah, Priyanki; Patell, Rushad
Considerable evidence suggests that lycopene, a carotenoid without provitamin A activity found in high concentrations in a small set of plant foods, has significant antioxidant potential in vitro and may play a role in preventing prostate cancer and cardiovascular disease in humans. Tomato products, including ketchup, tomato juice, and pizza sauce, are the richest sources of lycopene in the US diet, accounting for >80% of the total lycopene intake of Americans. Unlike other carotenoids, lycopene is not consistently lower among smokers than among nonsmokers, suggesting that any possible preventive activity is not as an antioxidant. Instead, lycopene may have a cholesterol synthesis-inhibiting effect and may enhance LDL degradation. Available evidence suggests that intimal wall thickness and risk of myocardial infarction are reduced in persons with higher adipose tissue concentrations of lycopene. The question of whether lycopene helps to prevent cardiovascular disease can only be answered by a trial specifically evaluating its effectiveness in this area. PMID:10837319
Arab, L; Steck, S
Obesity has reached epidemic proportions and is a significant public health concern. Obesity is associated with increased diabetes, cardiovascular and kidney disease, and associated morbidity and mortality. Despite the increasing public health problem of obesity, there is a dearth of effective treatment options. Following the FDA mandated withdrawal of sibutramine, the treatment options for obesity were limited to orlistat as the only pharmacological treatment option for long term management of obesity. Recently two new medications (Belviq and Qsymia) were approved by FDA for long term management of obesity. Many other anti-obesity drugs are under development. Bariatric surgery has been shown to be effective in the treatment of obesity and its comorbidities. The available data suggests that even modest weight loss improves diabetes and cardiovascular disease (CVD) risk factors. We summarize the treatment options for obesity and the efficacy of these options in ameliorating cardiovascular risk factors. We also focus on the recently approved anti-obesity drugs.
Jindal, Ankur; Whaley-Connell, Adam; Brietzke, Stephen; Sowers, James R
Obesity has reached epidemic proportions and is a significant public health concern. Obesity is associated with increased diabetes, cardiovascular and kidney disease, and associated morbidity and mortality. Despite the increasing public health problem of obesity, there is a dearth of effective treatment options. Following the FDA mandated withdrawal of sibutramine, the treatment options for obesity were limited to orlistat as the only pharmacological treatment option for long-term management of obesity. Recently two new medications (Belviq and Qsymia) were approved by FDA for long-term management of obesity. Many other antiobesity drugs are under development. Bariatric surgery has been shown to be effective in the treatment of obesity and its comorbidities. The available data suggest that even modest weight loss improves diabetes and cardiovascular disease (CVD) risk factors. We summarize the treatment options for obesity and the efficacy of these options in ameliorating cardiovascular risk factors. We also focus on the recently approved antiobesity drugs. PMID:23332347
Jindal, Ankur; Whaley-Connell, Adam; Brietzke, Stephen; Sowers, James R
Cardiovascular disease is the leading cause of mortality worldwide. Arsenic is a ubiquitous metalloid in the crust of the earth. Chronic arsenic poisoning is becoming an emerging epidemic in Asia. Epidemiological studies have shown that chronic arsenic poisoning through ingestion of arsenic-contaminated water is associated with various cardiovascular diseases in dose–response relationships. These cardiovascular disorders include carotid atherosclerosis detected by
Chih-Hao Wang; Chuhsing Kate Hsiao; Chi-Ling Chen; Lin-I Hsu; Hung-Yi Chiou; Shu-Yuan Chen; Yu-Mei Hsueh; Meei-Maan Wu; Chien-Jen Chen
NOD-like receptors (NLRs) constitute a recently identified family of macromolecules that participate in regulation of innate immune responses. To date, 23 members of the NLR family are identified in humans. Diverse NLRs are stimulated by a broad range of pathogen- or danger-associated molecular patterns, and collectively function as intracellular pattern recognition receptors (PRRs). The most studied inflammasomes are NLRP1 and NLRP3 that process inactive pro-caspase-1 to its active form, allowing the cleavage and subsequent activation of pro-IL-1? and pro-IL-18, and initiation of inflammatory responses. Three models, based upon extracellular ATP/K+ flux, lysosomal release of cathepsin, and reactive oxygen species, have been proposed to be involved in signaling activation of NLRs and downstream events. In this review, I discuss the current state of knowledge related to the roles of NLRs and inflammasomes in the development of cardiovascular diseases.
Garg, Nisha Jain
In the special issue “Oxidative Stress in Cardiovascular Disease” authors were invited to submit papers that investigate key questions in the field of cardiovascular free radical biology. The original research articles included in this issue provide important information regarding novel aspects of reactive oxygen species (ROS)-mediated signaling, which have important implications in physiological and pathophysiological cardiovascular processes. The issue also included a number of review articles that highlight areas of intense research in the fields of free radical biology and cardiovascular medicine.
Csanyi, Gabor; Miller, Francis J.
As we know there are two kind of systems in modeling epidemic disease, deterministic systems and stochastic systems. This two systems relate to deterministic and stochastic epidemic disease models, respectively. Almost we use deterministic model for big population size and stochastic model for small population size. To use stochastic models for epidemic disease models, can obtain good results with less error. Study and solving of full stochastic models has not been yet investigated so more. In this article we use the homotopy analysis method to solve the full stochastic susceptible-infective epidemic disease model in disease-free equilibrium point.
Chaharborj, Sarkhosh Seddighi; Mohd Rizam, A. B.; Fudziah, I.
Cardiovascular diseases are a major public health problem worldwide. They are the main cause of death in industrialized countries, while the mortality associated with cardiovascular disease is increasing in less developed countries. The modifiable risk factors for cardiovascular disease are cigarette smoking, hypertension, hyperlipidemia, diabetes mellitus and obesity. Obesity has been recorded in 10%-25% of the population, indicating that poor or inappropriate diet is one of the most common causes of cardiovascular disease. Unhealthy dietary habits including place and way of taking meals, number of daily meals and excessive salt intake from processed foods also contribute to body mass gain. In the present study, dietary habits were assessed in cardiovascular patients versus control group by use of Dietary Habits Questionnaire. Study results showed a statistically significantly higher (P < 0.05) prevalence of inappropriate eating habits in cardiovascular patients (lower number of daily meals, more often skipping breakfast and having dinner) than in control group. In conclusion, many lifestyle and individual behavior modifications are needed in most patients with or at a high risk of cardiovascular disease. PMID:20649073
Nola, Iskra Alexandra; Doko Jelini?, Jagoda; Bergovec, Mijo; Ruzi?, Alen; Persi?, Viktor
A brief review of the present state of knowledge regarding the relationship of water hardness to cardiovascular disease. Also included are recommendations for future research and a statement on the appropriateness of modifying current water treatment prac...
The purpose of this research was to determine if the availability of web-based telehealth nurse support had an effect on psychological and physiological outcomes, support, satisfaction, usage, and communication in persons with cardiovascular (CV) disease ...
C. Polifroni K. Burns P. Neafsey P. L. Chinn S. LaCoursiere
Recent major advances in medical science have introduced a wide variety of treatments against atherosclerosis-based cardiovascular diseases, which has led to a significant reduction in mortality associated with these diseases. However, atherosclerosis-based cardiovascular disease remains a leading cause of death. Furthermore, progress in medical science has demonstrated the pathogenesis of cardiovascular disease to be complicated, with a wide variety of underlying factors. Among these factors, stress is thought to be pivotal. Several types of stress are involved in the development of cardiovascular disease, including oxidative stress, mental stress, hemodynamic stress and social stress. Accumulating evidence indicates that traditional risk factors for atherosclerosis, including diabetes, hyperlipidemia, hypertension and smoking, induce oxidative stress in the vasculature. Oxidative stress is implicated in the pathogenesis of endothelial dysfunction, atherogenesis, hypertension and remodeling of blood vessels. Meanwhile, mental stress is a well-known major contributor to the development of cardiovascular disease. The cardiovascular system is constantly exposed to hemodynamic stress by the blood flow and/or pulsation, and hemodynamic stress exerts profound effects on the biology of vascular cells and cardiomyocytes. In addition, social stress, such as that due to a lack of social support, poverty or living alone, has a negative impact on the incidence of cardiovascular disease. Furthermore, there are interactions between mental, oxidative and hemodynamic stress. The production of reactive oxygen species is increased under high levels of mental stress in close association with oxidative stress. These stress responses and their interactions play central roles in the pathogenesis of atherosclerosis-based cardiovascular disease. Accordingly, the pathophysiological and clinical implications of stress are discussed in this article. PMID:24561512
Vitamin D plays a classical hormonal role in skeletal health by regulating calcium and phosphorus metabolism. Vitamin D metabolites also have physiological functions in nonskeletal tissues, where local synthesis influences regulatory pathways via paracrine and autocrine mechanisms. The active metabolite of vitamin D, 1?,25-dihydroxyvitamin D, binds to the vitamin D receptor that regulates numerous genes involved in fundamental processes of potential relevance to cardiovascular disease, including cell proliferation and differentiation, apoptosis, oxidative stress, membrane transport, matrix homeostasis, and cell adhesion. Vitamin D receptors have been found in all the major cardiovascular cell types including cardiomyocytes, arterial wall cells, and immune cells. Experimental studies have established a role for vitamin D metabolites in pathways that are integral to cardiovascular function and disease, including inflammation, thrombosis, and the renin-angiotensin system. Clinical studies have generally demonstrated an independent association between vitamin D deficiency and various manifestations of degenerative cardiovascular disease including vascular calcification. However, the role of vitamin D supplementation in the management of cardiovascular disease remains to be established. This review summarizes the clinical studies showing associations between vitamin D status and cardiovascular disease and the experimental studies that explore the mechanistic basis for these associations. PMID:24436433
Norman, P E; Powell, J T
Cardiovascular disease encompasses a range of conditions extending from myocardial infarction to congenital heart disease most of which are heritable. Enormous effort has been invested in understanding the genes and specific DNA sequence variants responsible for this heritability. Here, we review the lessons learned for monogenic and common, complex forms of cardiovascular disease. We also discuss key challenges that remain for gene discovery and for moving from genomic localization to mechanistic insights with an emphasis on the impact of next generation sequencing and the use of pluripotent human cells to understand the mechanism by which genetic variation contributes to disease.
Kathiresan, Sekar; Srivastava, Deepak
Atherosclerotic disease of the arteries is a major cause of coronary artery disease, peripheral vascular disease and stroke. Some patients are however not candidate for the standard treatment of angioplasty or bypass surgery. Hence there is tremendous enthusiasm for the utilization of angiogenesis as a therapeutic modality for atherosclerotic arterial disease. This augmentation of physiological neo-vascularization in cardiovascular disease can be achieved through different pathways. In this article we are reviewing the Use of Gene therapy, Protein therapy and cellular therapy.
Al Sabti, Hilal
Only a few decades ago, students of the pathophysiology of cardiovascular disease paid little heed to the involvement of inflammation and immunity. Multiple lines of evidence now point to the participation of innate and adaptive immunity and inflammatory signaling in a variety of cardiovascular conditions. Hence, interest has burgeoned in this intersection. This review will focus on the contribution of innate immunity to both acute injury to the heart muscle itself, notably myocardial infarction, and to chronic inflammation in the artery wall, namely atherosclerosis, the cause of most myocardial infarctions. Our discussion of the operation of innate immunity in cardiovascular diseases will focus on functions of the mononuclear phagocytes, with special attention to emerging data regarding the participation of different functional subsets of these cells in cardiovascular pathophysiology. PMID:23839097
Libby, Peter; Nahrendorf, Matthias; Swirski, Filip K
Dietary supplements and so-called "functional foods" are advertised for primary and secondary prevention of cardiovascular diseases. However, there are no studies available that show that these products reduce "hard cardiovascular outcomes" such as myocardial infarction or stroke. Moreover, some studies have shown that dietary supplementation might do more harm than good. Therefore, prior to a general recommendation more data on safety and effectiveness are necessary. PMID:24937080
Weingärtner, N; Elsässer, A; Weingärtner, O
Transforming growth factor ? (TGF?) family members are involved in a wide range of diverse functions and play key roles in embryogenesis, development and tissue homeostasis. Perturbation of TGF? signaling may lead to vascular and other diseases. In vitro studies have provided evidence that TGF? family members have a wide range of diverse effects on vascular cells, which are highly dependent on cellular context. Consistent with these observations genetic studies in mice and humans showed that TGF? family members have ambiguous effects on the function of the cardiovascular system. In this review we discuss the recent advances on TGF? signaling in (cardio)vascular diseases, and describe the value of TGF? signaling as both a disease marker and therapeutic target for (cardio)vascular diseases.
Pardali, Evangelia; ten Dijke, Peter
Several reproductive issues affect cardiovascular risk in women. Polycystic ovary syndrome is common and may include menstrual irregularities, hirsutism, and metabolic symptoms. Patients with this syndrome have an increased risk of impaired glucose tolerance and dyslipidemia. Hysterectomy is a common gynecologic surgery that may affect estrogen levels in women. There are conflicting data on the cardiovascular risk associated with estrogen use in women after a hysterectomy. Human papillomavirus is a newly identified risk factor for cardiovascular disease (CVD), but the mechanism and effect are still unknown. Contraceptives are the most commonly used prescription drugs among women in the United States. The absolute risk of CVD in young women is low; therefore, the threefold increase in risk that is associated with contraceptives is still low. Estrogen is thought to be the primary concern related to the increased cardiovascular risk associated with combined oral contraceptives. Contraceptive pills also may affect insulin, lipid, and blood pressure levels. PMID:23977829
Schrager, Sarina; Dalby, Jessica; Hayon, Ronni; Fox, Kelita
There is a worldwide epidemic of cardiovascular diseases causing not only a public health issue but also accounting for trillions of dollars of healthcare expenditure. Studies pertaining to epidemiology, pathophysiology, molecular biology, gene identification and genetic linkage maps have been able to lay a strong foundation for both the diagnosis and treatment of cardiovascular medicine. Although the concept of 'epigenetics' is not recent, the term in current usage is extended from the initial concept of 'controlling developmental gene expression and signaling pathways in undifferentiated zygotes' to include heritable changes to gene expression that are not from differences in the genetic code. The impact of epigenetics in cardiovascular disease is now emerging as an important regulatory key player at different levels from pathophysiology to therapeutics. This review focuses on the emerging role of epigenetics in major cardiovascular medicine specialties such as coronary artery disease, heart failure, cardiac hypertrophy and diabetes. PMID:24982752
Abi Khalil, Charbel
There is a worldwide epidemic of cardiovascular diseases causing not only a public health issue but also accounting for trillions of dollars of healthcare expenditure. Studies pertaining to epidemiology, pathophysiology, molecular biology, gene identification and genetic linkage maps have been able to lay a strong foundation for both the diagnosis and treatment of cardiovascular medicine. Although the concept of ‘epigenetics’ is not recent, the term in current usage is extended from the initial concept of ‘controlling developmental gene expression and signaling pathways in undifferentiated zygotes’ to include heritable changes to gene expression that are not from differences in the genetic code. The impact of epigenetics in cardiovascular disease is now emerging as an important regulatory key player at different levels from pathophysiology to therapeutics. This review focuses on the emerging role of epigenetics in major cardiovascular medicine specialties such as coronary artery disease, heart failure, cardiac hypertrophy and diabetes.
Vitamin D deficiency, as well as cardiovascular diseases (CVD) and related risk factors are highly prevalent worldwide and frequently co-occur. Vitamin D has long been known to be an essential part of bone metabolism, although recent evidence suggests that vitamin D plays a key role in the pathophysiology of other diseases, including CVD, as well. In this review, we aim to summarize the most recent data on the involvement of vitamin D deficiency in the development of major cardiovascular risk factors: hypertension, obesity and dyslipidemia, type 2 diabetes, chronic kidney disease and endothelial dysfunction. In addition, we outline the most recent observational, as well as interventional data on the influence of vitamin D on CVD. Since it is still an unresolved issue whether vitamin D deficiency is causally involved in the pathogenesis of CVD, data from randomized controlled trials (RCTs) designed to assess the impact of vitamin D supplementation on cardiovascular outcomes are awaited with anticipation. At present, we can only conclude that vitamin D deficiency is an independent cardiovascular risk factor, but whether vitamin D supplementation can significantly improve cardiovascular outcomes is still largely unknown. PMID:23912328
Kienreich, Katharina; Tomaschitz, Andreas; Verheyen, Nicolas; Pieber, Thomas; Gaksch, Martin; Grübler, Martin R; Pilz, Stefan
Cardiovascular disease is the number one cause of death worldwide. It is broadly defined to include anything which adversely affects the heart or blood vessels. One-third of Americans have one or more forms of it. By one estimate, average human life expectancy would increase by seven years if it were eliminated. The mainstream medical model seeks mostly to "manage" cardiovascular disease with pharmaceuticals or to surgically bypass or reopen blocked vessels via angioplasty. These methods have proven highly useful and saved countless lives. Yet drug therapy may be costly and ongoing, and it carries the risk of side effects while often doing little or nothing to improve underlying health concerns. Similarly, angioplasty or surgery are invasive methods which entail risk. Laser therapy1 regenerates tissue, stimulates biological function, reduces inflammation and alleviates pain. Its efficacy and safety have been increasingly well documented in cardiovascular disease of many kinds. In this article we will explore the effects of laser therapy in angina, atherosclerosis, coronary artery disease, hypertension, hyperlipidemia, myocardial infarction, stroke and other conditions. The clinical application of various methods of laser therapy, including laserpuncture and transcutaneous, supravascular and intravenous irradiation of blood will be discussed. Implementing laser therapy in the treatment of cardiovascular disease offers the possibility of increasing the health and wellbeing of patients while reducing the costs and enhancing safety of medical care.
The evidence linking cardiovascular disease risk and water quality parameters was weighed and analyzed to identify major gaps in understanding reasons for the regional differences in cardiovascular disease mortality in the United States. Epidemiologic stu...
A. P. Watson E. A. Zeighami
Nonalcoholic fatty liver disease (NAFLD) and cardiovascular disease (CVD) are two diseases that are common in the general population. To date, many studies have been conducted and demonstrate a direct link between NAFLD and CVD, but the exact mechanisms for this complex relationship are not well established. A systematic search of the PubMed database revealed that several common mechanisms are involved in many of the local and systemic manifestations of NAFLD and lead to an increased cardiovascular risk. The possible mechanisms linking NAFLD and CVD include inflammation, oxidative stress, insulin resistance, ectopic adipose tissue distribution, dyslipidemia, endothelial dysfunction, and adiponectin, among others. The clinical implication is that patients with NAFLD are at an increased risk of CVD and should undergo periodic cardiovascular risk assessment.
Liu, Hong; Lu, Hong-Yun
1. Major risk factors for coronary heart disease (CHD) are smoking, blood pressure and blood cholesterol and they interact in a multiplicative fashion. Family history of premature coronary heart disease and lack of exercise also contribute. Obesity increases risk probably mainly by its effect on blood cholesterol and blood pressure. Heavy alcohol consumption is a risk factor for stroke. 2. Prevention may be opportunistic or in specially organized clinics, the latter being less likely to result in the attendance of high risk individuals. 3. Worthwhile reductions in cigarette smoking can be achieved by brief advice and follow-up. Literature on smoking and other aspects of prevention is available from the district health education department. 4. Risk scores can be used to calculate the risk of coronary heart disease. They can help to indicate the advisability of measurement of blood cholesterol and to focus limited resources on those at highest risk by helping to define a 'special care group'. 5. Indications for measuring blood cholesterol are: a family history of premature coronary heart disease or hyperlipidaemia, personal history of coronary heart disease, clinical evidence of raised lipids (xanthelasma, corneal arcus under 50, xanthomas at any age), a high risk of coronary heart disease according to a risk score. Many would also include those under treatment for hypertension and diabetes. 6. Dietary advice can moderately reduce blood cholesterol. The proportion of calories from fat should be reduced from the current average of around 40% to a maximum of 33%. Dietary advice should be tailored to the patient's current diet. An increase in vegetables and fruit can be generally advocated. 7. Regular exercise has a worthwhile role to play in prevention. Rapid walking, jogging and swimming may all be suitable, as may be heavy gardening and housework. 8. A small proportion of patients may require lipid-lowering drugs. These include resins (cholestyramine and colestipol), fibrates (eg bezafibrate and gemfibrozil) and more recently HMG CoA inhibitors (eg simvastatin). The HMG CoA inhibitors produce large falls in cholesterol and may become first line drugs in future. Because of the current controversy about the effect of lipid-lowering drugs on total mortality, many believe that they should be reserved for those at the highest risk, for example patients with familial hypercholesterolaemia or with pre-existing coronary heart disease and a high plasma cholesterol (> 7.8 mmol/L). 9. The special care group defined by the practice should be offered regular follow-up.(ABSTRACT TRUNCATED AT 400 WORDS)
Haines, A.; Patterson, D.; Rayner, M.; Hyland, K.
During 2012, an observational study confirmed the high risk of cardiovascular disease ascribed to chronic kidney disease (CKD) and again raised the question of whether CKD should be considered a cardiovascular disease risk equivalent. Several other studies evaluated methods to mitigate cardiovascular risk in CKD. Although the results of these studies have advanced the field they have also raised more questions
Garimella, Pranav S.; Sarnak, Mark J.
Background: Work related dust exposure is a risk factor for acute and chronic respiratory irritation and inflammation. Exposure to dust and cigarette smoke predisposes to exogenous viral and bacterial infections of the respiratory tract. Respiratory infection can also act as a risk factor in the development of atherosclerotic and coronary artery disease. Aims: To investigate the association of dust exposure and respiratory diseases with ischaemic heart disease (IHD) and other cardiovascular diseases (CVDs). Methods: The study comprised 6022 dust exposed (granite, foundry, cotton mill, iron foundry, metal product, and electrical) workers hired in 1940–76 and followed until the end of 1992. National mortality and morbidity registers and questionnaires were used. The statistical methods were person-year analysis and Cox regression. Results: Co-morbidity from cardiovascular and respiratory diseases ranged from 17% to 35%. In at least 60% of the co-morbidity cases a respiratory disease preceded a cardiovascular disease. Chronic bronchitis, pneumonia, and upper respiratory track infections predicted IHD in granite workers (rate ratio (RR) = 1.9; 95% CI 1.38 to 2.72), foundry workers (2.1; 1.48 to 2.93), and iron foundry workers (1.7; 1.16 to 2.35). Dust exposure was not a significant predictor of IHD or other CVD in any group. Dust exposure was related to respiratory morbidity. Thus, some respiratory diseases appeared to act as intermediate variables in the association of dust exposure with IHD. Conclusion: Dust exposure had only a small direct effect on IHD and other CVD. IHD morbidity was associated with preceding respiratory morbidity. A chronic infectious respiratory tract disease appeared to play an independent role in the development of IHD.
Koskela, R; Mutanen, P; Sorsa, J; Klockars, M
A paradigm shift towards biology occurred in the 1990’s subsequently catalyzed by the sequencing of the human genome in 2000. The cost of DNA sequencing has gone from millions to thousands of dollars with sequencing of one’s entire genome costing only $1,000. Rapid DNA sequencing is being embraced for single gene disorders, particularly for sporadic cases and those from small families. Transmission of lethal genes such as associated with Huntington’s disease can, through in-vitro fertilization, avoid passing it on to one’s offspring. DNA sequencing will meet the challenge of elucidating the genetic predisposition for common polygenic diseases, especially in determining the function of the novel common genetic risk variants and identifying the rare variants, which may also partially ascertain the source of the missing heritability. The challenge for DNA sequencing remains great, despite human genome sequences being 99.5% identical, the 3 million single nucleotide polymorphisms (SNPs) responsible for most of the unique features add up to 60 new mutations per person which, for 7 billion people, is 420 billion mutations. It is claimed that DNA sequencing has increased 10,000 fold while information storage and retrieval only 16 fold. The physician and health user will be challenged by the convergence of two major trends, whole genome sequencing and the storage/retrieval and integration of the data.
Roberts, Robert; Marian, A.J.; Dandona, Sonny; Stewart, Alexandre F.R.
Fabry disease (FD, OMIM 301500) is a rare X-linked lysosomal storage disorder of the glycosphigolipid metabolism caused by total or partial deficiency of the lysosomal enzyme alpha-galactosidase A (?-gal A). Progressive intralysosomal accumulation of neutral glycosphingolipids in a variety of cell types triggers a cascade of pathophysiological events including cellular death, compromised energy metabolism, small vessel injury, K(Ca)3.1 channel dysfunction in endothelial cells, oxidative stress, impaired autophagosome maturation, tissue ischemia and, importantly, development of irreversible cardiac and renal tissue fibrosis, leading to major multisystemic manifestations. Cardiovascular complications of the disease are very frequent and contribute substantially to disease-related morbidity and mortality in men. Cardiovascular involvement is the leading cause of premature death in heterozygous female patients with FD. Left ventricular hypertrophy is the most prominent cardiac manifestation followed by conduction system disease, valve dysfunction, arrhythmias, vessel disease and coronary microvascular dysfunction. The diagnosis of subclinical forms of the disease, before the development of cardiac hypertrophy, using newer techniques (tissue doppler imaging, strain rate and cardiac magnetic resonance) is crucial to the early initation of the treatment. Greatest benefit of the enzyme replacement treatment is achieved when started at an early stage of the disease before extensive fibrosis or other irreversible tissue damage takes place. Fabry disease should be included in the differential diagnosis algorithm of idiopathic hypertrophy. Determination of Alpha-Gal A activity on plasma and peripheral leukocytes in males and genetic testing in females are the diagnostic gold-standards. PMID:23448453
Anastasakis, Aris; Papatheodorou, Efstathios; Steriotis, Alexandros Klavdios
Emerging infectious diseases pose a growing threat to human populations. Many of the world’s epidemic diseases (particularly those transmitted by intermediate hosts) are known to be highly sensitive to long-term changes in climate and short-term fluctuations in the weather. The application of environmental data to the study of disease offers the capability to demonstrate vector–environment relationships and potentially forecast the risk of disease outbreaks or epidemics. Accurate disease forecasting models would markedly improve epidemic prevention and control capabilities. This chapter examines the potential for epidemic forecasting and discusses the issues associated with the development of global networks for surveillance and prediction. Existing global systems for epidemic preparedness focus on disease surveillance using either expert knowledge or statistical modelling of disease activity and thresholds to identify times and areas of risk. Predictive health information systems would use monitored environmental variables, linked to a disease system, to be observed and provide prior information of outbreaks. The components and varieties of forecasting systems are discussed with selected examples, along with issues relating to further development.
Myers, M.F.; Rogers, D.J.; Cox, J.; Flahault, A.; Hay, S.I.
Emerging infectious diseases pose a growing threat to human populations. Many of the world's epidemic diseases (particularly those transmitted by intermediate hosts) are known to be highly sensitive to long-term changes in climate and short-term fluctuations in the weather. The application of environmental data to the study of disease offers the capability to demonstrate vector-environment relationships and potentially forecast the risk of disease outbreaks or epidemics. Accurate disease forecasting models would markedly improve epidemic prevention and control capabilities. This chapter examines the potential for epidemic forecasting and discusses the issues associated with the development of global networks for surveillance and prediction. Existing global systems for epidemic preparedness focus on disease surveillance using either expert knowledge or statistical modelling of disease activity and thresholds to identify times and areas of risk. Predictive health information systems would use monitored environmental variables, linked to a disease system, to be observed and provide prior information of outbreaks. The components and varieties of forecasting systems are discussed with selected examples, along with issues relating to further development.
Myers, M. F.; Rogers, D. J.; Cox, J.; Flahault, A.; Hay, S. I.
Erectile dysfunction is a highly prevalent disease, especially in cardiovascular-compromised men. Many of the well-established risk factors for cardiovascular disease are also risk factors for erectile dysfunction. A correlation between erectile dysfunction and endothelial dysfunction is well established. It is postulated that erectile dysfunction with an arteriovascular aetiology can predate and be an indicator of potential coronary artery disease. In this paper we will attempt to increase awareness among cardiologists for the predictive value of erectile dysfunction for future cardiovascular disease in order to optimise cardiovascular risk management. The treatment of erectile dysfunction and cardiovascular interactions is also discussed in detail. ImagesFigure 1AFigure 1B
Ophuis, A.J.M. Oude; Nijeholt, A.A.B. Lycklama a
BACKGROUND There is growing awareness of an association between cardiovascular disease and fractures, and a temporal increase in fracture risk after myocardial infarction has been identified. To further explore the nature of this relationship, we systematically examined the association of hip fracture with all disease categories and assessed related secular trends. METHODS Using resources of the Rochester Epidemiology Project, a population-based incident case-control study was conducted. Disease history was compared between all Olmsted County, Minnesota, residents aged 50 years or older with a first radiographically confirmed hip fracture in 1985–2006 and community control subjects individually matched (1:1) to cases on age, sex, and index year (n=3,808; mean age [SD], 82  years; 76% women). RESULTS All cardiovascular and numerous non-cardiovascular disease categories (e.g., infectious diseases, nutritional and metabolic diseases, mental disorders, diseases of the nervous system and sense organs, and diseases of the respiratory system) were associated with fracture risk. However, increasing temporal trends were almost exclusively detected in cardiovascular disease categories. The largest increases in association were observed for ischemic heart disease, other forms of heart disease (including heart failure), hypertension, and diabetes and were more pronounced among elderly women than among other demographic subgroups. CONCLUSIONS While the association with hip fracture was not specific to cardiovascular disease, temporal increases were mainly detected in cardio-metabolic diseases, all of which have also been linked previously to frailty. This mechanism and others warrant further investigation.
Gerber, Yariv; Melton, L. Joseph; McNallan, Sheila M.; Jiang, Ruoxiang; Weston, Susan A.; Roger, Veronique L.
The prevalence of diabetes mellitus will likely increase globally from 371 million individuals in 2013 to 552 million individuals in 2030. This epidemic is mainly attributable to type 2 diabetes mellitus (T2DM), which represents about 90-95% of all cases. Cardiovascular disease is the leading cause of mortality among individuals with diabetes mellitus, and >50% of patients will die from a cardiovascular event-especially coronary artery disease, but also stroke and peripheral vascular disease. Classic risk factors such as elevated levels of LDL cholesterol and blood pressure, as well as smoking, are risk factors for adverse cardiovascular events in patients with type 1 diabetes mellitus (T1DM) and T2DM to a similar degree as they are in healthy individuals. Patients with T1DM develop insulin resistance in the months after diabetes mellitus diagnosis, and patients with T2DM typically develop insulin resistance before hyperglycaemia occurs. Insulin resistance and hyperglycaemia, in turn, further increase the risk of adverse cardiovascular events. This Review discusses the mechanisms by which T1DM and T2DM can lead to cardiovascular disease and how these relate to the risk factors for coronary artery disease. PMID:24663222
Laakso, Markku; Kuusisto, Johanna
Mitochondria are dynamic and are able to interchange their morphology between elongated interconnected mitochondrial networks and a fragmented disconnected arrangement by the processes of mitochondrial fusion and fission, respectively. Changes in mitochondrial morphology are regulated by the mitochondrial fusion proteins (mitofusins 1 and 2, and optic atrophy 1) and the mitochondrial fission proteins (dynamin-related peptide 1 and mitochondrial fission protein 1) and have been implicated in a variety of biological processes including embryonic development, metabolism, apoptosis, and autophagy, although the majority of studies have been largely confined to non-cardiac cells. Despite the unique arrangement of mitochondria in the adult heart, emerging data suggest that changes in mitochondrial morphology may be relevant to various aspects of cardiovascular biology—these include cardiac development, the response to ischaemia–reperfusion injury, heart failure, diabetes mellitus, and apoptosis. Interestingly, the machinery required for altering mitochondrial shape in terms of the mitochondrial fusion and fission proteins are all present in the adult heart, but their physiological function remains unclear. In this article, we review the current developments in this exciting new field of mitochondrial biology, the implications for cardiovascular physiology, and the potential for discovering novel therapeutic strategies for treating cardiovascular disease.
Ong, Sang-Bing; Hausenloy, Derek J.
Abstract Cardiovascular disease (CVD) remains the leading cause of death in people with diabetes, and the risk of CVD for adults with diabetes is at least two to four times the risk in adults without diabetes. Complications of diabetes, including not only CVD but also microvascular diseases such as retinopathy and nephropathy, are a major health and financial burden. Diabetes is a disease of glucose intolerance, and so much of the research on complications has focused on the role of hyperglycemia. Clinical trials have clearly demonstrated the role of hyperglycemia in microvascular complications of diabetes, but there appears to be less evidence for as strong of a relationship between hyperglycemia and CVD in people with diabetes. Hypoglycemia has become a more pressing health concern as intensive glycemic control has become the standard of care in diabetes. Clinical trials of intensive glucose lowering in both type 1 and type 2 diabetes populations has resulted in significantly increased hypoglycemia, with no decrease in CVD during the trial period, although several studies have shown a reduction in CVD with extended follow-up. There is evidence that hypoglycemia may adversely affect cardiovascular risk in patients with diabetes, and this is one potential explanation for the lack of CVD prevention in trials of intensive glycemic control. Hypoglycemia causes a cascade of physiologic effects and may induce oxidative stress and cardiac arrhythmias, contribute to sudden cardiac death, and cause ischemic cerebral damage, presenting several potential mechanisms through which acute and chronic episodes of hypoglycemia may increase CVD risk. In this review, we examine the risk factors and prevalence of hypoglycemia in diabetes, review the evidence for an association of both acute and chronic hypoglycemia with CVD in adults with diabetes, and discuss potential mechanisms through which hypoglycemia may adversely affect cardiovascular risk.
Wadwa, R. Paul
The epidemic of heart failure continues apace, and development of novel therapies with clinical efficacy has lagged. Now, important insights into the molecular circuitry of cardiovascular autophagy have raised the prospect that this cellular pathway of protein quality control may be a target of clinical relevance. Whereas basal levels of autophagy are required for cell survival, excessive levels – or perhaps distinct forms of autophagic flux – contribute to disease pathogenesis. Our challenge will be to distinguish mechanisms that drive adaptive versus maladaptive autophagy and to manipulate those pathways for therapeutic gain. Recent evidence suggests this may be possible. Here, we review the fundamental biology of autophagy and its role in a variety of forms of cardiovascular disease. We discuss ways in which this evolutionarily conserved catabolic mechanism can be manipulated, discuss studies presently underway in heart disease, and provide our perspective on where this exciting field may lead in the future.
Nemchenko, Andriy; Chiong, Mario; Turer, Aslan; Lavandero, Sergio; Hill, Joseph A.
A significant body of evidence demonstrates that diets rich in fruit and vegetables promote health, and attenuate, or delay, the onset of various diseases, including cardiovascular disease (CVD), diabetes, certain cancers, and several other age-related degenerative disorders. The concept that moderate chocolate consumption could be part of a healthy diet has gained acceptance in the last years based on the health benefits ascribed to selected cocoa components. Specifically, cocoa as a plant and chocolate as food contain a series of chemicals that can interact with cell and tissue components providing protection against the development and amelioration of pathological conditions. The most relevant effects of cocoa and chocolate have been related to CVD. The mechanisms behind these effects are still under investigation. However the maintenance or restoration of vascular NO production and bioavailability and the antioxidant effects are the mechanisms most consistently supported by experimental data. This review will summarize the most recent research on the cardiovascular effects of cocoa flavanoles and related compounds.
Galleano, Monica; Oteiza, Patricia I.; Fraga, Cesar G.
Recent insights into myocardial biology uncovered a hereto unknown regenerative capacity of the adult heart. The discovery of dividing cardiomyocytes and the identification and characterization of cardiac stem and progenitor cells with myogenic and angiogenic potential have generated new hopes that cardiac regeneration and repair might become a therapeutic option. During the past decade, multiple candidate cells have been proposed for cardiac regeneration, and their mechanisms of action in the myocardium have been explored. Initial clinical trials have focused on the use of bone marrow-derived cells to promote myocardial regeneration in ischemic heart disease and have yielded very mixed results, with no clear signs of clinically meaningful functional improvement. Although the efficiency of bona fide cardiomyocyte generation is generally low, stem cells delivered into the myocardium act mainly via paracrine mechanisms. More recent studies taking advantage of cardiac committed cells (eg, resident cardiac progenitor cells or primed cardiogenic mesenchymal stem cells) showed promising results in first clinical pilot trials. Also, transplantation of cardiomyogenic cells generated by induced pluripotent stem cells and genetic reprogramming of dividing nonmyocytes into cardiomyocytes may constitute attractive new regenerative approaches in cardiovascular medicine in the future. We discuss advantages and limitations of specific cell types proposed for cell-based therapy in cardiology and give an overview of the first clinical trials using this novel therapeutic approach in patients with cardiovascular disease. PMID:24378637
Pfister, Otmar; Della Verde, Giacomo; Liao, Ronglih; Kuster, Gabriela M
Epidemiologic studies provide increasing evidence that hypertriglyceridemia is a risk factor for cardiovascular disease. A meta-analysis of 17 population-based studies of triglyceride levels and cardiovascular disease identified a 76% increase in cardiovascular disease risk in women and a 31% increase in men associated with a 1 mmol\\/L increase in triglyceride levels. Additional epidemiologic studies have shown that plasma triglyceride levels
Melissa A Austin
Autoimmune diseases, including rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), primary antiphospholipid syndrome (APS), systemic sclerosis and systemic vasculitis, affect a large number of people in whom one of the leading causes of morbidity and mortality is cardiovascular disease. Cardiovascular disease is associated with the development of accelerated atherosclerosis. It seems to occur at a younger age than in the
Simona Sitia; Fabiola Atzeni; Piercarlo Sarzi-Puttini; Vitantonio Di Bello; Livio Tomasoni; Luigi Delfino; Francesco Antonini-Canterin; Giovanni Di Salvo; Vito De Gennaro Colonna; Salvatore La Carrubba; Scipione Carerj; Maurizio Turiel
Americans' recent weight gains have been widely described as an "obesity epidemic." Such a characterization, however, has many problems: the average American weight gain has been relatively low (eight to 12 pounds over the last 20 years), and the causal linkages between adiposity, morbidity, and mortality are unclear. Nevertheless, the media and numerous health officials continue to sound dire warnings that obesity has become an epidemic disease. In this article, I examine how and why America's growing weight became an "obesity epidemic." I find the disease characterization has less to do with the health consequences of excess weight and more with the various financial and political incentives of the weight loss industry, medical profession, and public health bureaucracy. This epidemic image was also assisted by the method of displaying information about weight gain with maps in PowerPoint slides. Such characterizations, I argue, are problematic. Given the inconclusive scientific evidence and the absence of a safe and effective weight loss regimen, calling America's growing weight an epidemic disease is likely to cause more harm than good. PMID:17146144
Oliver, J Eric
Personalized medicine is a novel medical model with all decisions and practices being tailored to individual patients in whatever ways possible. In the era of genomics, personalized medicine combines the genetic information for additional benefit in preventive and therapeutic strategies. Personalized medicine may allow the physician to provide a better therapy for patients in terms of efficiency, safety and treatment length to reduce the associated costs. There was a remarkable growth in scientific publication on personalized medicine within the past few years in the cardiovascular field. However, so far, only very few cardiologists in the USA are incorporating personalized medicine into clinical treatment. We review the concepts, strengths, limitations and challenges of personalized medicine with a particular focus on cardiovascular diseases (CVDs). There are many challenges from both scientific and policy perspectives to personalized medicine, which can overcome them by comprehensive concept and understanding, clinical application, and evidence based practices. Individualized medicine serves a pivotal role in the evolution of national and global healthcare reform, especially, in the CVDs fields. Ultimately, personalized medicine will affect the entire landscape of health care system in the near future.
Lee, Moo-Sik; Flammer, Andreas J.; Lerman, Lilach O.
Non-communicable diseases have been somewhat neglected as a public health issue in the past, but there is now growing international consensus that they present a significant obstacle to economic development for both high- and low-income countries. Cardiovascular disease accounts for more than half of all non-communicable disease deaths, and presents a promising target for curbing the non-communicable disease epidemic. This article explains the pressing need for non-communicable disease prevention, focusing on strategies that can be employed to decrease cardiovascular disease risk at an individual and population level, and outlines the UK’s approaches to cardiovascular disease prevention in particular. Given the mounting burden of non-communicable diseases, responsible health governance and a balanced economic policy could consider the use of low cardiovascular disease rates as a measure of positive and sustainable economic development.
Polyphenols are compounds found in foods such as tea, coffee, cocoa, olive oil, and red wine and have been studied to determine if their intake may modify cardiovascular disease (CVD) risk. Historically, biologic actions of polyphenols have been attributed to antioxidant activities, but recent evidence suggests that immunomodulatory and vasodilatory properties of polyphenols may also contribute to CVD risk reduction. These properties will be discussed, and recent epidemiological evidence and intervention trials will be reviewed. Further identification of polyphenols in foods and accurate assessment of exposures through measurement of biomarkers (i.e., polyphenol metabolites) could provide the needed impetus to examine the impact of polyphenol-rich foods on CVD intermediate outcomes (especially those signifying chronic inflammation) and hard endpoints among high risk patients. Although we have mechanistic insight into how polyphenols may function in CVD risk reduction, further research is needed before definitive recommendations for consumption can be made.
Tangney, Christy; Rasmussen, Heather E.
Multiple factors are involved in the etiology of cardiovascular disease (CVD). Pathological changes occur in a variety of cell types long before symptoms become apparent and diagnosis is made. Dysregulation of physiological functions are associated with the activation of immune cells, leading to local and finally systemic inflammation that is characterized by production of high levels of reactive oxygen species (ROS). Patients suffering from inflammatory diseases often present with diminished levels of antioxidants either due to insufficient dietary intake or, and even more likely, due to increased demand in situations of overwhelming ROS production by activated immune effector cells like macrophages. Antioxidants are suggested to beneficially interfere with diseases-related oxidative stress, however the interplay of endogenous and exogenous antioxidants with the overall redox system is complex. Moreover, molecular mechanisms underlying oxidative stress in CVD are not fully elucidated. Metabolic dybalances are suggested to play a major role in disease onset and progression. Several central signaling pathways involved in the regulation of immunological, metabolic and endothelial function are regulated in a redox-sensitive manner. During cellular immune response, interferon ?-dependent pathways are activated such as tryptophan breakdown by the enzyme indoleamine 2,3-dioxygenase (IDO) in monocyte-derived macrophages, fibroblasts, endothelial and epithelial cells. Neopterin, a marker of oxidative stress and immune activation is produced by GTP-cyclohydrolase?I?in macrophages and dendritic cells. Nitric oxide synthase (NOS) is induced in several cell types to generate nitric oxide (NO). NO, despite its low reactivity, is a potent antioxidant involved in the regulation of the vasomotor tone and of immunomodulatory signaling pathways. NO inhibits the expression and function of IDO. Function of NOS requires the cofactor tetrahydrobiopterin (BH4), which is produced in humans primarily by fibroblasts and endothelial cells. Highly toxic peroxynitrite (ONOO-) is formed solely in the presence of superoxide anion (O2-). Neopterin and kynurenine to tryptophan ratio (Kyn/Trp), as an estimate of IDO enzyme activity, are robust markers of immune activation in vitro and in vivo. Both these diagnostic parameters are able to predict cardiovascular and overall mortality in patients at risk. Likewise, a significant association exists between increase of neopterin concentrations and Kyn/Trp ratio values and the lowering of plasma levels of vitamin-C, -E and -B. Vitamin-B deficiency is usually accompanied by increased plasma homoycsteine. Additional determination of NO metabolites, BH4 and plasma antioxidants in patients with CVD and related clinical settings can be helpful to improve the understanding of redox-regulation in health and disease and might provide a rationale for potential antioxidant therapies in CVD.
Mangge, Harald; Becker, Kathrin; Fuchs, Dietmar; Gostner, Johanna M
Multiple factors are involved in the etiology of cardiovascular disease (CVD). Pathological changes occur in a variety of cell types long before symptoms become apparent and diagnosis is made. Dysregulation of physiological functions are associated with the activation of immune cells, leading to local and finally systemic inflammation that is characterized by production of high levels of reactive oxygen species (ROS). Patients suffering from inflammatory diseases often present with diminished levels of antioxidants either due to insufficient dietary intake or, and even more likely, due to increased demand in situations of overwhelming ROS production by activated immune effector cells like macrophages. Antioxidants are suggested to beneficially interfere with diseases-related oxidative stress, however the interplay of endogenous and exogenous antioxidants with the overall redox system is complex. Moreover, molecular mechanisms underlying oxidative stress in CVD are not fully elucidated. Metabolic dybalances are suggested to play a major role in disease onset and progression. Several central signaling pathways involved in the regulation of immunological, metabolic and endothelial function are regulated in a redox-sensitive manner. During cellular immune response, interferon ?-dependent pathways are activated such as tryptophan breakdown by the enzyme indoleamine 2,3-dioxygenase (IDO) in monocyte-derived macrophages, fibroblasts, endothelial and epithelial cells. Neopterin, a marker of oxidative stress and immune activation is produced by GTP-cyclohydrolase?I?in macrophages and dendritic cells. Nitric oxide synthase (NOS) is induced in several cell types to generate nitric oxide (NO). NO, despite its low reactivity, is a potent antioxidant involved in the regulation of the vasomotor tone and of immunomodulatory signaling pathways. NO inhibits the expression and function of IDO. Function of NOS requires the cofactor tetrahydrobiopterin (BH4), which is produced in humans primarily by fibroblasts and endothelial cells. Highly toxic peroxynitrite (ONOO(-)) is formed solely in the presence of superoxide anion (O2 (-)). Neopterin and kynurenine to tryptophan ratio (Kyn/Trp), as an estimate of IDO enzyme activity, are robust markers of immune activation in vitro and in vivo. Both these diagnostic parameters are able to predict cardiovascular and overall mortality in patients at risk. Likewise, a significant association exists between increase of neopterin concentrations and Kyn/Trp ratio values and the lowering of plasma levels of vitamin-C, -E and -B. Vitamin-B deficiency is usually accompanied by increased plasma homoycsteine. Additional determination of NO metabolites, BH4 and plasma antioxidants in patients with CVD and related clinical settings can be helpful to improve the understanding of redox-regulation in health and disease and might provide a rationale for potential antioxidant therapies in CVD. PMID:24976919
Mangge, Harald; Becker, Kathrin; Fuchs, Dietmar; Gostner, Johanna M
Cardiovascular disease is the most important adult health problem in wealthy countries, where biological factors such as obesity, hypertension, dyslipidemia, diabetes, inappropriate diet, cigarette smoking, and sedentary life-style have contributed to its dissemination. Research concerning nutritional regimens has shown that persons who consume large amounts of fruit and vegetables have lower incidences of cardiovascular diseases, stroke, and tumors, although the
Graziano Riccioni; Tonino Bucciarelli; Barbara Mancini; Francesco Corradi; Carmine Di Ilio; Peter A. Mattei; Nicolantonio D'Orazio
Major and profound changes have taken place in China over the past 30 years. Rapid socioeconomic progress has exerted a great impact on lifestyle, ranging from food, clothing, working and living conditions, and means of transportation to leisure activities and entertainment. At the same time, new health problems have emerged, and health services are facing new challenges. Presently, cardiovascular diseases (CVD) are among the top health problems of the Chinese people, and pose a serious challenge to all engaged in the prevention and control of these diseases. An epidemic of CVD in China is emerging as a result of lifestyle changes, urbanization and longevity. Both national policy decision-making and medical practice urgently need an authoritative report which comprehensively reflects the trends in the epidemic of CVD and current preventive measures. Since 2005, guided by the Bureau of Disease Prevention of the Ministry of Health of the People's Republic of China and the National Center for Cardiovascular Diseases of China, nationwide experts in the fields of epidemiology, clinical medicine and health economics in the realms of CVD, cerebrovascular disease, diabetes and chronic kidney disease, completed the Report on Cardiovascular Diseases in China every year. The report aims to provide a timely review of the trend of the epidemic and to assess the progress of prevention and control of CVD. In addition, as the report is authoritative, representative and readable, it will become an information platform in the CVD field and an important reference book for government, academic institutes, medical organizations and clinical physicians. This publication is expected to play a positive role in the prevention and control of CVD in China. We present an abstract from the Report on Cardiovascular Diseases in China (2010), including trends in CVD, morbidity and mortality of major CVDs, up-to-date assessment of risk factors, as well as health resources for CVD, and a profile of medical expenditure, with the aim of providing evidence for decision-making in CVD prevention and control programs in China, and of delivering the most authoritative information on CVD prevention and control for all citizens. PMID:22840574
Hu, Sheng Shou; Kong, Ling Zhi; Gao, Run Lin; Zhu, Man Lu; Wang, Wen; Wang, Yong Jun; Wu, Zhao Su; Chen, Wei Wei; Liu, Ming Bo
The growing incidence of diabetes mellitus and the continuing epidemic of cardiovascular disease associated with this ailment\\u000a have induced numerous investigators to seek evidence of pre-clinical disease besides trying to diagnose advanced stages of\\u000a disease. Although many of the techniques used in the general population to diagnose obstructive coronary artery disease have\\u000a proven of value, it appears that the overall
Paolo Raggi; Leslee J. Shaw
Objective: Obesity, despite being a significant determinant of fitness for duty, is reaching epidemic levels in the workplace. Firefighters’ fitness is important to their health and to public safety.Research Methods and Procedures: We examined the distribution of BMI and its association with major cardiovascular disease (CVD) risk factors in Massachusetts firefighters who underwent baseline (1996) and annual medical examinations through
Elpidoforos S. Soteriades; Russ Hauser; Ichiro Kawachi; Dimitrios Liarokapis; David C. Christiani; Stefanos N. Kales
Ambient air pollution (AAP) and particulate matters (PM) have been closely associated with adverse health effects such as respiratory disease and cardiovascular diseases. Previous studies have examined the adverse health effects associated with short- and long-term exposure to AAP and outdoor PM on respiratory disease. However, the effect of PM size (PM2.5 and PM10) on cardiovascular disease has not been well studied. Thus, it remains unclear how the size of the inhalable particles (coarse, fine, or ultrafine) affects mortality and morbidity. Airborne PM concentrations are commonly used for ambient air quality management worldwide, owing to the known effects on cardiorespiratory health. In this article, we assess the relationship between cardiovascular diseases and PM, with a particular focus on PM size. We discuss the association of PM2.5 and PM10, nitrogen dioxide (NO2), and elemental carbon with mortality and morbidity due to cardiovascular diseases, stroke, and altered blood pressure, based on epidemiological studies. In addition, we provide evidence that the adverse health effects of AAP and PM are more pronounced among the elderly, children, and people with preexisting cardiovascular and respiratory conditions. Finally, we critically summarize the literature pertaining to cardiovascular diseases, including atherosclerosis and stroke, and introduce potential studies to better understand the health significance of AAP and PM on cardiovascular disease.
Lee, Byeong-Jae; Kim, Bumseok
Cardiovascular disease is the leading cause of mortality worldwide. Arsenic is a ubiquitous metalloid in the crust of the earth. Chronic arsenic poisoning is becoming an emerging epidemic in Asia. Epidemiological studies have shown that chronic arsenic poisoning through ingestion of arsenic-contaminated water is associated with various cardiovascular diseases in dose-response relationships. These cardiovascular disorders include carotid atherosclerosis detected by ultrasonography, impaired microcirculation, prolonged QT interval and increased QT dispersion in electrocardiography, and clinical outcomes such as hypertension, blackfoot disease (a unique peripheral vascular disease endemic in southwestern Taiwan), coronary artery disease and cerebral infarction. Chronic arsenic poisoning is an independent risk factor for cardiovascular disease. The adverse cardiovascular effects of long-term arsenic exposure may be persistent and/or irreversible. Arsenic-induced cardiovascular diseases in human population may result from the interaction among genetic, environment and nutritional factors. The major adverse cardiovascular effect of chronic arsenic poisoning has been established qualitatively and quantitatively in the high arsenic exposure areas, but the low-dose effect of arsenic on cardiovascular diseases remains to be explored. Cardiovascular death is the major cause of mortality worldwide, and a small increased risk may imply a large quantity of excess mortality.
Wang, C.-H.; Hsiao, C.K.; Chen, C.-L.; Hsu, L.-I; Chiou, H.-Y.; Chen, S.-Y.; Hsueh, Y.-M.; Wu, M.-M. [Department of Cardiology, Cardinal Tien Hospital and College of Medicine, Fu Jen Catholic University, Taipei, Taiwan (China); Graduate Institute of Epidemiology, College of Public Health, National Taiwan University, Taipei, Taiwan (China); Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan (China); School of Public Health, Taipei Medical University, Taipei, Taiwan (China); Department of Public Health, Tzu-Chi University, Hualien, Taiwan (China); Genomics Research Center, Academia Sinica, 128 Academia Road Section 2, Nankang, Taipei 11529, Taiwan (China); Chen, C.-J. [Department of Cardiology, Cardinal Tien Hospital and College of Medicine, Fu Jen Catholic University, Taipei, Taiwan (China); Graduate Institute of Epidemiology, College of Public Health, National Taiwan University, Taipei, Taiwan (China); Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan (China); School of Public Health, Taipei Medical University, Taipei, Taiwan (China); Department of Public Health, Tzu-Chi University, Hualien, Taiwan (China); Genomics Research Center, Academia Sinica, 128 Academia Road Section 2, Nankang, Taipei 11529, Taiwan (China)], E-mail: firstname.lastname@example.org
Anthocyanins are a group of abundant and widely consumed flavonoid constituents that occur ubiquitously in the plant kingdom, providing the bright red-orange to blue-violet colors present in many fruit- and vegetable-based food products. Their intake has been estimated to be up to 9-fold higher than that of other dietary flavonoids. Anthocyanins have become increasingly important to the food industry as their use as natural alternatives to artificial colors has become widespread and knowledge of their health-promoting properties has become more evident. Epidemiological studies suggest that increased consumption of anthocyanins lowers the risk of cardiovascular disease (CVD), the most common cause of mortality among men and women. Anthocyanins frequently interact with other phytochemicals, exhibiting synergistic biological effects but making contributions from individual components difficult to decipher. Over the past 2 decades, many peer-reviewed publications have demonstrated that in addition to their noted in vitro antioxidant activity, anthocyanins may regulate different signaling pathways involved in the development of CVD. This review summarizes the latest developments on the bioavailability/bioactivity and CVD preventative activities of anthocyanins, including results from in vitro cell culture and in vivo animal model systems as related to their multiple proposed mechanisms of action. Limited yet promising data from epidemiological studies and human clinical trials are also presented. Future studies aimed at enhancing the absorption of anthocyanins and characterizing their metabolic and/or breakdown products are necessary to ultimately evaluate their use for protection/prevention against the development of CVD.
Wallace, Taylor C.
Atherosclerosis, the major cause of cardiovascular disease (CVD), is a chronic inflammatory condition with immune competent cells in lesions producing mainly pro-inflammatory cytokines. Dead cells and oxidized forms of low density lipoproteins (oxLDL) are abundant. The major direct cause of CVD appears to be rupture of atherosclerotic plaques. oxLDL has proinflammatory and immune-stimulatory properties, causes cell death at higher concentrations and contains inflammatory phospholipids with phosphorylcholine (PC) as an interesting epitope. Antibodies against PC (anti-PC) may be atheroprotective, one mechanism being anti-inflammatory. Bacteria and virus have been discussed, but it has been difficult to find direct evidence, and antibiotic trials have not been successful. Heat shock proteins could be one major target for atherogenic immune reactions. More direct causes of plaque rupture include pro-inflammatory cytokines, chemokines, and lipid mediators. To prove that inflammation is a cause of atherosclerosis and CVD, clinical studies with anti-inflammatory and/or immune-modulatory treatment are needed. The potential causes of immune reactions and inflammation in atherosclerosis and how inflammation can be targeted therapeutically to provide novel treatments for CVD are reviewed.
Thyroid hormones, specifically triiodothyronine (T3), have significant effects on the heart and cardiovascular system. Hypothyroidism, hyperthyroidism, subclinical thyroid disease, and low T3 syndrome each cause cardiac and cardiovascular abnormalities through both genomic and nongenomic effects on cardiac myocytes and vascular smooth muscle cells. In compromised health, such as occurs in heart disease, alterations in thyroid hormone metabolism may further impair cardiac and cardiovascular function. Diagnosis and treatment of cardiac disease may benefit from including analysis of thyroid hormone status, including serum total T3 levels. PMID:24891175
Danzi, Sara; Klein, Irwin
Prostacyclin has vasoprotective effects such as vasodilation and antiplatelet aggregatory activity. A relative deficiency of prostacyclin contributes to the pathogenesis of cardiovascular disease including pulmonary artery disease (PAH). Inconvenient intravenous dosing of prostacyclin led to the development of more stable, an orally active analogue: beraprost. It is a chemically stable prostacyclin analogue owing to its cyclo-pentabenzofuranyl structure and produces strong vasodilation and inhibition of platelet aggregation. To date, beraprost has been used in the treatment of PAH and peripheral arterial disease (PAD). Recently, we have shown that beraprost induces neovascularization in ischemic myocardium by enhancement of bone marrow cell mobilization. Interestingly, meta-analysis of clinical studies for PAD has shown that repeated administration of beraprost decreases the number of cardiovascular events. These results suggest that oral administration of beraprost has beneficial effects on cardiovascular disease. Orally active prostacyclin analogues, are promising drugs for the treatment of cardiovascular disease. PMID:20357744
Besides the 'classic' cardiovascular risk factors (high blood pressure, dyslipidaemia, metabolic syndrome and diabetes), the work environment is playing an increasingly significant role in cardiovascular morbidity and mortality. Several elements contribute to the effect of the work environment: physical factors, chemical factors, shift work and psychosocial factors. The effects of psychosocial factors on the aetiology and progression of cardiovascular disease have been confirmed by several studies. Identification of these work-related psychosocial factors must be taken into account when evaluating cardiovascular risk factors, in order to ensure better prevention. PMID:22369916
Diène, Eloi; Fouquet, Aurélie; Esquirol, Yolande
Various autoimmune rheumatic diseases (ARDs), including rheumatoid arthritis, spondyloarthritis, vasculitis and systemic lupus erythematosus, are associated with premature atherosclerosis. However, premature atherosclerosis has not been uniformly observed in systemic sclerosis. Furthermore, although experimental models of atherosclerosis support the role of antiphospholipid antibodies in atherosclerosis, there is no clear evidence of premature atherosclerosis in antiphospholipid syndrome (APA). Ischemic events in APA are more likely to be caused by pro-thrombotic state than by enhanced atherosclerosis. Cardiovascular disease (CVD) in ARDs is caused by traditional and non-traditional risk factors. Besides other factors, inflammation and immunologic abnormalities, the quantity and quality of lipoproteins, hypertension, insulin resistance/hyperglycemia, obesity and underweight, presence of platelets bearing complement protein C4d, reduced number and function of endothelial progenitor cells, apoptosis of endothelial cells, epigenetic mechanisms, renal disease, periodontal disease, depression, hyperuricemia, hypothyroidism, sleep apnea and vitamin D deficiency may contribute to the premature CVD. Although most research has focused on systemic inflammation, vascular inflammation may play a crucial role in the premature CVD in ARDs. It may be involved in the development and destabilization of both atherosclerotic lesions and of aortic aneurysms (a known complication of ARDs). Inflammation in subintimal vascular and perivascular layers appears to frequently occur in CVD, with a higher frequency in ARD than in non-ARD patients. It is possible that this inflammation is caused by infections and/or autoimmunity, which might have consequences for treatment. Importantly, drugs targeting immunologic factors participating in the subintimal inflammation (e.g., T- and B-cells) might have a protective effect on CVD. Interestingly, vasa vasorum and cardiovascular adipose tissue may play an important role in atherogenesis. Inflammation and complement depositions in the vessel wall are likely to contribute to vascular stiffness. Based on biopsy findings, also inflammation in the myocardium and small vessels may contribute to premature CVD in ARDs (cardiac ischemia and heart failure). There is an enormous need for an improved CVD prevention in ARDs. Studies examining the effect of DMARDs/biologics on vascular inflammation and CV risk are warranted. PMID:23541482
Hollan, Ivana; Meroni, Pier Luigi; Ahearn, Joseph M; Cohen Tervaert, J W; Curran, Sam; Goodyear, Carl S; Hestad, Knut A; Kahaleh, Bashar; Riggio, Marcello; Shields, Kelly; Wasko, Mary C
... Disease, Stroke, or Other Cardiovascular Disease and Adult Vaccination Vaccines are especially critical for people with health ... have immunity to this disease Learn about adult vaccination and other health conditions Asplenia Diabetes Type 1 ...
Diagnostic tests for characterizing an individual's risk of developing or having a cardiovascular disease. In one embodiment the present diagnostic test comprises determining the level of myeloperoxidase (MPO) activity in a bodily sample obtained from the...
R. Zhang S. Hazen
The present invention provides methods and agents for treating subjects who have or are at risk of developing or having cardiovascular disease. Such agents inhibit binding of myeloperoxidase (MPO) to a molecule comprising the MPO binding site of apolipopr...
M. S. Penn S. L. Hazen
In addition to its effects on reproductive health, it is now well recognized that polycystic ovary syndrome (PCOS) is a metabolic disorder, characterized by decreased insulin sensitivity which leads to an excess lifetime risk of type 2 diabetes and cardiovascular disease. PCOS patients are often obese, hypertensive, dyslipidemic and insulin resistant; they have obstructive sleep apnea and have been reported to have higher aldosterone levels in comparison to normal healthy controls. These are all components of an adverse cardiovascular risk profile. Many studies exploring subclinical atherosclerosis using different methods (flow-mediated dilatation, intima media thickness, arterial stiffness, coronary artery calcification) as well as assessing circulating cardiovascular risk markers, point toward an increased cardiovascular risk and early atherogenesis in PCOS. The risk and early features of subclinical atherosclerosis can be reversed by non-medical (normalization of weight, healthy lifestyle) and medical (metformin, thiazolidinediones, spironolactone, and statins) interventions. However, the long-term risk for cardiovascular morbidity and mortality as well as the clinical significance of different interventions still need to be properly addressed in a large prospective study. PMID:24002406
Bajuk Studen, Katica; Jensterle Sever, Mojca; Pfeifer, Marija
An outbreak of legionnaires' disease and epidemic control measures taken at one of our hotels are described. Twenty (1% morbidity) hotel guests were affected with one dying. As a result of field investigations and survey the hot water supply system has been identified as the source of infection. Control measures which created conditions unfavourable to Legionella growth and replication in the hot water system stopped the outbreak. PMID:2747409
Gjenero-Margan, I; Drazenovi?, V; Vrbica, J; Vjerda, R; Aleraj, B; Borci?, B
Cardiovascular diseases are often found to be associated with certain physicochemical characteristics of the environment—namely, the hardness of the water and the types of rock and soil underlying the area. Areas supplied with soft water usually have higher cardiovascular death rates than do areas supplied with hard water. Evidence linking cardiovascular diseases with the geochemistry of rocks and soils is more limited. The nature of these associations is still speculative but it is possible that certain trace elements are involved, some being beneficial and others harmful. Further epidemiological studies to identify these various trace elements are desirable.
Masironi, R.; Miesch, A. T.; Crawford, M. D.; Hamilton, E. I.
The epidemics and endemic diseases in Mexico were not a problem before the Independence period. Hunger was less than in the past. The 1806 Influenza epidemics had been forgotten. Measles was considered a benign illness. In 1810, there was an increase in the number of cases of black vomit in Veracruz. Sixty percent of 541 hospitalized patients die of the disease. In 1812, an outbreak of yellow fever spread from Veracruz to Jalapa accompanying the movement of troops and killing over 300 soldiers of the Castilla's Battalion. The appearance of petechial fever, maybe typhus marketed in 1813 the onset of the most important epidemics. The preceding was the indirect effect of war: diseases of prisons and military quarters which became overwhelming in times where the movements of troops and of important groups of populations along with crowing, loss homes, hunger and bad hygiene habits. There was also Influenza or "pestilent cold." Measures of detection and quarantine were taken. "Naranjate" mixed with tartaric cremor was used against fever. Fumigation with nitric acid and burners, where they incinerated gun powder were among the health protection policies. It is noteworthy the advance and relief provided by the introduction of smallpox vaccine, the only preventive mean useful against smallpox which was a breakthrough in public health. PMID:20696106
Cardiovascular disease is the leading cause of death worldwide, affecting not only high-income but also low- and middle-income countries. Nearly 80 percent of all estimated cardiovascular disease-related deaths worldwide now occur in low- and middle-income countries, where nearly 30 percent of all deaths are attributable to cardiovascular disease. The health burden of cardiovascular disease and other chronic diseases is also accompanied by a significant deleterious economic impact at the level of both national economies and households. The global trends in the health and economic burden of cardiovascular disease provide a compelling argument in support of prioritizing urgent yet carefully planned efforts to prevent and control cardiovascular disease worldwide-and especially in low- and middle-income countries. After decades of escalating efforts to draw attention to the high burden of cardiovascular disease and other chronic diseases, this critically important issue is now emerging as a more central part of the global health and development agenda. The breadth of behavioral, biological, social, environmental, and systems-level factors that contribute to cardiovascular disease necessitates multisectoral approaches across the lifecourse that promote healthful lifestyles, reduce risk, and reduce cardiovascular-disease morbidity and mortality through the delivery of quality health care services. Given that the complex interactions among the determinants of cardiovascular disease vary in different contexts, real progress in control efforts will come through approaches that are driven by a country's disease burden and risk profile, capacities, resources, and priorities-approaches that are led by a country's key decision-makers and stakeholders, including governments, civil society, the private sector, and communities. Many countries are already establishing efforts to address chronic diseases. In addition to these locally driven efforts, success will require active engagement and sustained action from a wide array of stakeholders operating at global and regional levels. PMID:23239202
Kelly, Bridget B; Narula, Jagat; Fuster, Valentín
The average lifespan of humans is increasing, and with it the percentage of people entering the 65 and older age group is growing rapidly and will continue to do so in the next 20 years. Within this age group, cardiovascular disease will remain the leading cause of death, and the cost associated with treatment will continue to increase. Aging is an inevitable part of life and unfortunately poses the largest risk factor for cardiovascular disease. Although numerous studies in the cardiovascular field have considered both young and aged humans, there are still many unanswered questions as to how the genetic pathways that regulate aging in model organisms influence cardiovascular aging. Likewise, in the molecular biology of aging field, few studies fully assess the role of these aging pathways in cardiovascular health. Fortunately, this gap is beginning to close, and these two fields are merging together. We provide an overview of some of the key genes involved in regulating lifespan and health span, including sirtuins, AMP-activated protein kinase, mammalian target of rapamycin, and insulin-like growth factor 1 and their roles regulating cardiovascular health. We then discuss a series of review articles that will appear in succession and provide a more comprehensive analysis of studies carried out linking genes of aging and cardiovascular health, and perspectives of future directions of these two intimately linked fields.
North, Brian J.; Sinclair, David A.
Early 20th-century cardiovascular voluntary organizations in the United States drew strength from the well-established antituberculosis movement. By midcentury, heart disease among the young and tuberculosis had declined in this country. The international fight against tuberculosis has gathered force since the 1990s. Meanwhile, support for international cardiovascular interventions has lagged behind. We trace the divergent path of the international cardiovascular movement and suggest ways in which it could once again learn from the trials and achievements of tuberculosis control.
Bukhman, Gene; Kidder, Alice
Magnesium, the fourth most abundant cation in the human body, is involved in several essential physiological, biochemical, and cellular processes regulating cardiovascular function. It plays a critical role in modulating vascular smooth muscle tone, endothelial cell function, and myocardial excitability and is thus central to the pathogenesis of several cardiovascular disorders such as hypertension, atherosclerosis, coronary artery disease, congestive heart failure, and cardiac arrhythmias. This review discusses the vasodilatory, anti-inflammatory, anti-ischemic, and antiarrhythmic properties of magnesium and its current role in the prevention and treatment of cardiovascular disorders. PMID:24896250
Kolte, Dhaval; Vijayaraghavan, Krishnaswami; Khera, Sahil; Sica, Domenic A; Frishman, William H
Cardiovascular disease (CVD) is the leading cause of mortality in women. Pathophysiology, risk factors, clinical presentation,\\u000a and outcomes of coronary artery disease (CAD) differ in women, and a better understanding of the sex differences in these\\u000a factors will potentially lead to a slowing of this epidemic in women. Often forgotten, women have higher complication rates\\u000a post revascularization and higher in-hospital
Donna M. Polk; Tasneem Z. Naqvi
The early detection of disease epidemics reduces the chance of successful introductions into new locales, minimizes the number of infections, and reduces the financial impact. We develop a framework to determine the optimal sampling strategy for disease detection in zoonotic host-vector epidemiological systems when a disease goes from below detectable levels to an epidemic. We find that if the time of disease introduction is known then the optimal sampling strategy can switch abruptly between sampling only from the vector population to sampling only from the host population. We also construct time-independent optimal sampling strategies when conducting periodic sampling that can involve sampling both the host and the vector populations simultaneously. Both time-dependent and -independent solutions can be useful for sampling design, depending on whether the time of introduction of the disease is known or not. We illustrate the approach with West Nile virus, a globally-spreading zoonotic arbovirus. Though our analytical results are based on a linearization of the dynamical systems, the sampling rules appear robust over a wide range of parameter space when compared to nonlinear simulation models. Our results suggest some simple rules that can be used by practitioners when developing surveillance programs. These rules require knowledge of transition rates between epidemiological compartments, which population was initially infected, and of the cost per sample for serological tests.
Ferguson, Jake M.; Langebrake, Jessica B.; Cannataro, Vincent L.; Garcia, Andres J.; Hamman, Elizabeth A.; Martcheva, Maia; Osenberg, Craig W.
Older men have lower circulating testosterone (T) and insulin-like growth factor-I (IGF-I) but higher levels of thyrotrophin (TSH) compared with younger men, and exhibit poorer health. Whether age-associated differences in hormone levels are causally related to cardiovascular disease, or are biomarkers reflecting accumulated ill-health remains under debate. Lower T levels are associated with aortic, peripheral vascular, and cardiovascular disease in middle-aged and older men. In some but not all studies, lower levels of T predict increased incidence of cardiovascular events and mortality. Recently, dihydrotestosterone (DHT) has also been identified as a predictor for peripheral vascular and ischemic heart disease. Small scale randomized clinical trials (RCTs) of T supplementation suggest a protective effect against myocardial ischemia in men with coronary artery disease. There have been no RCTs with the prespecified outcomes of cardiovascular events or mortality. One RCT of T in older men with mobility limitations was stopped due to an excess of cardiovascular adverse events in men receiving T, but other RCTs have not raised similar concerns. Observational studies of testosterone supplementation have reported contrasting results. Levels of IGF-I and its binding proteins 1 and 3 have been variably associated with mortality in some but not all studies, and RCTs of interventions to modulate IGF-I levels are either lacking or lacking in power to examine outcomes of cardiovascular events or mortality. Subclinical hyper- and hypothyroidism predict poorer outcomes, and emerging data implicate higher levels of free thyroxine with other outcomes such as dementia and mortality in older men. However, RCTs that manipulate free thyroxine levels within the normal range are lacking and would be challenging to perform. Further research is needed to clarify the role of these hormones as predictors of cardiovascular outcomes in aging men, and to test whether interventions that modulate levels of T, DHT, IGF-I or free thyroxine would reduce cardiovascular morbidity and mortality. PMID:24529874
Yeap, Bu B; Flicker, Leon
Purpose of the review This article will summarize recent observations that provide mechanistic insight into the molecular and cellular links between inflammation and thrombosis in the context of cardiovascular and other thromboinflammatory disease states. Recent findings Several disease conditions are characterized by a thromboinflammatory state in which interactions of blood cells and components with the vascular wall perpetuate both thrombotic and inflammatory pathways. Targeting these pathways may be of benefit in inflammatory conditions and cardiovascular disease, respectively. Summary Ongoing clinical trials should provide additional insight into the hypothesis that the thromboinflammatory state contributes to adverse clinical outcomes.
Nagareddy, Prabhakara; Smyth, Susan S.
MicroRNA-21 (miR-21) is a highly expressed microRNA (miRNA) in cardiovascular system. Recent studies have revealed that its\\u000a expression is deregulated in heart and vasculature under cardiovascular disease conditions such as proliferative vascular\\u000a disease, cardiac hypertrophy and heart failure, and ischemic heart disease. miR-21 is found to play important roles in vascular\\u000a smooth muscle cell proliferation and apoptosis, cardiac cell growth
Yunhui Cheng; Chunxiang Zhang
Epidemic patterns of 12 infectious diseases based on the data derived from the surveillance system of infectious diseases in Japan are analyzed. Weekly numbers of patients per one monitor station (general clinics and hospitals) are calculated by prefecture. Based on these data, the patterns of epidemic are classified into five categories: Category 1, nationwide outbreak of short duration (rotavirus enteritis, hand-foot-mouth disease and herpangina); Category 2, nationwide outbreak of long duration (varicella); Category 3, concurrent outbreaks in several districts (rubella and erythema infectiosum); Category 4, epidemic of long duration in several prefectures at different times (measles, mumps, pertussis, streptococcal infection and atypical pneumonia); Category 5, unclear epidemic pattern (exanthema subitum). PMID:3368259
Nakamura, Y; Yanagawa, H; Nagai, M
Estrogen has pleiotropic effects on the cardiovascular system. The mechanisms by which estrogen confers these pleiotropic effects on cardiovascular function is under active investigation. Until a decade ago, all estrogen signaling was thought to occur by estrogen binding to nuclear estrogen receptors (ER? and ER?), which bind to DNA and function as ligand activated transcription factors. Estrogen binding to the receptor alters gene expression thereby altering cell function. In 2000 estrogen was also shown to bind to nuclear estrogen receptors that are tethered to the plasma membrane resulting in acute activation of signaling kinases such as PI3K. An orphan G-protein coupled receptor, GPR30, has also been shown to bind estrogen and activate acute signaling pathways. ER? has also been reported to be localized to the mitochondria, although this has been controversial. Thus estrogen can alter cell function by binding to several estrogen receptors. There appear to be mechanisms to localize these receptors to different cellular compartments, which results in complex signaling. This paper will review the different estrogen receptors and their signaling mechanisms, will also discuss mechanisms that might regulate estrogen receptor levels and locations, and lastly will consider cardiovascular effects of estrogen signaling.
Atherosclerosis is a chronic, progressive, inflammatory disease affecting many vascular beds. Disease progression leads to acute cardiovascular events such as myocardial infarction, stroke and death. The diseased carotid alone is responsible for one third of the 700,000 new or recurrent strokes occurring yearly in the United States. Imaging plays an important role in the management of atherosclerosis, and cardiovascular magnetic resonance (CMR) of the carotid vessel wall is one promising modality in the evaluation of patients with carotid atherosclerotic disease. Advances in carotid vessel wall CMR allow comprehensive assessment of morphology inside the wall, contributing substantial disease-specific information beyond luminal stenosis. Although carotid vessel wall CMR has not been widely used to screen for carotid atherosclerotic disease, many trials support its potential for this indication. This review summarizes the current state of knowledge regarding carotid vessel wall CMR and its potential clinical application for management of carotid atherosclerotic disease.
An epidemic outbreak of diarrheal diseases (primarily cholera) in Haiti in 2010 is a reminder that our understanding on disease triggers, transmission and spreading mechanisms is incomplete. Cholera can occur in two forms - epidemic (defined as sudden outbreak in a historically disease free region) and endemic (recurrence and persistence of the disease for several consecutive years). Examples of countries with epidemic cholera include Pakistan (2008), Congo (2008), and most recently Haiti (2010). A significant difference between endemic and epidemic regions is the mortality rate, i.e., 1% or lower in an endemic regions versus 3-7% during recent epidemic outbreaks. A fundamentally transformational approach - a warning system with several months prediction lead time - is needed to prevent disease outbreak and minimize its impact on population. Lack of information on spatial and temporal variability of disease incidence as well as transmission in human population continues to be significant challenge in the development of early-warning systems for cholera. Using satellite data on regional hydroclimatic processes, water and sanitation infrastructure indices, and biological pathogen growth information, here we present a Simple, Mechanistic, Adaptive, Remote sensing based Regional Transmission or SMART model to (i) identify regions of potential cholera outbreaks and (ii) quantify mechanism of spread of the disease in previously disease free region. Our results indicate that epidemic regions are located near regional rivers and are characterized by sporadic outbreaks, which are likely to be initiated during episodes of prevailing warm air temperature with low river flows, creating favorable environmental conditions for the growth of cholera bacteria. Heavy rainfall, through inundation or breakdown of sanitary infrastructure, accelerates interaction between contaminated water and human activities, resulting in an epidemic. We discuss the above findings in light of increased climatic variability, such as acceleration of hydrological cycle, hydroclimatic hazards, etc on diarrheal disease outbreaks.
Jutla, A.; Akanda, A. S.; Colwell, R. R.
In this paper, we consider a pair of homogeneous diseases spreading concurrently on uniform networks based on the SIS model. A new model describing the transmission process of the interacting diseases is established. The influence of the transmission parameters, the interacting parameter and the initial density value of infected nodes on the epidemic spreading is presented by simulating the transmission process of the proposed model. The mathematical expressions of the conditions among the transmission parameters, the interacting parameter and the network parameter when diseases can exist in the network based on the simplified model are presented. Comparing the transmission process of this interacting model under different intervals of the interacting parameter, it is found that the interacting of the two diseases leads to larger scale prevalence with a relatively larger interacting parameter when the infection breaks out.
Feng, Yun; Fan, Qingli; Ma, Lin; Ding, Li
An epidemic of renal disease is occurring among the Zuni Indians in western New Mexico. In 1985, 1.6% of Zunis had clinically recognized renal disease and 1% had renal insufficiency. The incidence of end-stage renal disease (ESRD) in 1984 and 1985 was 14 times the rate for US whites, and three times the rates of other Indians in ESRD network 6. One third of the cases of renal disease and ESRD is due to type 2 diabetes, but the etiology of disease in most of the remainder is unknown. Affected subjects range from early childhood to old age. Early signs are hematuria, mild to moderate proteinuria, normal BP, and low total hemolytic complement, normal or low C3 and C4 levels, in about 40% of the cases. The clinical course varies from benign to rapidly progressive renal failure. Biopsies usually reflect an immune-complex mediated mesangiopathic glomerulonephritis, with IgA, IgG, IgM, and C3 variably present in the mesangium. In some cases, there is a very strong familial pattern suggesting autosomal dominant inheritance or a marked communal exposure effect. This may be a genetic disease educed by the consanguinity in the ethnically homogeneous Zuni population. Mesangiopathic renal disease is common in some Oriental populations, and this phenomenon may reflect the American Indians' Oriental ancestry. This disease may also be due to toxic exposures related to jewelry-making, potting, Zuni water, Zuni salt, or herbal or other products used for medicinal or religious purposes. This epidemic is causing much morbidity and generating huge costs for ESRD treatment. Further study is needed to better understand its etiology.
Hoy, W.E.; Megill, D.M.; Hughson, M.D.
Cardiovascular disease is the leading cause of death worldwide and is often associated with partial or full occlusion of the blood vessel network in the affected organs. Restoring blood supply is critical for the successful treatment of cardiovascular diseases. Therapeutic angiogenesis provides a valuable tool for treating cardiovascular diseases by stimulating the growth of new blood vessels from pre-existing vessels. In this review, we discuss strategies developed for therapeutic angiogenesis using single or combinations of biological signals, cells and polymeric biomaterials. Compared to direct delivery of growth factors or cells alone, polymeric biomaterials provide a three-dimensional drug-releasing depot that is capable of facilitating temporally and spatially controlled release. Biomimetic signals can also be incorporated into polymeric scaffolds to allow environmentally-responsive or cell-triggered release of biological signals for targeted angiogenesis. Recent progress in exploiting genetically engineered stem cells and endogenous cell homing mechanisms for therapeutic angiogenesis is also discussed. PMID:22916079
Deveza, Lorenzo; Choi, Jeffrey; Yang, Fan
Here we present the Global Epidemic and Mobility (GLEaM) model that integrates sociodemographic and population mobility data in a spatially structured stochastic disease approach to simulate the spread of epidemics at the worldwide scale. We discuss the flexible structure of the model that is open to the inclusion of different disease structures and local intervention policies. This makes GLEaM suitable for the computational modeling and anticipation of the spatio-temporal patterns of global epidemic spreading, the understanding of historical epidemics, the assessment of the role of human mobility in shaping global epidemics, and the analysis of mitigation and containment scenarios. PMID:21415939
Balcan, Duygu; Gonçalves, Bruno; Hu, Hao; Ramasco, José J; Colizza, Vittoria; Vespignani, Alessandro
Here we present the Global Epidemic and Mobility (GLEaM) model that integrates sociodemographic and population mobility data in a spatially structured stochastic disease approach to simulate the spread of epidemics at the worldwide scale. We discuss the flexible structure of the model that is open to the inclusion of different disease structures and local intervention policies. This makes GLEaM suitable for the computational modeling and anticipation of the spatio-temporal patterns of global epidemic spreading, the understanding of historical epidemics, the assessment of the role of human mobility in shaping global epidemics, and the analysis of mitigation and containment scenarios.
Balcan, Duygu; Goncalves, Bruno; Hu, Hao; Ramasco, Jose J.; Colizza, Vittoria
Since the discovery of the endothelin system in 1988, it has been implicated in numerous physiological and pathological phenomena. In the cardiovascular system, endothelin-1 (ET-1) acts through intracellular pathways of two endothelin receptors (ETA and ETB) located mainly on smooth muscle and endothelial cells to regulate vascular tone and provoke mitogenic and proinflammatory reactions. The endothelin ETA receptor is believed to play a pivotal role in the pathogenesis of several cardiovascular disease including systemic hypertension, pulmonary arterial hypertension (PAH), dilated cardiomyopathy, and diabetic microvascular dysfunction. Growing evidence from recent experimental and clinical studies indicates that the blockade of endothelin receptors, particularly the ETA subtype, grasps promise in the treatment of major cardiovascular pathologies. The simultaneous blockade of endothelin ETB receptors might not be advantageous, leading possibly to vasoconstriction and salt and water retentions. This review summarizes the role of ET-1 in cardiovascular modulation and the therapeutic potential of endothelin receptor antagonism. PMID:24952955
Nasser, Suzanne A; El-Mas, Mahmoud M
Coronary artery disease (CAD) represents the primary cause of death in Western Countries with an high incidence on human health and community social costs. Oxidative stress induced by reactive oxygen species (ROS) plays an important role in the aetiology of this disease. In particular, the LDL-oxidization has a key role in the pathogenesis of atherosclerosis and cardiovascular heart diseases through the initiation of plaque formation process. Dietary phytochemical products such antioxidant vitamins (A,C,E) and bioactive food components (alpha- and beta-carotene) have shown an antioxidant effect in reducing both oxidative markers stress and LDL-oxidization process. Scientifical evidences support the beneficial roles of phytochemicals in the prevention of some chronic diseases. Lycopene, an oxygenated carotenoid with great antioxidant properties, has shown both in epidemiological studies and supplementation human trials a reduction of cardiovascular risk. However, controlled clinical trials and dietary intervention studies using well-defined subjects population haven't been provided a clear evidence of lycopene in the prevention of cardiovascular diseases. The present short review aims to evaluate the beneficial effect of lycopene in the prevention of cardiovascular disease. PMID:18700690
Riccioni, G; Mancini, B; Di Ilio, E; Bucciarelli, T; D'Orazio, N
Thyroid function has a profound effect on the heart, and both all-cause and cardiovascular mortality rates are increased in hyperthyroidism. New-onset atrial fibrillation carries a prolonged risk for the development of hyperthyroidism, suggesting altered availability of thyroid hormones at the cellular level. Subclinical hyperthyroidism is associated with increased left ventricular mass of the heart, which reverts after obtaining euthyroidism. Mortality and risk of major cardiovascular events are increased. Subclinical hypothyroidism is also associated with subtle changes in the heart, e.g. its increased stiffness, which reverts after treatment with levothyroxine. Mortality seems mildly reduced, although the risk of myocardial infarction is increased. The risk of atrial fibrillation is related to thyroid function over the whole spectrum: from a reduced risk in overt and subclinical hypothyroidism, a progressively increased risk in people with different levels of reduced TSH to a physiologically 'dose-dependent' effect of thyroid hormones on the heart in overt hyperthyroidism. Heart failure represents an intriguing clinical situation in which triiodothyronine treatment might be beneficial. In conclusion, subclinical dysthyroid states affect the heart with subsequent changes in morbidity and mortality. Subclinical hyperthyroidism seems a more serious condition than subclinical hypothyroidism, which should affect treatment decision in a more aggressive manner. © 2014 S. Karger AG, Basel. PMID:24943297
Faber, Jens; Selmer, Christian
\\u000a Experimental and epidemiological evidence have been accumulated in the last decades demonstrating a stringent correlation\\u000a between nutrition lifestyle and chronic-inflammatory diseases like cardiovascular diseases (CVD) and cancer. It is now agreed\\u000a that the incidence of these diseases can be reduced by diet. The French paradox , or the Mediterranean diet , has provided\\u000a a scientific explanation, namely that the antioxidants
Alfonso Giovane; Claudio Napoli
The epidemic of heart failure continues apace, and development of novel therapies with clinical efficacy has lagged. Now, important insights into the molecular circuitry of cardiovascular autophagy have raised the prospect that this cellular pathway of protein quality control may be a target of clinical relevance. Whereas basal levels of autophagy are required for cell survival, excessive levels - or perhaps distinct forms of autophagic flux - contribute to disease pathogenesis. Our challenge will be to distinguish mechanisms that drive adaptive versus maladaptive autophagy and to manipulate those pathways for therapeutic gain. Recent evidence suggests this may be possible. Here, we review the fundamental biology of autophagy and its role in a variety of forms of cardiovascular disease. We discuss ways in which this evolutionarily conserved catabolic mechanism can be manipulated, discuss studies presently underway in heart disease, and provide our perspective on where this exciting field may lead in the future. This article is part of a special issue entitled ''Key Signaling Molecules in Hypertrophy and Heart Failure.'' PMID:21723289
Nemchenko, Andriy; Chiong, Mario; Turer, Aslan; Lavandero, Sergio; Hill, Joseph A
There are many challenges that need to be overcome to address the global cardiovascular disease epidemic. They include (1) lack of multisectoral action to support reduction of behavioral risk factors and their determinants, (2) weak public health and health care system capacity for forging an accelerated national response, and (3) inefficient use of limited resources. To make progress, countries need to develop and implement multisectoral national action plans guided by the global action plan for prevention and control of noncommunicable diseases, strengthen surveillance and monitoring systems, and set national targets consistent with global voluntary targets, which are to be attained by 2025. In addition, a set of cost-effective preventive and curative interventions need to be prioritized. Further, resources need to be generated and capacity developed to ensure sustainable country-wide implementation of the prioritized interventions. According to WHO estimates, the implementation of a core set of very cost-effective interventions for prevention and control of cardiovascular disease requires about 4 % of current health spending in lower income countries, 2 % in lower middle income countries, and less than 1 % in upper middle income and high income countries. PMID:24718672
Mendis, Shanthi; Chestnov, Oleg
Despite biologically plausible mechanisms for cardiac protection and compelling evidence from observational studies suggesting that menopausal hormone therapy confers cardiovascular benefit, results of well-designed and conducted randomized clinical trials in healthy women and in women with established coronary heart disease displayed that menopausal hormone therapy failed to prevent clinical cardiovascular events and rather was associated with harms. Clinical trial of the SERM raloxifene also did not demonstrate a decrease in coronary events. It is unknown whether the earlier initiation of such therapies, i.e., at menopause, would result in favorable outcomes; or whether different hormonal preparations, lower doses, or alternate routes of administration would confer benefit. At present, proved coronary risk reduction strategies are requisite (albeit underutilized) for menopausal women; these include lifestyle and pharmacologic coronary preventive interventions. The baseline characteristics of menopausal women with coronary heart disease who were participants in cardiovascular outcome trials of menopausal hormone therapy or raloxifene were remarkably similar; globally, cardiovascular risk factors were not optimally controlled at entry into these trials, suggesting that more aggressive cardiovascular risk interventions are appropriate to achieve optimal target goals for menopausal women with documented coronary heart disease. PMID:17125716
Wenger, Nanette K
Habitual sleep duration has been associated with cardiometabolic disease, via several mechanistic pathways, but few have been thoroughly explored. One hypothesis is that short and/or long sleep duration is associated with a proinflammatory state, which could increase risk for cardiovascular and metabolic diseases. This hypothesis has been largely explored in the context of experimental sleep deprivation studies which have attempted to demonstrate changes in proinflammatory markers following acute sleep loss in the laboratory. Despite the controlled environment available in these studies, samples tend to lack generalization to the population at large and acute sleep deprivation may not be a perfect analog for short sleep. To address these limitations, population based studies have explored associations between proinflammatory markers and habitual sleep duration. This review summarizes what is known from experimental and cross-sectional studies about the association between sleep duration, cardiovascular disease, and proinflammatory biomarkers. First, the association between sleep duration with both morbidity and mortality, with a focus on cardiovascular disease, is reviewed. Then, a brief review of the potential role of proinflammatory markers in cardiovascular disease is presented. The majority of this review details specific findings related to specific molecules, including tumor necrosis factor-?, interleukins-1, -6, and -17, C-reactive protein, coagulation molecules, cellular adhesion molecules, and visfatin. Finally, a discussion of the limitations of current studies and future directions is provided.
Grandner, Michael A; Sands-Lincoln, Megan R; Pak, Victoria M; Garland, Sheila N
Cardiac and peripheral vascular biomarkers are increasingly becoming targets of both research and clinical practice. As of 2008, cardiovascular-related medical care accounts for greater than 20% of all the economic costs of illness in the United States. In the age of burgeoning financial pressures on the entire health care system, never has it been more important to try to understand who is at risk for cardiovascular disease in order to prevent new events. In this paper, we will discuss the cost of cardiovascular disease to society, clarify the definition of and need for biomarkers, offer an example of a current biomarker, namely high-sensitivity C-reactive protein, and finally examine the approval process for utilizing these in clinical practice.
Montgomery, Jana E; Brown, Jeremiah R
Osteoporosis is a common complication of chronic kidney disease (CKD), and the latter is a major risk factor for cardiovascular mortality. Recent studies have elucidated some of the mechanisms by which CKD is a cardiovascular risk, and they relate to osteoporosis. Thus, the mechanisms of CKD induced cardiovascular risk provide valuable insight into the relationship between cardiovascular disease and osteoporosis, and they are reviewed here. Observational studies have determined hyperphosphatemia to be a cardiovascular risk factor in chronic kidney disease. Mechanistic studies have elucidated that hyperphosphatemia is a direct stimulus to vascular calcification, which is one cause of morbid cardiovascular events contributing to the excess mortality of chronic kidney disease. Hyperphosphatemia in chronic kidney is due to failure of excretion by the kidneys and excess bone resorption. It stimulates vascular cells to mineralize atherosclerotic plaques through osteoblastic processes. Hyperphosphatemia in chronic kidney disease is a distinct syndrome characterized by disordered skeletal remodeling, heterotopic mineralization and cardiovascular morbidity. The heterotopic mineralization stimulated by CKD is relevant to osteoporosis.
Hruska, Keith A; Mathew, Suresh; Lund, Richard
Improvement in survival of patients with cardiovascular diseases and an ageing population mean that management of cardiovascular conditions remains an important challenge for primary care. Traditionally cardiovascular research has been based largely in secondary or tertiary care settings. The majority of care for people with cardiovascular diseases, however, takes place in the community and within primary care. In recent years,
N Mavaddat; J Mant
Summary Future intervention studies should include a detailed assessment of the bioavailability of polyphenols. Beyond clinical trials carried out with polyphenol-rich foods, more studies with pure polyphenols will also be needed to establish their role in the prevention of cardiovascular diseases.
Claudine Manach; Andrzej Mazur; Augustin Scalbert
What part menopause and hormone replacement therapy (HRT) play in the risk of cardiovascular disease in women after middle-age is still debated. The associations between menopause, HRT and cardiovascular disease as well as atherosclerosis were examined in a large cohort study. Our results suggest menopause has an unfavorable association with several cardiovascular risk factors, structural characteristics of the large arteries, on atherosclerosis and on coronary heart disease. HRT was shown to protect women from development of atherosclerosis in the lower extremities and in the common carotid artery. This suggests that the mechanisms underlying this protection include inhibition of the atherosclerotic process. Our analyses of a randomised, placebo-controlled study could not confirm the effect on HRT on atherosclerosis of the common carotid artery. As findings from large randomised trials do not confirm the benefit of estrogen therapy for prevention of cardiovascular disease no definite conclusions can be drawn, and HRT should not be recommended for this purpose in clinical practice. ImagesFigure 1Figure 2Figure 3
Westendorp, I.C.D.; Grobbee, D.E.; Witteman, J.C.M.
Cardiovascular risk factors as well as morbidity and mortality from coronary heart disease among Turkish adults are herein reviewed. Lipids and lipoproteins are in focus, but other relevant risk factors are also discussed. Turks have distinctively low levels of total and high-density lipoprotein (HDL)-cholesterol, associated with high levels of hepatic lipase and fasting triglycerides. In addition, physical inactivity is common
The evidence linking cardiovascular disease risk and water quality parameters was weighed and analyzed to identify major gaps in understanding reasons for the regional differences in cardiovascular disease mortality in the United States. Epidemiologic studies evaluating occupational and public health exposure to nitrates, carbon monoxide, carbon disulfide, fibrogenic dusts, heavy metals and trace elements, chlorides, and hydro- and fluorocarbons were analyzed. Intake of cholesterol, calcium, and magnesium from food items, cooking water enhancement, and drinking water were also appraised. Based on the current state of knowledge, it is our judgment that the drinking water characteristics of highest priority from the standpoint of cardiovascular disease risks are calcium/magnesium content and chlorine treatment. The potential importance of cadmium, lead, nitrate(s), and chloride/sodium concentrations also needs to be considered. We present working hypotheses to evaluate the role(s) of these parameters and a discussion of variables that should be considered in any study design addressing the association between cardiovascular disease risk and water quality. Important variables are sample size, biological endpoint events (mortality, incidence, clinical determination), population characteristics, drinking water parameters, and dietary intake estimates. 207 references, 6 figures, 17 tables.
Watson, A.P.; Zeighami, E.A.
Beneficial effects of wine are mainly due to polyphenol components with a major role for resveratrol. Moderate wine consumption decreases cardiovascular mortality. Very favorable effects in coronary artery disease and cholesterol. Deleterious effects in systemic hypertension and dilated cardiomyopathy. Recommendation: 1 to 2 drinks (10 to 20g of alcohol) per day. PMID:24880824
Juillière, Yves; Bosser, Gilles; Schwartz, Jérome
Oxidative stress and inflammation are established processes contributing to cardiovascular disease caused by atherosclerosis. However, antioxidant therapies tested in cardiovascular disease such as vitamin E, C and ?-carotene have proved unsuccessful at reducing cardiovascular events and mortality. Although these outcomes may reflect limitations in trial design, new, more potent antioxidant therapies are being pursued. Astaxanthin, a carotenoid found in microalgae, fungi, complex plants, seafood, flamingos and quail is one such agent. It has antioxidant and anti-inflammatory effects. Limited, short duration and small sample size studies have assessed the effects of astaxanthin on oxidative stress and inflammation biomarkers and have investigated bioavailability and safety. So far no significant adverse events have been observed and biomarkers of oxidative stress and inflammation are attenuated with astaxanthin supplementation. Experimental investigations in a range of species using a cardiac ischaemia-reperfusion model demonstrated cardiac muscle preservation when astaxanthin is administered either orally or intravenously prior to the induction of ischaemia. Human clinical cardiovascular studies using astaxanthin therapy have not yet been reported. On the basis of the promising results of experimental cardiovascular studies and the physicochemical and antioxidant properties and safety profile of astaxanthin, clinical trials should be undertaken. PMID:22349894
Fassett, Robert G; Coombes, Jeff S
\\u000a Coronary artery disease (CAD) represents the primary cause of death in Western countries and has a great impact on human health\\u000a and high social costs. Oxidative stress induced by reactive oxygen species (ROS) plays an important role in the etiology of\\u000a this disease. In particular, low-density lipoprotein (LDL) oxidization has a key role in the pathogenesis of atherosclerosis\\u000a and cardiovascular
G. Riccioni; V. Sblendorio; N. D’Orazio
Abstract Tetrahydrobiopterin (BH4) functions as a cofactor for several important enzyme systems, and considerable evidence implicates BH4 as a key regulator of endothelial nitric oxide synthase (eNOS) in the setting of cardiovascular health and disease. BH4 bioavailability is determined by a balance of enzymatic de novo synthesis and recycling, versus degradation in the setting of oxidative stress. Augmenting vascular BH4 levels by pharmacological supplementation has been shown in experimental studies to enhance NO bioavailability. However, it has become more apparent that the role of BH4 in other enzymatic pathways, including other NOS isoforms and the aromatic amino acid hydroxylases, may have a bearing on important aspects of vascular homeostasis, inflammation, and cardiac function. This article reviews the role of BH4 in cardiovascular development and homeostasis, as well as in pathophysiological processes such as endothelial and vascular dysfunction, atherosclerosis, inflammation, and cardiac hypertrophy. We discuss the therapeutic potential of BH4 in cardiovascular disease states and attempt to address how this modulator of intracellular NO-redox balance may ultimately provide a powerful new treatment for many cardiovascular diseases. Antioxid. Redox Signal. 20, 3040–3077.
Bendall, Jennifer K.; Douglas, Gillian; McNeill, Eileen; Channon, Keith M.
Abstract Tetrahydrobiopterin (BH4) functions as a cofactor for several important enzyme systems, and considerable evidence implicates BH4 as a key regulator of endothelial nitric oxide synthase (eNOS) in the setting of cardiovascular health and disease. BH4 bioavailability is determined by a balance of enzymatic de novo synthesis and recycling, versus degradation in the setting of oxidative stress. Augmenting vascular BH4 levels by pharmacological supplementation has been shown in experimental studies to enhance NO bioavailability. However, it has become more apparent that the role of BH4 in other enzymatic pathways, including other NOS isoforms and the aromatic amino acid hydroxylases, may have a bearing on important aspects of vascular homeostasis, inflammation, and cardiac function. This article reviews the role of BH4 in cardiovascular development and homeostasis, as well as in pathophysiological processes such as endothelial and vascular dysfunction, atherosclerosis, inflammation, and cardiac hypertrophy. We discuss the therapeutic potential of BH4 in cardiovascular disease states and attempt to address how this modulator of intracellular NO-redox balance may ultimately provide a powerful new treatment for many cardiovascular diseases. Antioxid. Redox Signal. 20, 3040-3077. PMID:24294830
Bendall, Jennifer K; Douglas, Gillian; McNeill, Eileen; Channon, Keith M; Crabtree, Mark J
The global epidemic of cardiovascular disease (CVD) calls for multidisciplinary and multiprofessional approaches to the management of this condition, with strategic emphasis on prevention, treatment, and control. In addition, there is increasing recognition that effective prevention and management of CVD requires a diverse workforce skilled in the social, environmental, and policy determinants of health. Nowhere are these approaches and strategies brought together and more closely aligned than in the field of preventive cardiovascular nursing. This executive summary of "Global Cardiovascular Prevention: A Call to Action for Nursing" includes key points from the 6 papers written by the Preventive Cardiovascular Nurses Association and published in July-August 2011 as a supplement to the Journal of Cardiovascular Nursing and the European Journal of Cardiovascular Nursing. This supplement addresses innovative efforts to stem the current global epidemic of CVD and emphasizes the need for effective team-based interventions for lifestyle and behavior changes across the life span. Social solutions, strategies for working with key players to develop interactive models, as well as coordinated multilevel policies, partnerships, and programs that are culturally relevant and context specific are examined. Such approaches are urgently needed to reduce death and disability from CVD in the United States and globally. Nurse leaders and other members of the healthcare team are well positioned internationally to meet these challenges. PMID:22955185
Berra, Kathy; Fletcher, Barbara; Hayman, Laura L; Miller, Nancy Houston
Background Studies suggest a higher prevalence of unfavourable cardiovascular risk factors amongst migraineurs, but results have been conflicting. The aim of this study was to investigate traditional and newly recognized risk factors as well as other surrogate markers of cardiovascular risk in obese and normal weight women with migraine. Methods Fifty-nine adult female probands participated in this case–control study. The sample was divided into normal weight and obese migraineurs and age- and body mass index-matched control groups. The following cardiovascular risk factors were analyzed: serum levels of lipids, fasting glucose, and insulin; insulin resistance; blood pressure; smoking (categorized as current, past or never); Framingham 10-year risk of general cardiovascular disease score; C-reactive protein; family history of cardiovascular disease; physical activity; sleep disturbances; depression; and bioelectrical impedance phase angle. The means of continuous variables were compared using Student’s t-test for independent samples or the Mann–Whitney U-test (for 2 groups) and ANOVA or the Kruskal-Wallis test (for 4 groups) depending on the distribution of data. Results All migraineurs were sedentary irrespective of nutritional status. Migraineurs had higher depression scores and shorter sleep duration, and obese migraineurs, in particular, had worse sleep quality scores. Insulin resistance and insulinaemia were associated with obesity, and obese migraineurs had lower HDL-c than normal weight controls and migraineurs. Also, the Framingham risk score was higher in obese migraineurs. Conclusion These findings suggest that female migraineurs experience marked inactivity, depression, and some sleep disturbance, that higher insulin resistance and insulinaemia are related to obesity, and that obesity and migraine probably exert overlapping effects on HDL-c levels and Framingham 10-year cardiovascular risk.
Contraceptive hormones, most commonly prescribed as oral contraceptives (OC), are a widely utilized method to prevent ovulation, implantation and therefore pregnancy. The Women’s Health Initiative demonstrated cardiovascular risk linked to menopausal hormone therapy among women without pre-existing cardiovascular disease, prompting review of the safety, efficacy and side effects of other forms of hormone therapy. A variety of basic science, animal and human data suggest that contraceptive hormones have anti-atheromatous effects, however relatively less is known regarding the impact on atherosclerosis, thrombosis, vasomotion and arrhythmogenesis. Newer generation OC formulations currently in use indicate no increased myocardial infarction (MI) risk for current users, but a persistent increased risk of venous thrombo-embolism (VTE). There are no cardiovascular data available for the newest generation contraceptive hormone formulations, including those that contain newer progestins that lower blood pressure, as well as the non-oral routes (topical and vaginal). Current guidelines indicate that, as with all medication, contraceptive hormones should be selected and initiated by weighing risks and benefits for the individual patient. Women 35 years and older should be assessed for cardiovascular risk factors including hypertension, smoking, diabetes, nephropathy and other vascular diseases including migraines, prior to use. Existing data are mixed with regard to possible protection from OC for atherosclerosis and cardiovascular events; longer-term cardiovascular follow-up of menopausal women with regard to prior OC use, including subgroup information regarding adequacy of ovulatory cycling, the presence of hyperandrogenic conditions, and the presence of prothrombotic genetic disorders is needed to address this important issue.
Shufelt, Chrisandra L.; Noel Bairey Merz, C.
Recent increase in human lifespan has shifted the spectrum of aging-related disorders to an unprecedented upsurge in cardiovascular diseases, especially calcific aortic valve stenosis, which has an 80% risk of progression to heart failure and death. A current therapeutic option for calcified valves is surgical replacement, which provides only temporary relief. Recent progress in cardiovascular research has suggested that arterial and valve calcification are the result of an active process of osteogenic differentiation, induced by a pro-atherogenic inflammatory response. At molecular level, the calcification process is regulated by a network of signaling pathways, including Notch, Wnt and TGFbeta/BMP pathways, which control the master regulator of osteogenesis Cbfa1/Runx2. Genetic and in vitro studies have implicated Notch signaling in the regulation of macrophage activation and cardiovascular calcification. Individuals with inactivating Notch1 mutations have a high rate of cardiovascular disorders, including valve stenosis and calcification. This article reviews recent progress in the mechanism of cardiovascular calcification and discusses potential molecular mechanisms involved, focusing on Notch receptors. We propose a calcification model where extreme increases in vascular wall cell density due to inflammation-induced cell proliferation can trigger an osteogenic differentiation program mediated by Notch receptors.
Rusanescu, Gabriel; Weissleder, Ralph; Aikawa, Elena
Over a few weeks, 69 children (13%) enrolled in a private school manifested an erythematous and migratory rash, most commonly on the extremities, along with fever or other systemic or respiratory symptoms. Fever lasted for a mean of four days, and rash, 11 days. Cases appeared in every grade from kindergarten through ninth, and the incidence peaked in the fifth through seventh grades. More boarding students were affected than day students. Secondary cases in households of affected children and among adults from the school were noted. Eighty-eight attempts at virus isolation were unsuccessful. The illnesses were consistent with erythema infectiosum, a disease of unknown etiology, which has occurred in epidemic form in schools and also in sporadic cases. PMID:7097901
Brass, C; Elliott, L M; Stevens, D A
Vascular involvement is a common complication of Behçet's disease (BD) and affects up to 40% of BD patients. These complications worsen the prognosis of BD. The concept of vasculo-Behçet has been adopted for cases in which vascular complications dominate the clinical features. Vascular manifestations affect particularly young men, during the first years following onset of the disease. Venous complications are the most frequent vascular complications, affecting 14 to 40% of BD patients. Superficial and deep lower limb thrombosis is the most frequent venous complications but one third of venous thrombosis concern large vessels (such as cerebral venous thrombosis, pulmonary embolism, and inferior or superior vena cava, etc.). Budd-Chiari syndrome is the worst prognostic factor increasing mortality by 9 times. Arterial complications (2 to 17% of BD patients) include aneurysms and occlusions/stenosis. Main locations of arterial lesions are aortic (abdominal and thoracic), femoral, pulmonary and iliac arteries. Aneurysms are the most severe arterial complications, particularly pulmonary aneurysms associated with a high risk of massive bleeding. Cardiac complications (up to 6% of BD patients) include pericarditis, endocardial lesions (aortic regurgitation and less often mitral insufficiency), myocardial lesions (myocardial infarction, myocarditis and endomyocardial fibrosis) and intracardiac thrombosis (right ventricle and atrium). Coronary lesions complicated to myocardial infarction are the most severe cardiac complications. Treatment is based on corticosteroids and immunosuppressive drugs. The use of anticoagulation in venous thrombosis is still controversial. PMID:24434015
Desbois, A-C; Wechsler, B; Cluzel, P; Helft, G; Boutin, D; Piette, J-C; Cacoub, P; Saadoun, D
Cardiovascular disease remains the leading cause of mortality and morbidity worldwide so research continues into underlying mechanisms. Since innate immunity and its potent component mannan-binding lectin have been proven to play an important role in the inflammatory response during infection and ischaemia-reperfusion injury, attention has been paid to its role in the development of cardiovascular complications as well. This review provides a general outline of the structure and genetic polymorphism of MBL and its role in inflammation/tissue injury with emphasis on associations with cardiovascular disease. MBL appears to be involved in the pathogenesis of atherosclerosis and, in consequence, coronary artery disease and also inflammation and tissue injury after myocardial infarction and heart transplantation. The relationship between MBL and disease is rather complex and depends on different genetic and environmental factors. That could be why the data obtained from animal and clinical studies are sometimes contradictory proving not for the first time that innate immunity is a “double-edge sword,” sometimes beneficial and, at other times disastrous for the host.
It has been widely suggested that depression negatively affects patients with cardiovascular disease. There are several pathophysiological mechanisms as well as behavioral processes linking depression and cardiac events. Improvements in nursing and medical care have prolonged survival of this patient population; however, this beneficial outcome has led to increased prevalence of depression. Since mortality rates in chronic heart failure patients remain extremely high, it might be as equally important to screen for depression and there are several valid and reliable screening tools that healthcare personnel could easily employ to identify patients at greater risk. Consultation should be provided by a multidisciplinary team, consisting of cardiologists, psychiatrists, and hospital or community nurses so as to carefully plan, execute, and evaluate medical intervention and implement lifestyle changes. We aim to systematically review the existing knowledge regarding current definitions, prognostic implications, pathophysiological mechanisms, and current and future treatment options in patients with depression and cardiovascular disease, specifically those with heart failure.
Mastrogiannis, Dimos; Giamouzis, Gregory; Dardiotis, Efthimios; Karayannis, George; Chroub-Papavaiou, Artemis; Kremeti, Dimitra; Spiliopoulos, Kyriakos; Georgoulias, Panagiotis; Koutsias, Stelios; Bonotis, Konstantinos; Mantzorou, Marianna; Skoularigis, John; Hadjigeorgiou, Georgios M.; Butler, Javed; Triposkiadis, Filippos
With widespread access to high-quality medical care as in Australia, human immunodeficiency virus (HIV) is now considered a chronic, treatable condition, with a good life expectancy. The use of combined highly active antiretroviral therapy has enabled effective suppression of the virus, but has also been associated with increased cardiac morbidity and mortality. Over representation of traditional cardiac risk factors, such as hyperlipidaemia and diabetes, as well as an increased incidence of ischaemic and non-ischaemic heart disease is now considered a major concern of treatment with antiretroviral therapy. Therefore, a contemporary management strategy for patients with HIV must include active prevention and treatment of cardiovascular risk. This review will outline the complex interplay between HIV infection, antiretroviral drug regimens and accelerated cardiovascular disease, with a particular focus on screening, prevention and treatment options in a contemporary Australian HIV population. PMID:24754684
Cheruvu, S; Holloway, C J
The immune system has long been recognised as playing a central role in the organism's defence against infectious diseases and possibly the development of neoplasia. The active stimulation of the immune system by immunisation and the passive administration of antitoxins have a venerable history in medicine. Yet the concept that antibodies may be used to modify physiological or pharmacological effects or may act as diagnostic agents in the living organisms has only recently come to be recognised. Advances, both in an understanding of the structural chemistry of the antibody molecule and in the ability to culture antibody-producing cells, now permit the selection and production of homogeneous antibodies and their smaller fragments in quantity by means other than conventional immunisation. These innovations will allow the development of a new pharmacology based on the remarkable resolving power of the antibody combining site. Antibodies or their fragments are shown to inhibit the pressor action of renin, to neutralise the pharmacological actions of digitalis, to block the beta-adrenergic receptor, and to detect and image myocardial infarcts. Images
At NASA's Jet Propulsion Laboratory (JPL), NASA-developed Video Imaging Communication and Retrieval (VICAR) software laid the groundwork for analyzing images of all kinds. A project seeking to use imaging technology for health care diagnosis began when the imaging team considered using the VICAR software to analyze X-ray images of soft tissue. With marginal success using X-rays, the team applied the same methodology to ultrasound imagery, which was already digitally formatted. The new approach proved successful for assessing amounts of plaque build-up and arterial wall thickness, direct predictors of heart disease, and the result was a noninvasive diagnostic system with the ability to accurately predict heart health. Medical Technologies International Inc. (MTI) further developed and then submitted the technology to a vigorous review process at the FDA, which cleared the software for public use. The software, patented under the name Prowin, is being used in MTI's patented ArterioVision, a carotid intima-media thickness (CIMT) test that uses ultrasound image-capturing and analysis software to noninvasively identify the risk for the major cause of heart attack and strokes: atherosclerosis. ArterioVision provides a direct measurement of atherosclerosis by safely and painlessly measuring the thickness of the first two layers of the carotid artery wall using an ultrasound procedure and advanced image-analysis software. The technology is now in use in all 50 states and in many countries throughout the world.
Cardiovascular disease (CVD) is a major cause of morbidity and mortality among patients with chronic renal disease (CRD). Despite improvement in treatment for CVD over the past 30 years, CVD mortality is approximately 15 times higher in dialysis patients than in the general population. The high prevalence of CVD among incident dialysis patients suggests that CVD begins in earlier stages
Mark J. Sarnak; Andrew S. Levey
\\u000a Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in women in the USA. Women with diabetes are\\u000a at a greater risk of CVD than men with diabetes. In this chapter we review the various mechanisms by which hyperglycemia potentiates\\u000a this increased CVD risk, including coagulation abnormalities as well as endothelial dysfunction. Where applicable, sex-specific\\u000a differences in these
Sonia Gajula; Ashwini Reddy; L. Romayne Kurukulasuriya; Camila Manrique; Guido Lastra; James R. Sowers
Homocysteine (Hcy) is an endogenous, non-structural protein, a sulfur-containing amino acid emerging on the pathway of methionine and cysteine, actively involved in numerous biochemical reactions. Total concentration of homocysteine in plasma of healthy humans is low and its level is between 5.0 and 15.0 mmol/l, assessed with the use of HPLC, or 5.0-12.0 mmol/l, using immunoassay methods. Higher concentration of this amino acid in blood is called hyperhomocysteinemia. Hyperhomocysteinemia is significantly correlated with cardiovascular disease and its complications: heart attacks and strokes. It is believed that hyperhomocysteinemia damages endothelial cells, reduces the flexibility of vessels, and adversely affects the process of hemostasis. In addition, hyperhomocysteinemia enhances the adverse effects of risk factors such as hypertension, smoking, and impaired glucose, lipid and lipoprotein metabolism, as well as promoting the development of inflammation. The concentration of homocysteine can be effectively lowered by supplementation with folic acid and vitamins B12 and B6. However, intervention studies conducted in the past decade did not confirm the clinical benefit of vitamin therapy lowering the level of homocysteine in blood of patients with cardiovascular disease. Moreover, there is not clear evidence from genetic studies that the presence of the gene for MTFHR polymorphism 677C>T, which is one of the most common causes of hyperhomocysteinemia, is also associated with the development of cardiovascular disease. These results led the researchers to discuss the role of homocysteine in the development and treatment of cardiovascular disease as well as the need for further research on this issue. PMID:24864108
Baszczuk, Aleksandra; Kopczy?ski, Zygmunt
The nucleolus is a multifunctional organelle with multiple roles involving cell proliferation, growth, survival, ribosome biogenesis and stress response signaling. Alteration of nucleolar morphology and architecture signifies an early response to increased cellular stress. This review briefly summarizes nucleolar response to cardiac stress signals and details the role played by nucleolar proteins in cardiovascular pathophysiology. This article is part of a Special Issue entitled: Role of the Nucleolus in Human Disease. PMID:24514103
Hariharan, Nirmala; Sussman, Mark A
In spite of significant progress in pharmacotherapy the incidence of newly diagnosed cases of cardiovascular diseases and cardiovascular morbidity is alarmingly high. Treatment of hypertension or heart failure still remains a serious challenge. Continuous attempts are made to identify the mechanisms that decide about susceptibility to pathogenic factors, and to determine effectiveness of a specific therapeutic approach. Coincidence of cardiovascular diseases with metabolic disorders and obesity has initiated intensive research for their common background. In the recent years increasing attention has been drawn to disproportionately greater number of depressive disorders and susceptibility to stress in patients with coronary artery disease. An opposite relationship, i.e. a greater number of sudden cardiovascular complications in patients with depression, has been also postulated. Progress in functional neuroanatomy and neurochemistry provided new information about the neural network responsible for regulation of cardiovascular functions, metabolism and emotionality in health and under pathological conditions. In this review we will focus on the role of neuromodulators and neurotransmitters engaged in regulation of the cardiovascular system, neuroendocrine and metabolic functions in health and in pathogenesis of cardiovascular diseases and obesity. Among them are classical neurotransmitters (epinephrine and norepinephrine, serotonin, GABA), classical (CRH, vasopressin, neuropeptide Y) and newly discovered (orexins, apelin, leptin IL-1beta, TNF-alpha, ghrelin) neuropeptides, gasotransmitters, eicozanoids, endocannabinoids, and some other compounds involved in regulation of neuroendocrine, sympatho-adrenal and parasympathetic nervous systems. Special attention is drawn to those factors which play a role in immunology and inflammatory processes. Interaction between various neurotransmitter/neuromodulatory systems which may be involved in integration of metabolic and cardiovascular functions is analyzed. The survey gives evidence for significant disturbances in release or action of the same mediators in hypertension heart failure, obesity, diabetes mellitus, metabolic syndrome, starvation, chronic stress, depression and other psychiatric disorders. With regard to the pathogenic background of the cardiovascular diseases especially valuable are the studies showing inappropriate function of angiotensin peptides, vasopressin, CRH, apelin, cytokines and orexins in chronic stress, cardiovascular and metabolic diseases. The studies surveyed in this review suggest that multiple brain mechanisms interact together sharing the same neural circuits responsible for adjustment of function of the cardiovascular system and metabolism to current needs. PMID:21081794
Szczepanska-Sadowska, E; Cudnoch-Jedrzejewska, A; Ufnal, M; Zera, T
Atherosclerotic cardiovascular disease risks in chronic hemodialysis patients.BackgroundCardiovascular diseases are the most common causes of death among chronic hemodialysis patients, yet the risk factors for these events have not been well established.MethodsIn 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
Alfred K. Cheung; Mark J. Sarnak; Guofen Yan; Johanna T. Dwyer; Robert J. Heyka; Michael V. Rocco; Brendan P. Teehan; Andrew S. Levey
Cardiovascular disease is a major cause of morbidity and mortality, especially in developed countries. Various therapies for cardiovascular disease are investigated actively and are performed clinically. Recently, cell-based regenerative medicine using several cell sources has appeared as an alternative therapy for curing cardiovascular diseases. Scaffold-based or cell sheet-based tissue engineering is focused as a new generational cell-based regenerative therapy, and the clinical trials have also been started. Cell-based regenerative therapies have an enormous potential for treating cardiovascular disease. This review summarizes the recent research of cell sources and cell-based-regenerative therapies for cardiovascular diseases.
Haraguchi, Yuji; Shimizu, Tatsuya; Yamato, Masayuki
OPININION STATEMENT: All patients with ischemic stroke should undergo a comprehensive assessment of cardiovascular risk. Patients with carotid artery disease, symptoms of cerebral ischemia and high cardiovascular risk profiles should be considered for noninvasive testing for coronary artery disease (CAD). Routine testing for CAD before carotid endarterctomy is not recommended. Patients with coexisting coronary and carotid artery disease should be more aggressively treated for reducing their "very high" risk of cardiovascular events. In patients candidates to carotid revascularization, a preoperative coronary angiography and coronary revascularization are not recommended. Warfarin is recommended in all patients with moderate to high risk of stroke. Novel oral anticoagulants represent an attractive alternative to warfarin. However, their place in therapy in clinical practice is not yet established. Percutaneous closure of the left atrial appendage for stroke prophylaxis may be considered in selected patients with atrial fibrillation and contraindications for oral anticoagulant therapy. Warfarin is not indicated in patients with heart failure who are in sinus rhythm. Percutaneous closure of patent foramen does not seem to be superior to medical therapy for the prevention of recurrences in patients with cryptogenic stroke. PMID:23096595
Di Pasquale, Giuseppe; Urbinati, Stefano; Perugini, Enrica; Gambetti, Simona
Cardiovascular disease (CVD) is currently the number one killer of American women. Consequently, CVD is a concern for all women, including ethnic women. However, little is known about CVD behaviors and responses to CVD symptomology among minority women, especially American Indian women. Response behaviors to chest pain require important actions. This article examines response behaviors to chest pain in a group of American Indian women participants of the Inter-Tribal Heart Project. In 1992 to 1994, 866 American Indian women, aged 22 years and older, participated in face-to-face interviews to answer survey questions on multiple areas related to cardiovascular disease on 3 rural reservations in Minnesota and Wisconsin. A secondary data analysis was conducted on selected variables including demographic characteristics, healthcare access, rating of health status, personal and family history of cardiovascular disease, and action in response to crushing chest pain that lasted longer than 15 minutes. Research findings report that 68% of women would actively seek healthcare immediately if experiencing crushing chest pain that lasted longer than 15 minutes. However, 264 women (32%) would take a passive action to crushing chest pain, with 23% reporting they would sit down and wait until it passed. Analysis revealed women reporting a passive response were younger in age (under age 45) and had less education (less than a high school education). These findings have implications for nurses and other healthcare providers working in rural, geographically isolated Indian reservations. How to present CVD education in a culturally appropriate manner remains a challenge.
Struthers, Roxanne; Savik, Kay; Hodge, Felicia Schanche
Sleep dramatically influences cardiovascular regulation. Changes in sleep duration or quality as seen in sleep disorders may prevent blood pressure to fall during sleep as expected in human physiology. This supports the increased prevalence of hypertension and drug-resistant hypertension in those with sleep loss. Other cardiovascular outcomes i.e. coronary lesions seem to be associated with sleep duration. Systemic inflammation, oxidative stress and endothelial dysfunction seem to be associated with both sleep loss and sleep disorders. The most critical example is Obstructive Sleep Apnea (OSA). Sympathetic activation, oxidative stress and systemic inflammation are the main intermediary mechanisms associated with sleep apnea and intermittent hypoxia. There are now convincing data regarding the associations between hypertension, arrhythmias, stroke, coronary heart disease, increased cardiovascular mortality and OSA. There are also data in OSA and in animal models supporting the link between sleep apnea and atherosclerosis and dysmetabolism. Whether treating sleep apnea enables the reversal of chronic cardiovascular and metabolic consequences of OSA, remains to be studied in adequately designed studies, particularly in comparison with usual treatment strategies. PMID:22202016
Levy, Patrick; Tamisier, Renaud; Arnaud, Claire; Monneret, Denis; Baguet, Jean Philippe; Stanke-Labesque, Francoise; Dematteis, Maurice; Godin-Ribuot, Diane; Ribuot, Christophe; Pepin, Jean-Louis
Although the clinical manifestations of cardiovascular disease (CVD), such as myocardial infarction, stroke, and peripheral vascular disease, appear from middle age, the process of atherosclerosis can begin early in childhood. The early stage and progression of atherosclerosis in youth are influenced by risk factors that include obesity, hypertension, dyslipidemia, and smoking, and by the presence of specific diseases, such as diabetes mellitus and Kawasaki disease (KD). The existing evidence indicates that primary prevention of atherosclerotic disease should begin in childhood. Identification of children at risk for atherosclerosis may allow early intervention to decrease the atherosclerotic process, thereby preventing or delaying CVD. This review will describe the origin and progression of atherosclerosis in childhood, and the identification and management of known risk factors for atherosclerotic CVD in children and young adults.
The mineralocorticoid receptor (MR) and glucocorticoid receptor are ligand-activated transcription factors that have important physiological and pathophysiological actions in a broad range of cell types including monocytes and macrophages. While the glucocorticoids cortisol and corticosterone have well-described anti-inflammatory actions on both recruited and tissue resident macrophages, a role for the mineralocorticoid aldosterone in these cells is largely undefined. Emerging evidence, however, suggests that MR signalling may promote pro-inflammatory effects. This review will discuss the current understanding of the role of corticosteroid receptors in macrophages and their effect on diseases involving inflammation, with a particular focus on cardiovascular disease. PMID:19158233
Rickard, Amanda J; Young, Morag J
Cardiovascular disease is the major cause of mortality in adults and children on chronic dialysis and in adults after kidney transplantation. Cardiovascular disease burden and cardiovascular mortality are high in adults with chronic kidney disease. The early development of cardiovascular disease risk factors, some of which are modifiable, largely explain this phenomenon. Limited data are available on the prevalence of
Blanche M Chavers; Charles A Herzog
Cardiovascular disease is highly prevalent in chronic kidney disease and has been associated with increased morbidity and mortality. Several morphological and functional tests are available to assess the cardiovascular system. Since structural and functional cardiovascular abnormalities have prognostic implications, their identification may become crucial for the implementation of effective preventive and therapeutic strategies. We review the most frequently used imaging
Cristina Karohl; Paolo Raggi
Objective: Metabolomic profiling has been used to identify novel biomarkers and mechanisms of cardiovascular disease risk. We will review seminal studies in this arena. Background: Cardiovascular disease (CVD) is the greatest public health burden in the United States and globally. Clinical models for CVD risk are incomplete. Novel molecular technologies such as metabolomic profiling hold great promise in improving such models. In our own work, we have used targeted, quantitative metabolomic profiling to identify independent, incremental biomarkers and mechanisms for CVD risk. Methods: We have used mass-spectrometry based, quantitative, targeted metabolomic profiling of 63 metabolites in peripheral, fasting plasma collected from a large cardiovascular cohort of patients referred for cardiac catheterization at Duke University (CATHGEN, N=3900). Principal components analysis (PCA) was used for multidimensional data reduction. PCA-derived factors were compared between coronary artery disease (CAD) cases and non-CAD controls using linear regression. Association between PCA-derived factors and incident CVD events were tested using Cox proportional hazards time-to-event analysis. Incremental predictive capabilities were tested using reclassification analyses. Results: We found that a novel biosignature composed of short chain dicarboxylacylcarnitine (SCDA) metabolites is independently and incrementally predictive of incident CVD events. Specifically, the SCDA factor predicted incident death in multivariable models (HR 1.17 [1.05–1.31], P = .005). In reclassification analyses, 27% of intermediate-risk patients were correctly reclassified (net reclassification improvement 8.8%). We have shown these same metabolites to be heritable in families burdened with early onset CVD. Preliminary results of a genomewide association study (GWAS) of SCDA levels have identified several genetic variants reporting on a shared biological pathway potentially mediating CVD event risk. Conclusions: We (and others) have successfully used metabolomic profiling in cardiometabolic diseases for both “form” (identification of novel biomarkers for improved risk prediction) and “function” (identification of novel mechanisms of disease).
Cardiovascular disease (CVD) is an increasing world health problem. Traditional risk factors fail to account for all deaths from CVD. It is mainly the environmental, dietary and lifestyle behavioral factors that are the control keys in the progress of this disease. The potential association between chronic heavy metal exposure, like arsenic, lead, cadmium, mercury, and CVD has been less well defined. The mechanism through which heavy metals act to increase cardiovascular risk factors may act still remains unknown, although impaired antioxidants metabolism and oxidative stress may play a role. However, the exact mechanism of CVD induced by heavy metals deserves further investigation either through animal experiments or through molecular and cellular studies. Furthermore, large-scale prospective studies with follow up on general populations using appropriate biomarkers and cardiovascular endpoints might be recommended to identify the factors that predispose to heavy metals toxicity in CVD. In this review, we will give a brief summary of heavy metals homeostasis, followed by a description of the available evidence for their link with CVD and the proposed mechanisms of action by which their toxic effects might be explained. Finally, suspected interactions between genetic, nutritional and environmental factors are discussed.
Alissa, Eman M.; Ferns, Gordon A.
Obesity has been increasing in epidemic proportions, with a disproportionately higher increase in morbid or class III obesity, and obesity adversely affects cardiovascular (CV) hemodynamics, structure, and function, as well as increases the prevalence of most CV diseases. Progressive declines in physical activity over 5 decades have occurred and have primarily caused the obesity epidemic. Despite the potential adverse impact of overweight and obesity, recent epidemiological data have demonstrated an association of mild obesity and, particularly, overweight on improved survival. We review in detail the obesity paradox in CV diseases where overweight and at least mildly obese patients with most CV diseases seem to have a better prognosis than do their leaner counterparts. The implications of cardiorespiratory fitness with prognosis are discussed, along with the joint impact of fitness and adiposity on the obesity paradox. Finally, in light of the obesity paradox, the potential value of purposeful weight loss and increased physical activity to affect levels of fitness is reviewed. PMID:24530666
Lavie, Carl J; McAuley, Paul A; Church, Timothy S; Milani, Richard V; Blair, Steven N
Posttraumatic stress disorder (PTSD) is an anxiety disorder initiated by exposure to a traumatic event and characterized by intrusive thoughts about the event, attempts to avoid reminders of the event, and physiological hyperarousal. In a number of large prospective observational studies, PTSD has been associated with incident cardiovascular disease (CVD) and mortality. Also, in recent years, a number of studies have shown that cardiovascular events can themselves cause PTSD in more than 1 in 8 patients with acute coronary syndrome. Further, a few small studies suggest that PTSD secondary to an acute CVD event then places patients at increased risk for subsequent CVD events and mortality. In this article, we review the evidence for a link between PTSD and CVD, and discuss potential mechanisms for that association as well as future directions for research.
Edmondson, Donald; Cohen, Beth E.
Psoriasis is an inflammatory disease associated with multiple comorbidities and cardiovascular risk factors. Patients with psoriasis have an increased risk of cardiovascular disease (CVD) and cardiovascular death. It has been proposed that overlapping mechanisms of systemic inflammation contribute to the link between psoriasis and cardiovascular disease. Some psoriasis treatments decrease systemic inflammation, but the effect of psoriasis treatments on heart disease is unknown. In this review of 23 original research publications, we present preliminary evidence that some psoriasis therapies improve cardiovascular biomarkers and the incidence of cardiovascular risk. Phototherapy may reduce some inflammatory cytokines, but there is little evidence for a decreased risk of CVD outcomes. Both methotrexate and tumour necrosis factor-? inhibitors improve cardiovascular inflammatory biomarkers and improve CVD outcomes. Short-term data on interleukin-12/23 inhibitors are varied, but most data suggest there is not an increase in cardiovascular events. PMID:24420963
Churton, Sarah; Brown, Liza; Shin, Thuzar M; Korman, Neil J
Patients with chronic kidney disease have a higher burden of cardiovascular disease, which increases in a dose-dependent fashion with worsening kidney function. Traditional cardiovascular risk factors, including advanced age, diabetes mellitus, hypertension and dyslipidemia, have an important role in the progression of cardiovascular disease in patients who have a reduced glomerular filtration rate, especially in those with mild-to-moderate kidney disease.
Sarina van der Zee; Usman Baber; Sammy Elmariah; Jonathan Winston; Valentin Fuster
Garlic is an important component in the complementary and alternative medicine. Large segments of population believe in and utilize herbal products even when these have not been as thoroughly researched as garlic. Experimental and clinical studies confirm that the ancient experience with beneficial effects of garlic holds validity even in prevention of cardiovascular disorders and other metabolic ills. Most recent data published after year 2000 convincingly point out that garlic and its various forms reduce cardiovascular risk, including abnormal plasma lipids, oxidized low density lipoproteins (LDL), abnormal platelet aggregation and a high blood pressure. Stimulation of nitric oxide generation in endothelial cells seems to be the critical preventive mechanism. Garlic may promote an anti-inflammatory environment by cytokine modulation in human blood. Cardioprotective effects of dietary garlic are mediated in large part via the generation of hydrogen sulfide (H2S). Garlic-derived organic polysulfides are converted by erythrocytes into hydrogen sulfide which relaxes vascular smooth muscle, induces vasodilation of blood vessels, and significantly reduces blood pressure. There are data on potential ability of garlic to inhibit the rate of progression of coronary calcification. Garlic as a dietary component appears to hold promise to reduce the risk of cardiovascular disease (Fig. 2, Ref. 46). PMID:21033626
Ginter, E; Simko, V
Patients with human immunodeficiency virus (HIV) infection are at increased risk of developing coronary heart disease (CHD). Although factors potentially contributing to this elevated risk include traditional CHD risk factors and antiretroviral medications, more recent data support a role for inflammatory and immunologic factors as central to a complex mechanism. Decreasing CHD risk among HIV-infected patients is likely to involve modification of inflammatory and immunologic factors through antiretroviral therapy or other novel strategies as well as targeted treatment of traditional CHD risk factors. This review will highlight epidemiologic data investigating the association between HIV and CHD outcomes. An overview of potential mechanistic factors associated with CHD in HIV infection and of strategies for managing CHD risk in HIV-infected patients is also included. Specific cardiovascular and metabolic risk factors, CHD risk prediction, and the immunologic basis for CHD in HIV-infected patients will be discussed in separate reviews.
Diabetes increases cardiovascular (CV) risk to a similar extent as myocardial infarction. Epidemiologic data support the same\\u000a concept for the presence of Stage 3 (ie, glomerular filtration rate of < 60 mL\\/min) or higher nephropathy without diabetes.\\u000a The most common cause of end-stage kidney disease requiring dialysis is diabetes. Hence, CV risk is highest among those with\\u000a kidney disease and
Suma Dronovalli; Basil O. Burney; George L. Bakris
The health condition in Mexico was bad around de beginning of the revolutionary period. The movement of troops led the development of epidemics like yellow fever, typhus, smallpox, and influenza that were enhance with natural disasters and hunger in whole country, from cost to cost and in the north big cities like Monterrey, Guadalajara and Saltillo. Doctor Liceaga conducted a well planned campaign against yellow fever eradicating water stagnant deposits in order to combat the vector transmission, the Aedes aegypti, mosquito with satisfactory results. The first smallpox epidemic in the XX Century in Mexico was in 1916. The Mexican physicians used the smallpox vaccine against this epidemic. An American physician named Howard Taylor Ricketts arrived to Mexico for studying the typhus transmission. Accidentally he had been infected and finally, he died from typhus. Definitively, the epidemics predominate along de revolutionary period in Mexico. PMID:20929620
Social contacts are an important channel for the propagation of disease through a population and should be considered in conjunction with traditional epidemic diffusion. Such channels should always be taken into account for a realistic estimation of a lon...
A. Skvortsov P. Dawson R. Connell
Plasma low-density lipoprotein cholesterol (LDL-C) levels are a key determinant of the risk of cardiovascular disease, which is why many studies have attempted to elucidate the pathways that regulate its metabolism. Novel latest-generation sequencing techniques have identified a strong association between the 1p13 locus and the risk of cardiovascular disease caused by changes in plasma LDL-C levels. As expected for a complex phenotype, the effects of variation in this locus are only moderate. Even so, knowledge of the association is of major importance, since it has unveiled a new metabolic pathway regulating plasma cholesterol levels. Crucial to this discovery was the work of three independent teams seeking to clarify the biological basis of this association, who succeeded in proving that SORT1, encoding sortilin, was the gene in the 1p13 locus involved in LDL metabolism. SORT1 was the first gene identified as determining plasma LDL levels to be mechanistically evaluated and, although the three teams used different, though appropriate, experimental methods, their results were in some ways contradictory. Here we review all the experiments that led to the identification of the new pathway connecting sortilin with plasma LDL levels and risk of myocardial infarction. The regulatory mechanism underlying this association remains unclear, but its discovery has paved the way for considering previously unsuspected therapeutic targets and approaches. PMID:23910371
Coutinho, Maria Francisca; Bourbon, Mafalda; Prata, Maria João; Alves, Sandra
Omentin is an adipokine preferentially produced by visceral adipose tissue with insulin-sensitizing effects. Its expression is reduced in obesity, insulin resistance and type 2 diabetes. Omentin is also positively related with adiponectin, high-density lipoprotein levels and negatively related with body mass index, waist circumference, insulin resistance, triglyceride and leptin levels. Lower plasma omentin levels contribute to the pathogenesis of insulin resistance, type 2 diabetes and cardiovascular diseases in obese or overweight patients. Omentin has anti-inflammatory, antiatherogenic, anti-cardiovascular disease and antidiabetic properties. With respect to vascular biology, omentin causes vasodilatation of blood vessels and attenuates C-reactive protein-induced angiogenesis. The ability of omentin to reduce insulin resistance in conjunction with its anti-inflammatory and anti-atherogenic properties makes it a promising therapeutic target. Thus, omentin may have beneficial effects on the metabolic syndrome and could potentially be used as a biologic marker and/or pharmacologic agent/target in this respect. PMID:22724476
Zhou, Ji-Yin; Chan, Lawrence; Zhou, Shi-Wen
The Developmental Origins of Health and Disease (DOHaD) proposes that adverse events during early life program an increased risk for cardiovascular disease. Experimental models provide proof of concept but also indicate that insults during early life program sex differences in adult blood pressure and cardiovascular risk. This review will highlight the potential mechanisms that contribute to the etiology of sex differences in the developmental programming of cardiovascular disease. PMID:24583768
Intapad, Suttira; Ojeda, Norma B; Dasinger, John Henry; Alexander, Barbara T
The rapid increase in prevalence of noncommunicable diseases (NCDs) is probably the most important global health problem of the 21st century. Already in every region except Africa, NCDs account for greater mortality than communicable, maternal, perinatal and nutritional conditions combined. Although modifiable lifestyle behaviors in adult life are the main risk factors, substantial evidence now suggests that factors in early life also have a major role in the development of NCDs. For instance, breastfeeding and a slower pattern of infant weight gain have been shown to reduce the risk of obesity, cardiovascular disease and diabetes in both low-income and high-income countries. The mechanisms involved are poorly understood, but include epigenetic changes and resetting of endocrine systems that affect energy metabolism and appetite. These early life factors may interact with and exacerbate the detrimental effects of a sedentary lifestyle and energy-dense diets later in life. As a consequence, the impact of early-life factors on long-term health may be particularly important in low- and middle-income countries, which face the fastest increases in urbanization and greatest changes to lifestyle. Strategies to optimize infant nutrition could therefore make a major contribution to stemming the current global epidemic of NCD. PMID:24504213
Atherosclerotic cardiovascular disease (CVD) is one of the leading causes of death and disability worldwide including in developing countries like India. Indians are known to be predisposed to CVD, which occur almost a decade earlier in them. Though these diseases manifest in the middle age and beyond, it is now clear that the roots of CVD lie in childhood and adolescence. Many of the conventional risk factors of CVD such as high blood pressure, dyslipidemia, tobacco use, unhealthy diet and obesity have their beginnings in childhood and then track overtime. It is thus important to screen and identify these risk factors early and treat them to prevent onset of CVD. Similarly community based strategies to prevent onset of these risk factors is imperative to tackle this burgeoning public health crisis especially in countries like ours with limited resources. PMID:22638996
Praveen, Pradeep A; Roy, Ambuj; Prabhakaran, Dorairaj
Recent advances in molecular imaging have permitted the noninvasive imaging of apoptosis, a critical process underlying the pathogenesis of many diseases of the cardiovascular system including atherosclerotic vascular disease, myocardial ischemia and reperfusion injury, chronic heart failure, myocarditis, and cardiac allograft rejection. Multiple molecular targets including phosphatidylserine, phosphatidylinositol 3-kinase, and caspases have been targeted by a variety of imaging agents and modalities such as nuclear scintigraphy, PET, MRI, and fluorescent and bioluminescent imaging. Translationally, methods utilizing radiolabeled annexin V have proven promising in several clinical trials of ischemia-reperfusion injury and cardiac allograft rejection. New approaches using novel molecular imaging agents show great potential for the ability to image apoptosis in the research and clinical setting. Ultimately the ability to detect apoptosis noninvasively would help to identify patients for emerging anti-apoptotic therapies and guide clinical management with the aim of maximal myocardial preservation.
Korngold, Ethan Chauncey; Jaffer, Farouc Amin; Weissleder, Ralph
Ketone bodies are metabolized through evolutionarily conserved pathways that support bioenergetic homeostasis, particularly in brain, heart, and skeletal muscle when carbohydrates are in short supply. The metabolism of ketone bodies interfaces with the tricarboxylic acid cycle, ?-oxidation of fatty acids, de novo lipogenesis, sterol biosynthesis, glucose metabolism, the mitochondrial electron transport chain, hormonal signaling, intracellular signal transduction pathways, and the microbiome. Here we review the mechanisms through which ketone bodies are metabolized and how their signals are transmitted. We focus on the roles this metabolic pathway may play in cardiovascular disease states, the bioenergetic benefits of myocardial ketone body oxidation, and prospective interactions among ketone body metabolism, obesity, metabolic syndrome, and atherosclerosis. Ketone body metabolism is noninvasively quantifiable in humans and is responsive to nutritional interventions. Therefore, further investigation of this pathway in disease models and in humans may ultimately yield tailored diagnostic strategies and therapies for specific pathological states.
Cotter, David G.; Schugar, Rebecca C.
Early cardiovascular involvement in Chronic Obstructive Pulmonary Disease. M. Malerba, G. Romanelli. Cardiovascular (CV) disease represents a consider- able risk factor in terms of both morbidity and mortality in elderly patients with chronic obstructive pulmonary disease (COPD). In fact, there is a considerable evidence of this association: for only 20 years forced expiratory vol- ume in 1 second (FEV1) has
M. Malerba; G. Romanelli
Background: This guideline focuses on long-term administration of antithrombotic drugs designed for primary and secondary prevention of cardiovascular disease, including two new antiplatelet therapies. Methods: The methods of this guideline follow those described in Methodology for the Development of Antithrombotic Therapy and Prevention of Thrombosis Guidelines: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines in this supplement. Results: We present 23 recommendations for pertinent clinical questions. For primary prevention of cardiovascular disease, we suggest low-dose aspirin (75-100 mg/d) in patients aged > 50 years over no aspirin therapy (Grade 2B). For patients with established coronary artery disease, defined as patients 1-year post-acute coronary syndrome, with prior revascularization, coronary stenoses > 50% by coronary angiogram, and/or evidence for cardiac ischemia on diagnostic testing, we recommend long-term low-dose aspirin or clopidogrel (75 mg/d) (Grade 1A). For patients with acute coronary syndromes who undergo percutaneous coronary intervention (PCI) with stent placement, we recommend for the first year dual antiplatelet therapy with low-dose aspirin in combination with ticagrelor 90 mg bid, clopidogrel 75 mg/d, or prasugrel 10 mg/d over single antiplatelet therapy (Grade 1B). For patients undergoing elective PCI with stent placement, we recommend aspirin (75-325 mg/d) and clopidogrel for a minimum duration of 1 month (bare-metal stents) or 3 to 6 months (drug-eluting stents) (Grade 1A). We suggest continuing low-dose aspirin plus clopidogrel for 12 months for all stents (Grade 2C). Thereafter, we recommend single antiplatelet therapy over continuation of dual antiplatelet therapy (Grade 1B). Conclusions: Recommendations continue to favor single antiplatelet therapy for patients with established coronary artery disease. For patients with acute coronary syndromes or undergoing elective PCI with stent placement, dual antiplatelet therapy for up to 1 year is warranted.
Vandvik, Per Olav; Lincoff, A. Michael; Gore, Joel M.; Gutterman, David D.; Sonnenberg, Frank A.; Alonso-Coello, Pablo; Akl, Elie A.; Lansberg, Maarten G.; Guyatt, Gordon H.
Cardiovascular morbidity and mortality in patients with chronic kidney disease (CKD) is high, and the presence of CKD worsens outcomes of cardiovascular disease (CVD). CKD is associated with specific risk factors. Emerging evidence indicates that the pathology and manifestation of CVD differ in the presence of CKD. During a clinical update conference convened by the Kidney Disease: Improving Global Outcomes
Charles A Herzog; Richard W Asinger; Alan K Berger; David M Charytan; Javier Díez; Robert G Hart; Kai-Uwe Eckardt; Bertram L Kasiske; Peter A McCullough; Rod S Passman; Stephanie S DeLoach; Patrick H Pun; Eberhard Ritz
Cardiovascular disease disproportionately affects people with diabetes and is a leading cause of death. Glycemic control has\\u000a so far not been conclusively shown to decrease cardiovascular events. The therapeutic agents used in treating glycemia have\\u000a different effects on cardiovascular risks and, therefore, may have different effects on outcome. Insulin sensitizers impact\\u000a cardiovascular risk factors, including dyslipidemia and fibrinolysis. Metformin is
Brandy Panunti; Biju Kunhiraman; Vivian Fonseca
Atherosclerosis (AS), a major pathologic consequence of obesity, is the main etiological factor of cardiovascular disease (CVD), which is the most common cause of death in the western world. A systemic chronic low grade immune- mediated inflammation (scLGI) is substantially implicated in AS and its consequences. In particular, proinflammatory cytokines play a major role, with Th1-type cytokine interferon-? (IFN-?) being a key mediator. Among various other molecular and cellular effects, IFN-? activates the enzyme indoleamine 2,3-dioxygenase (IDO) in monocytederived macrophages, dendritic, and other cells, which, in turn, decreases serum levels of the essential amino acid tryptophan (TRP). Thus, people with CVD often have increased serum kynurenine to tryptophan ratios (KYN/TRP), a result of an increased TRP breakdown. Importantly, increased KYN/TRP is associated with a higher likelihood of fatal cardiovascular events. A scLGI with increased production of the proinflammatory adipokine leptin, in combination with IFN-? and interleukin-6 (IL-6), represents another central link between obesity, AS, and CVD. Leptin has also been shown to contribute to Th1-type immunity shifting, with abdominal fat being thus a direct contributor to KYN/TRP ratio. However, TRP is not only an important source for protein production but also for the generation of one of the most important neurotransmitters, 5-hydroxytryptamine (serotonin), by the tetrahydrobiopterin-dependent TRP 5-hydroxylase. In prolonged states of scLGI, availability of free serum TRP is strongly diminished, affecting serotonin synthesis, particularly in the brain. Additionally, accumulation of neurotoxic KYN metabolites such as quinolinic acid produced by microglia, can contribute to the development of depression via NMDA glutamatergic stimulation. Depression had been reported to be associated with CVD endpoints, but it most likely represents only a secondary loop connecting excess adipose tissue, scLGI and cardiovascular morbidity and mortality. Accelerated catabolism of TRP is further involved in the pathogenesis of the anemia of scLGI. The pro-inflammatory cytokine IFN-? suppresses growth and differentiation of erythroid progenitor cells, and the depletion of TRP limits protein synthesis and thus hemoglobin production, and, through reduction in oxygen supply, may contribute to ischemic vascular disease. In this review we discuss the impact of TRP breakdown and the related complex mechanisms on the prognosis and individual course of CVD. Measurement of TRP, KYN concentrations, and calculation of the KYN/TRYP ratio will contribute to a better understanding of the interplay between inflammation, metabolic syndrome, mood disturbance, and anemia, all previously described as significant predictors of an unfavorable outcome in patients with CVD. The review leads to a novel framework for successful therapeutic modification of several cardinal pathophysiological processes leading to adverse cardiovascular outcome. PMID:24606499
Mangge, H; Stelzer, I; Reininghaus, E Z; Weghuber, D; Postolache, T T; Fuchs, D
In the United States, cardiovascular disease, e.g., atherosclerosis and hypertension, that lead to heart failure and stroke, is the leading cause of mortality, accounting for over 40 percent of deaths in those aged 65 years and above. Over 80 percent of all cardio-vascular deaths occur in the same age group. Thus, age, per se, is the major risk factor for cardiovascular disease. Clinical manifestations and prognosis of these cardiovascular diseases likely become altered in older persons with advanced age because interactions occur between age-associated cardiovascular changes in health and specific pathophysiologic mechanisms that underlie a disease. A fundamental understanding of age-associated changes in cardiovascular structure and function ranging in scope from humans to molecules is required for effective and efficient prevention and treatment of cardiovascular disease in older persons. A sustained effort over the past two decades has been applied to characterize the multiple effects of aging in health on cardiovascular structure and function in a single study population, the Baltimore Longitudinal Study on Aging. In these studies, community dwelling, volunteer participants are rigorously screened to detect both clinical and occult cardiovascular disease and characterized with respect to lifestyle, e.g. exercise habits, in an attempt to deconvolute interactions among lifestyle, cardiovascular disease and the aging process in health. This review highlights some specific changes in resting cardiovascular structure and function and cardiovascular reserve capacity that occur with advancing age in healthy humans. Observations from relevant experiments in animal models have been integrated with those in humans to provide possible mechanistic insight. PMID:11790921
Lakatta, Edward G
Smoking tobacco is a major risk factor for patients with cardiovascular disease (CVD). Quitting smoking rapidly reduces the risk for cardiovascular events. The majority of patients who smoke express a desire to stop, and cost-effective interventions are available. Behavioral (counseling) and pharmacologic (nicotine replacement and non-nicotine medications) treatments double or triple the rate of long-term cessation and should be offered in combination to all patients with CVD who use tobacco. Behavioral therapy can be effectively delivered by a variety of health care providers and means (in person, telephone, mail). For patients with CVD, more intensive and sustained interventions should be encouraged. Nicotine patches have been studied extensively in patients with stable CVD and are safe. Bupropion (a non-nicotine aid) also may be especially useful for patients with CVD. Special consideration is needed for patients with acute coronary syndromes (ie, myocardial infarction and unstable angina). It is important to create a clinical environment that supports treatment of patients with nicotine addiction. Simple changes in office and hospital routines and procedures (establishing routine screening to identify users of tobacco, prompts to encourage intervention, establishing links to more intensive nicotine-dependence treatment programs) can substantially improve the identification, treatment, and outcomes for patients with CVD who use tobacco. PMID:11445061
Joseph, Anne M.; An, Lawrence C.
Physical illness or disability inevitably has a damaging effect on sexual relationships. Physicians are usually unaware of the sexual consequences of illness on their patients, and lack experience in treating sexual dysfunctions. The report of treatment of a couple with serious cardiovascular disease illustrates the potential efficacy of brief sex therapy for improving the quality of a patient's life. If a primary physician lacks the skills to conduct sex therapy, he may collaborate with nonphysician therapists. The physician's knowledge of the physiological and psychological effects of a specific illness on his patient is essential to successful therapy. Often, simple education, encouragement or reassurance by the physician is enough to overcome the damaging effects of illness on a patient's sex life.
Scalzi, Cynthia C.; Golden, Joshua S.; Loya, Fred
Background Compared to those with health insurance, the uninsured receive less care for chronic conditions such as hypertension and diabetes and they experience higher mortality. Methods We investigated the relations of health insurance status to prevalence, treatment, and control of major cardiovascular disease risk factors, hypertension and elevated low-density lipoprotein (LDL) cholesterol, among Framingham Heart Study (FHS) participants in sex-specific age-adjusted analyses. Participants who attended either the seventh Offspring cohort examination cycle (1998–2001) or the first Third Generation cohort examination cycle (2002–2005) were studied. Results Among 6098 participants, 3.8% were uninsured at the time of the FHS clinic examination and participants’ ages ranged from 19 to 64 years. The prevalence of hypertension and elevated LDL cholesterol was similar for the insured and uninsured, however the proportion of those who obtained treatment and achieved control of these risk factors was lower among the uninsured. Uninsured men and women were less likely to be treated for hypertension with odds ratios for treatment of 0.19 (95% CI 0.07–0.56) for men and 0.31 (95% CI 0.12–0.79) for women. Among men, the uninsured were less likely to receive treatment or achieve control of elevated LDL cholesterol than the insured, with odds ratios of 0.12 (95% CI 0.04–0.38) for treatment and 0.17 (95% CI 0.05–0.56) for control. Conclusions The treatment and control of hypertension and hypercholesterolemia are lower among uninsured adults. Increasing the proportion of insured individuals may be a means to improve the treatment and control of cardiovascular disease risk factors and reduce health disparities.
Brooks, Erica L.; Preis, Sarah Rosner; Hwang, Shih-Jen; Murabito, Joanne M.; Benjamin, Emelia J.; Kelly-Hayes, Margaret; Sorlie, Paul; Levy, Daniel
Sickle cell disease is characterized by recurrent episodes of ischemia-reperfusion injury to multiple vital organ systems and a chronic hemolytic anemia, both contributing to progressive organ dysfunction. The introduction of treatments that induce protective fetal hemoglobin and reduce infectious complications has greatly prolonged survival. However, with increased longevity, cardiovascular complications are increasingly evident, with the notable development of a progressive proliferative systemic vasculopathy, pulmonary hypertension (PH) and left ventricular diastolic dysfunction. Pulmonary hypertension is reported in autopsy studies and numerous clinical studies have shown that increased pulmonary pressures are an important risk marker for mortality in these patients. In epidemiological studies, the development of PH is associated with intravascular hemolysis, cutaneous leg ulceration, renal insufficiency, iron overload and liver dysfunction. Chronic anemia in sickle cell disease results in cardiac chamber dilation and a compensatory increase in left ventricular mass. This is often accompanied by left ventricular diastolic dysfunction which has also been a strong independent predictor of mortality patients with sickle cell disease. Both PH and diastolic dysfunction are associated with marked abnormalities in exercise capacity in these patients. Sudden death is an increasingly recognized problem and further cardiac investigations are necessary to recognize and treat high-risk patients.
Gladwin, Mark T.; Sachdev, Vandana
The structure of protein-protein interaction (PPI) networks has already been successfully used as a source of new biological information. Even though cardiovascular diseases (CVDs) are a major global cause of death, many CVD genes still await discovery. We explore ways to utilize the structure of the human PPI network to find important genes for CVDs that should be targeted by drugs. The hope is to use the properties of such important genes to predict new ones, which would in turn improve a choice of therapy. We propose a methodology that examines the PPI network wiring around genes involved in CVDs. We use the methodology to identify a subset of CVD-related genes that are statistically significantly enriched in drug targets and "driver genes." We seek such genes, since driver genes have been proposed to drive onset and progression of a disease. Our identified subset of CVD genes has a large overlap with the Core Diseasome, which has been postulated to be the key to disease formation and hence should be the primary object of therapeutic intervention. This indicates that our methodology identifies "key" genes responsible for CVDs. Thus, we use it to predict new CVD genes and we validate over 70% of our predictions in the literature. Finally, we show that our predicted genes are functionally similar to currently known CVD drug targets, which confirms a potential utility of our methodology towards improving therapy for CVDs. PMID:23977067
Sarajli?, Anida; Janji?, Vuk; Stojkovi?, Neda; Radak, Djordje; Pržulj, Nataša
The structure of protein-protein interaction (PPI) networks has already been successfully used as a source of new biological information. Even though cardiovascular diseases (CVDs) are a major global cause of death, many CVD genes still await discovery. We explore ways to utilize the structure of the human PPI network to find important genes for CVDs that should be targeted by drugs. The hope is to use the properties of such important genes to predict new ones, which would in turn improve a choice of therapy. We propose a methodology that examines the PPI network wiring around genes involved in CVDs. We use the methodology to identify a subset of CVD-related genes that are statistically significantly enriched in drug targets and “driver genes.” We seek such genes, since driver genes have been proposed to drive onset and progression of a disease. Our identified subset of CVD genes has a large overlap with the Core Diseasome, which has been postulated to be the key to disease formation and hence should be the primary object of therapeutic intervention. This indicates that our methodology identifies “key” genes responsible for CVDs. Thus, we use it to predict new CVD genes and we validate over 70% of our predictions in the literature. Finally, we show that our predicted genes are functionally similar to currently known CVD drug targets, which confirms a potential utility of our methodology towards improving therapy for CVDs.
Stojkovic, Neda; Radak, Djordje; Przulj, Natasa
A host of studies have established essential roles for microRNAs in cardiovascular development and disease. Moreover, the discovery of stable microRNAs in bodily fluids indicated their potential as non-invasive biomarkers. In this review, we summarize the current studies describing microRNAs in blood cells or serum/plasma, as potential biomarkers of cardiovascular disease. PMID:21846509
Di Stefano, Valeria; Zaccagnini, Germana; Capogrossi, Maurizio C; Martelli, Fabio
Cardiovascular diseases (CVD) are among the leading causes of shorter life expectancy and loss of quality of life worldwide. Thus, any influence of diet or life habits on the cardiovascular system may have important implications for public health. Epidemiological studies have shown that moderate alcohol consumption is associated with a lower risk of coronary heart disease (CHD). Moreover, high alcohol
Dimitris Grigorakis; Vassiliki Bountziouka; Nick Kalogeropoulos
Because atherosclerotic heart disease (AHD) causes significant losses of USAF manpower and dollar resources, the USAFSAM Cardiovascular Disease Study was designed to delineate the relationship of serum lipid and lipoprotein levels to the development of AH...
D. A. Clark F. H. Wilson M. F. Allen
Globally, cardiovascular disease (CVD) is the number one cause of death, being responsible for approximately 30% of deaths worldwide. Urbanization and a westernized lifestyle are thought to play a major role in the development of CVD. There is accumulating evidence that vitamin D is a nonclassical risk factor for CVD. The active vitamin D metabolite, 1,25-dihydroxyvitamin D, which is synthesized from its precursor 25-hydroxyvitamin D (25[OH]D), down-regulates several negative and up-regulates various protective pathways in the heart and vasculature. First randomized trials demonstrate that vitamin D supplementation leads to vasodilatation and suppresses cardiovascular risk markers such as triglycerides and the inflammation marker tumor necrosis factor-?. Solar UV-B radiation is the major source of vitamin D for humans. Consequently, the vitamin D status is largely influenced by season, geographic latitude, daily outdoor activities, and the percentage of body surface exposed to solar UV-B. A significant proportion of individuals in Europe and North America have vitamin D concentrations in the deficiency range (25[OH]D<25 nmol/l). Available data indicate that low solar UV-B exposure and/or low 25(OH)D concentrations are associated with an increased risk of CVD. Large nonrandomized studies indicate that CVD mortality is more than twice as high in older individuals with deficient 25(OH)D concentrations compared with those individuals who have adequate 25(OH)D concentrations (>75 nmol/l). Together, experimental and epidemiological evidence does support a plausible role for improving vitamin D status in CVD prevention in the population at large. Nevertheless, future randomised clinical trials are needed to evaluate whether vitamin D is effective with respect to primary, secondary, and/or tertiary prevention of CVD. PMID:20138781
Zittermann, Armin; Gummert, Jan F
Computational fluid dynamics (CFD) is a mechanical engineering field for analyzing fluid flow, heat transfer, and associated phenomena, using computer-based simulation. CFD is a widely adopted methodology for solving complex problems in many modern engineering fields. The merit of CFD is developing new and improved devices and system designs, and optimization is conducted on existing equipment through computational simulations, resulting in enhanced efficiency and lower operating costs. However, in the biomedical field, CFD is still emerging. The main reason why CFD in the biomedical field has lagged behind is the tremendous complexity of human body fluid behavior. Recently, CFD biomedical research is more accessible, because high performance hardware and software are easily available with advances in computer science. All CFD processes contain three main components to provide useful information, such as pre-processing, solving mathematical equations, and post-processing. Initial accurate geometric modeling and boundary conditions are essential to achieve adequate results. Medical imaging, such as ultrasound imaging, computed tomography, and magnetic resonance imaging can be used for modeling, and Doppler ultrasound, pressure wire, and non-invasive pressure measurements are used for flow velocity and pressure as a boundary condition. Many simulations and clinical results have been used to study congenital heart disease, heart failure, ventricle function, aortic disease, and carotid and intra-cranial cerebrovascular diseases. With decreasing hardware costs and rapid computing times, researchers and medical scientists may increasingly use this reliable CFD tool to deliver accurate results. A realistic, multidisciplinary approach is essential to accomplish these tasks. Indefinite collaborations between mechanical engineers and clinical and medical scientists are essential. CFD may be an important methodology to understand the pathophysiology of the development and progression of disease and for establishing and creating treatment modalities in the cardiovascular field. PMID:21949524
Background—Fibrinogen has been identified as an independent risk factor for cardiovascular disease and associated with traditional cardiovascular risk factors. Also, the role of elevated fibrinogen in thrombosis suggests that it may be on the causal pathway for certain risk factors to exert their effect. These associations remain incompletely characterized. Moreover, the optimal fibrinogen assay for risk stratification is uncertain. Methods
James J. Stec; Halit Silbershatz; Geoffrey H. Tofler; Travis H. Matheney; Patrice Sutherland; Izabela Lipinska; Joseph M. Massaro; Peter F. W. Wilson; James E. Muller; Ralph B. D'Agostino Sr
The presence of cardiovascular disease (CVD) in Type 1 diabetes largely impairs life expectancy. Hyperglycemia leading to an increase in oxidative stress is considered to be the key pathophysiological factor of both micro- and macrovascular complications. In Type 1 diabetes, the presence of coronary calcifications is also related to coronary artery disease. Cardiac autonomic neuropathy, which significantly impairs myocardial function and blood flow, also enhances cardiac abnormalities. Also hypoglycemic episodes are considered to adversely influence cardiac performance. Intensive insulin therapy has been demonstrated to reduce the occurrence and progression of both micro- and macrovascular complications. This has been evidenced by the Diabetes Control and Complications Trial (DCCT) / Epidemiology of Diabetes Interventions and Complications (EDIC) study. The concept of a metabolic memory emerged based on the results of the study, which established that intensified insulin therapy is the standard of treatment of Type 1 diabetes. Future therapies may also include glucagon-like peptide (GLP)-based treatment therapies. Pilot studies with GLP-1-analogues have been shown to reduce insulin requirements.
In the last few years, the advent of next generation sequencing (NGS) has revolutionized the approach to genetic studies, making whole-genome sequencing a possible way of obtaining global genomic information. NGS has very recently been shown to be successful in identifying novel causative mutations of rare or common Mendelian disorders. At the present time, it is expected that NGS will be increasingly important in the study of inherited and complex cardiovascular diseases (CVDs). However, the NGS approach to the genetics of CVDs represents a territory which has not been widely investigated. The identification of rare and frequent genetic variants can be very important in clinical practice to detect pathogenic mutations or to establish a profile of risk for the development of pathology. The purpose of this paper is to discuss the recent application of NGS in the study of several CVDs such as inherited cardiomyopathies, channelopathies, coronary artery disease and aortic aneurysm. We also discuss the future utility and challenges related to NGS in studying the genetic basis of CVDs in order to improve diagnosis, prevention, and treatment. PMID:23110245
Faita, Francesca; Vecoli, Cecilia; Foffa, Ilenia; Andreassi, Maria Grazia
Despite the fact that the epidemiological evidence linking cigarette smoking with cardiovascular disease is overwhelming, the precise components of cigarette smoke responsible for this relationship and the mechanisms by which they exert their effect have not yet been elucidated. There are however, some promising pointers as a result of recent developments and this review concentrates on new evidence since earlier reviews of this topic. It is now known that the endothelium has a vastly more important role than was ever thought to be the case a decade ago. Its role in health and disease is increasingly understood, as is the relationship between endothelial injury and the development of atherosclerosis. There is considerable evidence that cigarette smoking can result in both morphological and biochemical disturbances to the endothelium both in vivo and in cell culture systems. Cigarette smoke is a complex mixture and only a few components have been extensively studied. Nicotine and carbon monoxide are much less damaging than is whole smoke. However the free radical components of cigarette smoke have been shown to cause damage in model systems. Further work will be necessary to consolidate the evidence base but the data reported in this review suggest that the free radical components of cigarette smoke may be responsible for the morphological and functional damage to endothelium that has been observed in model systems.
Michael Pittilo, R
Recent epidemiologic studies have linked higher serum phosphorus concentrations to cardiovascular disease (CVD) events and mortality. This association has been identified in the general population and in those with chronic kidney disease (CKD). The risk of adverse outcomes appears to begin with phosphorus concentrations within the upper limit of the normal reference range. Multiple experimental studies have suggested pathogenetic mechanisms that involve direct and indirect effects of high phosphorus concentrations to explain these associations. Drawing from these observations, guideline-forming agencies have recommended that serum phosphorus concentrations be maintained within the normal reference range in patients with CKD and that dietary phosphorus restriction or use of intestinal phosphate binders should be considered to achieve this goal. However, outside the dialysis population, the links between dietary phosphorus intake and serum phosphorus concentrations, and dietary phosphorus intake and CVD events, are uncertain. With specific reference to the nondialysis populations, this review discusses the available data linking dietary phosphorus intake with serum phosphorus concentrations and CVD events. PMID:24117725
Menon, Madhav C; Ix, Joachim H
In addition to general lifestyle, a number of foods and dietary patterns, such as the Mediterranean diet (MD), are associated with lower incidences of chronic, age-related diseases, and mortality. We have shown that increased polyamine intake decreases age-associated pathology and increases longevity in mice. Several foods in the MD, such as fruits and legumes, are foods containing high amount of polyamines. Among age-associated conditions, cardiovascular diseases (CVD) are the leading cause of mortality worldwide, and individuals who adhere to a MD have a lower incidence of CVD. The possible contribution of increased polyamine intake to CVD prevention is discussed in this manuscript. Polyamines from food are distributed to all organs and tissues, and long-term intake increases polyamine concentration in blood. Because most polyamines are associated with red and white blood cells, they act to suppress synthesis of pro-inflammatory cytokines and of leukocyte function-associated antigen-1. Foods with anti-inflammatory properties such as n-3 polyunsaturated fatty acids are known to help prevent CVD. Additionally, suppression of de novo polyamine synthesis results from increased polyamines intake, normally synthesized from arginine. This in turn increases availability of arginine for synthesis of nitric oxide, which plays an important role in preserving normal vascular physiology. PMID:20347532
In the last few years, the advent of next generation sequencing (NGS) has revolutionized the approach to genetic studies, making whole-genome sequencing a possible way of obtaining global genomic information. NGS has very recently been shown to be successful in identifying novel causative mutations of rare or common Mendelian disorders. At the present time, it is expected that NGS will be increasingly important in the study of inherited and complex cardiovascular diseases (CVDs). However, the NGS approach to the genetics of CVDs represents a territory which has not been widely investigated. The identification of rare and frequent genetic variants can be very important in clinical practice to detect pathogenic mutations or to establish a profile of risk for the development of pathology. The purpose of this paper is to discuss the recent application of NGS in the study of several CVDs such as inherited cardiomyopathies, channelopathies, coronary artery disease and aortic aneurysm. We also discuss the future utility and challenges related to NGS in studying the genetic basis of CVDs in order to improve diagnosis, prevention, and treatment.
Faita, Francesca; Vecoli, Cecilia; Foffa, Ilenia; Andreassi, Maria Grazia
In high-income countries, social inequalities in cardiovascular disease (CVD) risk are well-documented. Although Latin America has a rich history of theory and conceptual discussion regarding social inequalities in health, empirical research has been more limited. In this commentary we summarize recent empirical work on social inequalities in CVD risk in Latin America, and highlight key research needs as well as implications for prevention. Although much remains unknown about the social patterning of CVD in Latin America, the limited studies to date indicate that inequalities in CVD risk vary across populations and markers of socioeconomic position, as well as disease risk marker. The strongest social inequalities are seen among women, and in urban areas, with regards to obesity, diabetes, and diet. Few studies, though, have been conducted in some parts of Latin America, including the countries of Central America and northern South America. Vital registration systems and nationally-representative risk factor surveys can be important sources of data, as long as information on socioeconomic indicators is collected. Longitudinal studies will also be important for investigating factors driving social inequalities. As policies and prevention strategies are put into place to reduce CVD in Latin America, they must also address factors generating social inequalities in CVD risk. PMID:24448943
Fleischer, Nancy L; Diez Roux, Ana V
Lipoprotein(a) (Lp(a)) is an LDL-like molecule consisting of an apolipoprotein B-100 (apo(B-100)) particle attached by a disulphide bridge to apo(a). Many observations have pointed out that Lp(a) levels may be a risk factor for cardiovascular diseases. Lp(a) inhibits the activation of transforming growth factor (TGF) and contributes to the growth of arterial atherosclerotic lesions by promoting the proliferation of vascular smooth muscle cells and the migration of smooth muscle cells to endothelial cells. Moreover Lp(a) inhibits plasminogen binding to the surfaces of endothelial cells and decreases the activity of fibrin-dependent tissue-type plasminogen activator. Lp(a) may act as a proinflammatory mediator that augments the lesion formation in atherosclerotic plaques. Elevated serum Lp(a) is an independent predictor of coronary artery disease and myocardial infarction. Furthermore, Lp(a) levels should be a marker of restenosis after percutaneous transluminal coronary angioplasty, saphenous vein bypass graft atherosclerosis, and accelerated coronary atherosclerosis of cardiac transplantation. Finally, the possibility that Lp(a) may be a risk factor for ischemic stroke has been assessed in several studies. Recent findings suggest that Lp(a)-lowering therapy might be beneficial in patients with high Lp(a) levels. A future therapeutic approach could include apheresis in high-risk patients in order to reduce major coronary events.
Malaguarnera, Michele; Vacante, Marco; Russo, Cristina; Malaguarnera, Giulia; Antic, Tijana; Malaguarnera, Lucia; Bella, Rita; Pennisi, Giovanni; Galvano, Fabio; Frigiola, Alessandro
Chronic obstructive pulmonary disease (COPD) is a chronic, progressive lung disease resulting from exposure to cigarette smoke, noxious gases, particulate matter, and air pollutants. COPD is exacerbated by acute inflammatory insults such as lung infections (viral and bacterial) and air pollutants which further accelerate the steady decline in lung function. The chronic inflammatory process in the lung contributes to the extrapulmonary manifestations of COPD which are predominantly cardiovascular in nature. Here we review the significant burden of cardiovascular disease in COPD and discuss the clinical and pathological links between acute exacerbations of COPD and cardiovascular disease.
Laratta, Cheryl R.; van Eeden, Stephan
C-reactive protein (CRP) has been proposed as a risk factor for cardiovascular disease; however, this association is confounded by mutual relationships with both classical and haematological cardiovascular risk factors. We, therefore, measured CRP with a high-sensitivity assay in stored plasma samples from 414 men and 515 women in the north Glasgow MONICA (MONItoring trends in CArdiovascular diseases) survey, to study its correlation with haematological variables, classical risk factors and prevalent cardiovascular disease. CRP correlated with age, oral contraceptive use, menopause and most classical cardiovascular risk factors (except blood pressure). CRP also correlated with plasma levels of the pro-inflammatory cytokine interleukin 6, and haematocrit, viscosity, red cell aggregation, white cell count, and coagulation factors [fibrinogen, factor (F) VII in women, FVIII, FIX] and inhibitors (antithrombin and protein C in women; protein S) but not coagulation activation markers. CRP was significantly associated with prevalent cardiovascular disease in both men (P = 0.03) and women (P = 0.009), however, the association became non-significant after adjustment for firstly classical risk factors, then fibrinogen. We conclude that correlations with classical and haematological risk factors account for a substantial component of the association of CRP with prevalent cardiovascular disease, but there is evidence of a residual, independent effect among women. PMID:12823355
Woodward, Mark; Rumley, Ann; Lowe, Gordon D O; Tunstall-Pedoe, Hugh
Patients with tetralogy of Fallot can survive to late adulthood; however, there are few data on cardiovascular outcomes in this population. We conducted a single-center retrospective analysis of cardiovascular outcomes and risk factors in 208 patients with tetralogy of Fallot to better evaluate the burden of cardiovascular disease in this group. Descriptive statistics were used to determine the prevalence of relevant cardiovascular risk factors and outcomes, including a composite analysis of cardiovascular disease. Rates and mean values from the American Heart Association 2011 Heart Disease and Stroke Statistics Update were used as population estimates for comparison. In tetralogy of Fallot patients, cardiovascular disease prevalence was not different from that found in the general population (40% vs 36%, P=0.3). However, there was significantly more cardiovascular disease in tetralogy of Fallot men aged 20 to 39 years (30% vs 14%, P < 0.05) and in tetralogy of Fallot men aged 40 to 59 years (63% vs 29%, P < 0.0001). This was due to higher prevalence of coronary disease (12% vs 7%, P < 0.05) and heart failure (16% vs 2%, P < 0.0001). In particular, the increased prevalence of heart failure (regardless of pulmonary valve disease) accounts for the frequency of cardiovascular disease in tetralogy of Fallot men aged 20 to 59 years. These data support the need to routinely screen young adult male survivors of tetralogy of Fallot for asymptomatic heart failure. Further studies are needed to determine the incidence, severity, and long-term effects of cardiovascular disease in the adult congenital heart disease population.
Bradley, Elisa; Parker, Jeff; Novak, Eric; Ludbrook, Philip; Billadello, Joseph; Cedars, Ari
Hypertension is a syndrome beyond high blood pressure alone. Hypertension is one of the cardiovascular diseases that may cause cardiovascular remodeling and endothelial dysfunction. Angiotensin II type 1 (AT1R) and type 2 (AT2R) receptors are expressed in most organs and tissues and are implicated in hypertension, endothelial dysfunction, and cardiovascular diseases. Genetic and epigenetic manipulations of the renin angiotensin system play a critical role in programming of cardiovascular diseases, and certain variants of AT1R and AT2R are constitutively predisposed to higher cardiovascular risk and hypertension. The structure-function relationship of angiotensin receptors has been reviewed previously. So, in this review we focused on the structure, expression of angiotensin II receptors, their mode of action, role in cardiovascular pathobiology, and how cardiovascular diseases are programmed in utero. In addition, we described genetic variants of angiotensin receptors, and also discussed possible ways of therapeutic intervensions of Ang II stimulation. Collectively, this information may lead us to future new drug design against cardiovascular diseases.
Dasgupta, Chiranjib; Zhang, Lubo
The objective of this investigation was to describe the detection of foot and mouth disease (FMD) outbreaks in nonendemic areas, and to consider how events early in an epidemic influence the epidemic's course. We identified 24 epidemics that occurred between 1992 and 2003 in areas officially considered free of FMD. We obtained information about these epidemics from many sources, including the scientific literature, the grey (non peer-reviewed) literature, and individuals involved with the outbreaks. While most of the epidemics consisted of fewer than 150 infected premises, there were 4 extremely large epidemics, each consisting of more than 2000 infected premises. There was no direct relationship between the time to detection and either the total number of infected premises or the number of animals killed for disease control purposes. We believe that the movement of infected animals through markets was the most critical factor that contributed to the unusual magnitude of the very large epidemics. PMID:17987967
McLaws, Melissa; Ribble, Carl
Several epidemiological studies have clearly shown that low plasma levels of high density lipoprotein cholesterol (HDL-C) represent a cardiovascular disease (CVD) risk factor. However, it is unclear if there is a causal association between HDL-C concentration and CVD. A recent study published in the Lancet, which performed two Mendelian randomization analyses, showed that increased HDL-C levels were not associated with a decreased risk of myocardial infarction. These findings, together with the termination of the niacin-based AIM-HIGH trial and the discontinuation of cholesteryl ester transfer protein inhibitor dalcetrapib, challenge the concept that raising of plasma HDL-C will uniformly translate into reductions in CVD risk. HDL particles exhibit several anti-atherosclerotic properties, such as anti-inflammatory and anti-oxidative activities and cellular cholesterol efflux activity. Furthermore, HDL particles are very heterogeneous in terms of size, structure, composition and metabolism. HDL functionality may be associated more strongly with CVD risk than the traditional HDL-C levels. More research is needed to assess the association of the structure of HDL particle with its functionality and metabolism. PMID:23888190
Filippatos, Theodosios D; Elisaf, Moses S
Positron emission tomography (PET) represents an advanced form of nuclear imaging technology. The use of positron emitting isotopes, such as C-11, O-15, N-13, and F-18 permit radiolabelling of naturally occurring compounds in the body or close analogues. This, combined with technical advantages of PET imaging, allow quantification of physiological processes in humans. PET has become established as the most accurate noninvasive means for the diagnosis of coronary artery disease using myocardial perfusion radiotracers, which include rubidium-82, N-13-amonia, and O-15-water. These approaches have also been applied for long term evaluation of the effects of therapy and for the quantification of myocardial bloodflow. Radiolabelling of metabolic substrates, including C-11 palmitate, C-11 acetate and F-18 flurodeoxyglucose (FDG) have permitted evaluation of myocardial metabolism. F-18 FDG PET imaging has been established as the best means for defining viable myocardium in patients with reduced ventricular function being considered for revascularization. FDG PET can also identify patients being considered for cardiac transplant, who may be candidates for revascularization. In this review, other applications for metabolic, autonomic nervous system and receptor imaging are also discussed. The availability of cardiac PET in Canada is currently limited. However, with the reducing costs of capital and more cost effectiveness data, PET may become more widely available. Cardiac PET imaging is established as a tremendous diagnostic tool for defining viable myocardium, assessment of perfusion and long term evaluation of therapy without invasive procedures. PET is also a vital research tool capable of evaluating flow, metabolism, myocardial receptors, autonomic nervous system and potentially radiolabelled drugs. Cardiac PET imaging will continue to provide important insight, expanding our understanding and treatment of patients with cardiovascular disease. PMID:9191475
Increasing evidence indicates that hypertension in pregnancy is an under-recognized risk factor for cardiovascular disease (CVD). Compared with women who have had normotensive pregnancies, those who are hypertensive during pregnancy are at greater risk of cardiovascular and cerebrovascular events and have a less favorable overall risk profile for CVD years after the affected pregnancies. One factor that might underlie this
Suzanne R Hayman; Vesna D Garovic
Obstructive sleep apnea syndrome (OSAS) is a highly prevalent sleep disorder, characterized by repeated disruptions of breathing during sleep. This disease has many potential consequences including excessive daytime sleepiness, neurocognitive deterioration, endocrinologic and metabolic effects, and decreased quality of life. Patients with OSAS experience repetitive episodes of hypoxia and reoxygenation during transient cessation of breathing that provoke systemic effects. Furthermore, there may be increased levels of biomarkers linked to endocrine-metabolic and cardiovascular alterations. Epidemiological studies have identified OSAS as an independent comorbid factor in cardiovascular and cerebrovascular diseases, and physiopathological links may exist with onset and progression of heart failure. In addition, OSAS is associated with other disorders and comorbidities which worsen cardiovascular consequences, such as obesity, diabetes, and metabolic syndrome. Metabolic syndrome is an emerging public health problem that represents a constellation of cardiovascular risk factors. Both OSAS and metabolic syndrome may exert negative synergistic effects on the cardiovascular system through multiple mechanisms (e.g., hypoxemia, sleep disruption, activation of the sympathetic nervous system, and inflammatory activation). It has been found that CPAP therapy for OSAS provides an objective improvement in symptoms and cardiac function, decreases cardiovascular risk, improves insulin sensitivity, and normalises biomarkers. OSAS contributes to the pathogenesis of cardiovascular disease independently and by interaction with comorbidities. The present review focuses on indirect and direct evidence regarding mechanisms implicated in cardiovascular disease among OSAS patients.
Zamarron, Carlos; Valdes Cuadrado, Luis; Alvarez-Sala, Rodolfo
BACKGROUND: Consumption of chocolate has been often hypothesized to reduce the risk of cardiovascular disease (CVD) due to chocolate's high levels of stearic acid and antioxidant flavonoids. However, debate still lingers regarding the true long term beneficial cardiovascular effects of chocolate overall. METHODS: We reviewed English-language MEDLINE publications from 1966 through January 2005 for experimental, observational, and clinical studies of
Eric L Ding; Susan M Hutfless; Xin Ding; Saket Girotra
In this short article the treatment of some cardiovascular diseases with magnesium is reviewed. Magnesium is one of the most important minerals in almost all physiological systems of the body including the cardiovascular one. The most important functions dependent on magnesium are calcium antagonism, membrane sealing or stabilization, regulation of energy transfer, control of oxidative phosphorylation, glycolysis, production and function
Context Migraine with aura has been associated with an adverse cardiovascular risk profile and prothrombotic factors that, along with migraine-specific physiology, may increase the risk of vascular events. Although migraine with aura has been associated with increased risk of ischemic stroke, an association with cardiovascular disease (CVD) and, specifically, coronary events remains unclear. Objective To evaluate the association between migraine
Tobias Kurth; J. Michael Gaziano; Nancy R. Cook; Giancarlo Logroscino; Hans-Christoph Diener; Julie E. Buring
Subjects with diabetes have increased cardiovascular disease risk compared to those without diabetes. Addressing residual cardiovascular disease risk in this disease, beyond blood pressure and LDL cholesterol control, remains important as the prevalence of diabetes increases worldwide. The accelerated atherosclerosis and cardiovascular disease in diabetes is likely multifactorial and there are numerous therapeutic approaches that can be considered. Results of mechanistic studies conducted in isolated cells, animals, or humans can provide important insights with potential to influence clinical management decisions and improve outcomes. In this review, we focus on three areas in which pathophysiologic considerations could be particularly informative in this regard; the roles of hyperglycemia, diabetic dyslipidemia (beyond LDL cholesterol level), and inflammation (including that in adipose tissue) for accelerating vascular injury and the rates of cardiovascular disease in Type 2 diabetes are outlined and evaluated.
Mazzone, Theodore; Chait, Alan; Plutzky, Jorge
This review provides an up-to-date summary of the evidence from clinical and epidemiologic studies indicating that persons with post-traumatic stress disorder (PTSD) may have an increased risk of coronary heart disease and possibly thromboembolic stroke. Persons with PTSD, a common anxiety disorder in both veteran and nonveteran populations, have been reported to have an increased risk of hypertension, hyperlipidemia, obesity, and cardiovascular disease. Increased activity of the sympathoadrenal axis may contribute to cardiovascular disease through the effects of catecholamines on the heart, vasculature, and platelet function. Reported links between PTSD and hypertension and other cardiovascular risk factors may partly account for reported associations between PTSD and heart disease. The associations observed between PTSD and cardiovascular diseases have implications for cardiology practice and research.
Coughlin, Steven S
Under disease conditions including obesity (insulin resistance) and diabetes, dysregulation of adipokines such as tumor necrosis factor (TNF)-?, leptin, resistin, and adiponectin contribute to the development of metabolic and cardiovascular disease. Unlike other adipokines, adiponectin has been shown to be a therapeutic target for metabolic syndrome and cardiovascular disease. Circulating levels of adiponectin are markedly reduced in obese, diabetic, hypertensive, and coronary artery disease patients as well as experimental animal models of insulin resistance and diabetes. Recently, the small molecule adiponectin receptors (AdipoRs) agonist was discovered and suggested that the agonist is a novel therapeutic target for the treatment of type 2 diabetes linked to obesity in an experimental mouse model. This review will focus on signaling pathways involved in adiponectin and its receptors and the role of adiponectin in metabolic and cardiovascular disease including insulin resistance, cardiomyopathy, and cardiovascular dysfunction.
Lee, Sewon; Kwak, Hyo-Bum
Mortality from major cardiovascular diseases (International Classification of Diseases, Tenth Revision (ICD 10) I00I78) includes deaths from Diseases of heart (ICD10 codes I00I09, I11, I13, I20I51); Essential hypertension and hypertensive renal disease (I...
A. M. Minino R. J. Klein
The incidence of diabetes has reached epidemic proportions across the world. In patients with diabetes, there is a two to four times increased risk of developing coronary artery disease (CAD). Diabetes seems to eliminate the protective benefits of hormones in women against CAD. Patients with type II diabetes also have hypertension, dyslipidemia, obesity, endothelial dysfunction and prothrombotic factors, called ‘the
Jaffar Ali Raza; Assad Movahed
With the growing epidemic of obesity in an aging population, obstructivesleepapnea(OSA)isincreasinglyencounteredin clinical practice. Given the acute cardiopulmonary stressors consequent to repetitive upper airway collapse, as well as evidence for cardiovas- cular homeostatic dysregulation in subjects with sleep apnea, there is ample biologic plausibility that OSA imparts increased cardiovas- cular risk, independent of comorbid disease. Indeed, observational studies have suggested strong
Jason M. Golbin; Virend K. Somers; Sean M. Caples
Smoking cessation lowers the risk of death substantially in patients with cardiovascular disease. Although varenicline is an effective medication for smoking cessation, its safety in this population has been questioned and evaluated in several studies. In 2 randomized controlled trials of patients with cardiovascular disease, the rates of serious cardiovascular events were up to 2% higher in patients receiving varenicline than placebo, though the differences were not statistically significant. In the first meta-analysis of mostly trials involving patients with a history of cardiovascular disease, varenicline was found to significantly increase the risk of cardiovascular events by 72%; however, a second meta-analysis did not find a significant increased risk. In an observational study, varenicline was not associated with an increased risk of events when compared to bupropion in a subgroup analysis of patients with a history of cardiovascular disease. Because the evidence on the safety of varenicline in this population is limited and conflicting, additional data are needed to formulate stronger conclusions. In the meantime, health care professionals should consider individual smoking patterns, concomitant medical conditions, and cost when recommending smoking cessation pharmacotherapy for patients with cardiovascular disease. PMID:24080536
Haber, Stacy L; Boomershine, Virginia; Raney, Erin
Hypercholesterolemia is a major cardiovascular risk factor that increases the incidence of atherosclerotic diseases in adults, although the association is less well established in the elderly. The role of statins is well characterized for the reduction of myocardial infarction incidence or death in individuals with a history or high risk of cardiovascular diseases, regardless of age. Therapeutic measures recommended to prevent cardiovascular diseases and to reduce cholesterol levels in the elderly, such as lifestyle changes and lipid-lowering drugs, particularly statins, are based on studies conducted in younger adults. This narrative review aims to summarize the main observational studies and randomized clinical trials that have studied the relationship between cholesterol and cardiovascular diseases and the potential benefits and drawbacks of statins use in elderly patients.
Felix-Redondo, Francisco J.; Grau, Maria; Fernandez-Berges, Daniel
Cardiovascular diseases have become an increasing clinical issue worldwide. Acute ischaemic injury and chronic cardiomyopathies lead to permanent loss of cardiac tissue and ultimately heart failure. Current therapies widely aim to attenuate the pathological changes that occur after injury and to reduce risk factors of cardiovascular diseases. However, they do not improve the patient's quality of life or the prognosis more than moderate. A new challenge in the treatment of the cardiovascular disease is cellular transplantation or cellular cardiomyoplasty. Different types of stem cells have been used for stem cell therapy. Clinical trials using primary bone-marrow-derived cells and skeletal myoblasts have also shown some encouraging results. An additional clinical and pre-clinical study to further enhance the beneficial effects of cell therapy is necessary. Recent studies have shown that there are various pools of putative resident stem cells in an adult heart, raising the hope that these cells can contribute to the treatment of cardiovascular diseases. PMID:22577419
Reza Mohammadhasani, Mohammad; Hasanzad, Mandana; Mohammadhasani, Amirreza; Samzadeh, Mohammad; Eslami, Maryam
Cardiovascular diseases have become an increasing clinical issue worldwide. Acute ischaemic injury and chronic cardiomyopathies lead to permanent loss of cardiac tissue and ultimately heart failure. Current therapies widely aim to attenuate the pathological changes that occur after injury and to reduce risk factors of cardiovascular diseases. However, they do not improve the patient's quality of life or the prognosis more than moderate. A new challenge in the treatment of the cardiovascular disease is cellular transplantation or cellular cardiomyoplasty. Different types of stem cells have been used for stem cell therapy. Clinical trials using primary bone-marrow-derived cells and skeletal myoblasts have also shown some encouraging results. An additional clinical and pre-clinical study to further enhance the beneficial effects of cell therapy is necessary. Recent studies have shown that there are various pools of putative resident stem cells in an adult heart, raising the hope that these cells can contribute to the treatment of cardiovascular diseases.
Reza Mohammadhasani, Mohammad; Hasanzad, Mandana; Mohammadhasani, Amirreza; Samzadeh, Mohammad; Eslami, Maryam
Cardiovascular disease (CVD) is the major public health problem in the U.S. today. Health education teachers should take the initiative to teach others about the relationships of diet, personal attributes, metabolic disorders, and lifestyle characteristics to CVD. (JN)
Roush, Robert E.
The mechanisms by which particulate matter (PM) exposure disrupts cardiac function and worsens cardiovascular disease (CVD) are not well understood. There is a growing body of knowledge that suggests that PM exposure can induce inflammatory changes in blo...
Sexual Health Concerns in Patients With Cardiovascular Disease Lindsey Rosman , MA ; John M. Cahill , MD ; Susan L. McCammon , ... disrupt sexual activity. Additional Factors That Can Disrupt Sexual Health Emotional distress Fear that it is not safe ...
Hematopoietic cell transplantation (HCT) is increasingly offered as a curative option for many patients with hematologic malignancies. Improvements in HCT strategies and supportive care have resulted in a growing number of long-term survivors. However, these survivors are at an increased risk of developing long-term debilitating chronic health conditions, including premature cardiovascular disease. These complications are more common than in the general population, and there are well-described associations between therapeutic exposures, traditional cardiovascular risk factors, and subsequent cardiovascular disease risk. The authors present herein an overview of the current state of knowledge regarding pathogenesis and risk factors for some of the more commonly occurring cardiovascular complications after HCT, highlighting existing surveillance recommendations and future directions for research to minimize cardiovascular morbidity in these survivors. PMID:24166350
Armenian, Saro H; Chow, Eric J
Background Cardiovascular diseases (CVD) are associated with significant morbidity and mortality, which is highest in Eastern Europe including Estonia. Accumulating evidence suggests that life-style is associated with the development of CVD. The aim of this study was to evaluate the informative power of common CVD-related markers under unhealthy conditions. Subjects Subjects (n = 51; mean age 45 years; 90% men) were recruited from a shelter for homeless people in Tallinn, Estonia, and consisted of persons who constantly used alcohol or surrogates, smoked, and were in a bad physical condition (amputated toes, necrotic ulcers, etc.). Methods Blood pressure, pulse rate, and waist circumference were measured, and body mass index (BMI) was calculated. The following markers were measured in blood serum: total cholesterol (TChol), high-density lipoprotein cholesterol (HDL-Chol), low-density lipoprotein cholesterol (LDL-Chol), plasma triglycerides (TG), apolipoproteins A-l (ApoA1) and B (ApoB), lipoprotein(a) (Lp(a)), glycated hemoglobin (HbA1c), glucose (Gluc), high-sensitivity C-reactive protein (hsCRP), serum carbohydrate-deficient transferrin (CDT), gamma-glutamyltransferase (GGT), alanine aminotransferase (ALT), and aspartate aminotransferase (AST). Except smoking, the anamnestic information considering eating habits, declared alcohol consumption and medication intake were not included in the analysis due to the low credibility of self-reported data. Results More than half of the investigated patients had values of measured markers (hsCRP, TChol, LDL-Chol, TG, HbA1c, ApoA1, ApoB, Lp(a), Gluc) within normal range. Surprisingly, 100% of subjects had HDL-Chol within endemic norm. Conclusion This study demonstrates that traditional markers, commonly used for prediction and diagnosis and treatment of CVD, are not always applicable to homeless people, apparently due to their aberrant life-style.
Elevated serum uric acid concentration is a common laboratory finding in subjects with metabolic syndrome/obesity, hypertension, kidney disease and cardiovascular events. Hyperuricemia has been attributed to hyperinsulinemia in metabolic syndrome and to decreased uric acid excretion in kidney dysfunction and is not acknowledged as a main mediator of metabolic syndrome, renal disease, and cardiovascular disorder development. However, more recent investigations have altered this traditional view and shown by providing compelling evidence to support an independent link between hyperuricemia and increased risk of metabolic syndrome, diabetes, hypertension, kidney disease and cardiovascular disorders. However, despite these new findings, controversy regarding the exact role of uric acid in inducing these diseases remains to be unfolded. Furthermore, recent data suggest that the high-fructose diet in the United State, as a major cause of hyperuricemia, may be contributing to the metabolic syndrome/obesity epidemic, diabetes, hypertension, kidney disease and cardiovascular disorder. Our focus in this review is to discuss the available evidence supporting a role for uric acid in the development of metabolic syndrome, hypertension, renal disease, and cardiovascular disorder; and the potential pathophysiology mechanisms involved.
Soltani, Zohreh; Rasheed, Kashef; Kapusta, Daniel R.; Reisin, Efrain
Background The global spread of the severe acute respiratory syndrome (SARS) epidemic has clearly shown the importance of considering the long-range transportation networks in the understanding of emerging diseases outbreaks. The introduction of extensive transportation data sets is therefore an important step in order to develop epidemic models endowed with realism. Methods We develop a general stochastic meta-population model that incorporates actual travel and census data among 3 100 urban areas in 220 countries. The model allows probabilistic predictions on the likelihood of country outbreaks and their magnitude. The level of predictability offered by the model can be quantitatively analyzed and related to the appearance of robust epidemic pathways that represent the most probable routes for the spread of the disease. Results In order to assess the predictive power of the model, the case study of the global spread of SARS is considered. The disease parameter values and initial conditions used in the model are evaluated from empirical data for Hong Kong. The outbreak likelihood for specific countries is evaluated along with the emerging epidemic pathways. Simulation results are in agreement with the empirical data of the SARS worldwide epidemic. Conclusion The presented computational approach shows that the integration of long-range mobility and demographic data provides epidemic models with a predictive power that can be consistently tested and theoretically motivated. This computational strategy can be therefore considered as a general tool in the analysis and forecast of the global spreading of emerging diseases and in the definition of containment policies aimed at reducing the effects of potentially catastrophic outbreaks.
Colizza, Vittoria; Barrat, Alain; Barthelemy, Marc; Vespignani, Alessandro
We report the results of a study we conducted using a simple multiplayer online game that simulates the spread of an infectious disease through a population composed of the players. We use our virtual epidemics game to examine how people respond to epidemics. The analysis shows that people's behavior is responsive to the cost of self-protection, the reported prevalence of disease, and their experiences earlier in the epidemic. Specifically, decreasing the cost of self-protection increases the rate of safe behavior. Higher reported prevalence also raises the likelihood that individuals would engage in self-protection, where the magnitude of this effect depends on how much time has elapsed in the epidemic. Individuals' experiences in terms of how often an infection was acquired when they did not engage in self-protection are another factor that determines whether they will invest in preventive measures later on. All else being equal, individuals who were infected at a higher rate are more likely to engage in self-protective behavior compared to those with a lower rate of infection. Lastly, fixing everything else, people's willingness to engage in safe behavior waxes or wanes over time, depending on the severity of an epidemic: when prevalence is high, people are more likely to adopt self-protective measures as time goes by; when prevalence is low, a ‘self-protection fatigue’ effect sets in whereby individuals are less willing to engage in safe behavior over time.
Chen, Frederick; Griffith, Amanda; Cottrell, Allin; Wong, Yue-Ling
The global epidemic of diabetes mellitus (?95% type 2 diabetes) has been fueled by a parallel increase in obesity and overweight. Together, these metabolic disease epidemics have contributed to the increasing incidence and prevalence of cardiovascular disease. The accumulation of metabolic and cardiovascular risk factors in patients with type 2 diabetes—risk factors that may exacerbate one another—complicates treatment. Inadequate treatment,
Robert Chilton; Jamison Wyatt; Shailesh Nandish; Rene Oliveros; Michael Lujan
Abstract Humans are continually exposed to ionizing radiation from terrestrial sources. The two major contributors to radiation exposure of the U.S. population are ubiquitous background radiation and medical exposure of patients. From the early 1980s to 2006, the average dose per individual in the United States for all sources of radiation increased by a factor of 1.7–6.2?mSv, with this increase due to the growth of medical imaging procedures. Radiation can place individuals at an increased risk of developing cardiovascular disease. Excess risk of cardiovascular disease occurs a long time after exposure to lower doses of radiation as demonstrated in Japanese atomic bomb survivors. This review examines sources of radiation (atomic bombs, radiation accidents, radiological terrorism, cancer treatment, space exploration, radiosurgery for cardiac arrhythmia, and computed tomography) and the risk for developing cardiovascular disease. The evidence presented suggests an association between cardiovascular disease and exposure to low-to-moderate levels of radiation, as well as the well-known association at high doses. Studies are needed to define the extent that diagnostic and therapeutic radiation results in increased risk factors for cardiovascular disease, to understand the mechanisms involved, and to develop strategies to mitigate or treat radiation-induced cardiovascular disease. Antioxid. Redox Signal. 15, 1945–1956.
Moulder, John E.; Hopewell, John W.
Abstract population are ubiquitous background radiation and medical exposure of patients. From the early 1980s to 2006, the average dose per individual in the United States for all sources of radiation increased by a factor of 1.7-6.2?mSv, with this increase due to the growth of medical imaging procedures. Radiation can place individuals at an increased risk of developing cardiovascular disease. Excess risk of cardiovascular disease occurs a long time after exposure to lower doses of radiation as demonstrated in Japanese atomic bomb survivors. This review examines sources of radiation (atomic bombs, radiation accidents, radiological terrorism, cancer treatment, space exploration, radiosurgery for cardiac arrhythmia, and computed tomography) and the risk for developing cardiovascular disease. The evidence presented suggests an association between cardiovascular disease and exposure to low-to-moderate levels of radiation, as well as the well-known association at high doses. Studies are needed to define the extent that diagnostic and therapeutic radiation results in increased risk factors for cardiovascular disease, to understand the mechanisms involved, and to develop strategies to mitigate or treat radiation-induced cardiovascular disease. PMID:21091078
Baker, John E; Moulder, John E; Hopewell, John W
Introduction: Research on the effects of meteorological parameters on cardiovascular diseases may allow the development of novel prevention strategies. Aim: The aim of the authors was to examine the correlation between meteorological parameters and the occurrence of acute cardiovascular diseases. Method: A retrospective analysis was performed in 343 patients diagnosed with acute cardiovascular disease and treated at the Department of Vascular Surgery, Semmelweis University in 2010. Results: Acute cardiovascular diseases showed a seasonal variation with the highest occurrence in winter months (p = 0.0001). The daily increase of the events (n?3) were associated with front movements days (in 62.5% of cases). A significant correlation was found between the intraday temperature difference (p<0.0001), the intraday atmospheric pressure difference (p = 0.0034), the lowest maximum daily temperature (p<0.0001) and the occurrence of acute cardiovascular diseases. During the days with front movements 64% of the patients were older than 66 years of age. Among risk factors, hypertension showed front sensitivity. Conclusions: Meteorological parameters are minor risk factors in the occurrence of acute cardiovascular diseases. Orv. Hetil., 2014, 155(27), 1078-1082. PMID:24974843
Boussoussou, Nora; Boussoussou, Melinda; Entz, László; Nemes, Attila
Abstract. Zimmet,P (International Diabetes Insti- tute, Melbourne, Australia). Globalization, coca- colonization and the chronic,disease epidemic: can the Doomsday,scenario be averted? J Intern Med 2000; 247: 301?310. There are at present,approximately,110 million
Singapore experienced a large epidemic of hand, foot and mouth disease (HFMD) in 2000. After reviewing HFMD notifi- cations from doctors and child-care centers, we found that the incidence of HFMD rose in September and declined at the end of October. During this period, 3,790 cases were reported. We performed enteroviral cultures on 311 and 157 specimens from 175 HFMD
Kwai Peng Chan; Kee Tai Goh; Chia Yin Chong; Eng Swee Teo; Gilbert Lau; Ai Ee Ling
The role of hemostatic variables (which promote hemostatic plugs and thrombi) and rheological variables (which affect blood flow) in the pathogenesis of vascular diseases (ischemic heart disease, stroke, and peripheral arterial disease) is reviewed, with emphasis on epidemiological studies. Rheological variables are consistently associated with both prevalent and incident cardiovascular disease. These associations are only partly explained by conventional risk factors. The predictive value of plasma viscosity for cardiovascular events is partly explained by fibrinogen, and partly by lipoproteins. The associations of whole blood viscosity with cardiovascular disease are partly explained by plasma viscosity and partly by hematocrit. White cell count, but not platelet count, predicts ischemic heart disease events. Cigarette smokers have higher levels of rheological variables than non-smokers, these increases are partly or wholly reversible in ex-smokers. Lipoprotein reduction by pravastatin lowers plasma and whole-blood viscosity, which may be one mechanism through which lipid lowering produces an early reduction in cardiovascular events. Data from the Edinburgh Artery Study suggest that viscosity is related both to the extent of atherosclerosis, and to ischemia in the presence of a given degree of atherosclerotic stenoses. Among hemostatic variables, fibrinogen, factor VIII: vWF complex, tpA antigen, and fibrin D-dimer are associated with both prevalent and incident cardiovascular disease. Again, these associations are only partly explained by conventional risk factors They suggest that endothelial disturbance and increased fibrin turnover may play roles in cardiovascular disease. Hemostatic and rheological variables are therefore associated with both prevalent and incident cardiovascular disease, and may be mechanisms through which risk factors such as smoking, hyperlipidemia and infections (including oral infections) promote vascular events. PMID:9722696
Lowe, G D
The recent increase in human lifespan, coupled with unhealthy diets and lifestyles have led to an unprecedented increase in cardiovascular diseases. Even in the presence of a wide range of therapeutic options with variable efficacy, mortality due to heart failure is still high and there is a need to identify new therapeutic targets. Genetic and in vitro studies have implicated the Notch signalling in the development and maintenance of the cardiovascular system through a direct effect on biological functions of vascular cells (endothelial and vascular smooth muscle cells) and cardiomyocytes. Notch signalling is also involved in the modulation of inflammation, which plays a major role in causing and exacerbating cardiovascular diseases. The Notch pathway could represent a new therapeutic target for the treatment of cardiovascular diseases.
Aquila, Giorgio; Pannella, Micaela; Morelli, Marco Bruno; Caliceti, Cristiana; Fortini, Cinzia; Rizzo, Paola; Ferrari, Roberto
Immune-mediated inflammation plays a major role in atherosclerosis and atherothrombosis, two essential features for cardiovascular disease (CVD) development, currently considered as the leading cause of death in the western world. There is accumulating evidence showing that humoral autoimmunity might play an important role in CVD and that some autoantibodies could represent emerging cardiovascular risk factors. Recent studies demonstrate that IgG autoantibodies against apolipoprotein A-1 (apoA-1) are raised in many diseases associated with a high cardiovascular risk, such as systemic lupus erythematosus, acute coronary syndrome, rheumatoid arthritis, severe carotid stenosis, and end-stage renal disease. In this work, we aimed at reviewing current data in the literature pointing to anti-apolipoprotein A-1 antibodies (anti-apoA-1 IgG) as a possible prognostic and diagnostic biomarker of cardiovascular risk and appraising their potential role as active mediators of atherogenesis.
Teixeira, P. C.; Cutler, P.; Vuilleumier, N.
Heart rate reflects autonomic nervous system activity. Numerous studies have demonstrated that an increased heart rate at rest is associated with cardiovascular morbidity and mortality as an independent risk factor. It has been shown a link between cardiac autonomic balance and inflammation. Thus, an elevated heart rate produces a micro-inflammatory response and is involved in the pathogenesis of endothelial dysfunction. In turn, decrease in heart rate produces benefits in congestive heart failure, myocardial infarction, atrial fibrillation, obesity, hyperinsulinemia, insulin resistance, and atherosclerosis. Alteration of other heart rate-related parameters, such as their variability and recovery after exercise, is associated with risk of cardiovascular events. Drugs reducing the heart rate (beta-blockers, calcium antagonists and inhibitors of If channels) have the potential to reduce cardiovascular events. Although not recommended in healthy subjects, interventions for reducing heart rate constitute a reasonable therapeutic goal in certain pathologies. PMID:23937816
Brito Díaz, Buenaventura; Alemán Sánchez, José Juan; Cabrera de León, Antonio
Purpose of review To provide an update on the connection between obstructive sleep apnea (OSA) and cardiovascular disease. Recent findings Large prospective studies have established that OSA is associated with an increased incidence of hypertension and, in men, of coronary disease, stroke, and heart failure. Advances in understanding the pathophysiologic basis for these associations include identification of a role for OSA in inducing abnormalities in hepatic lipid-metabolizing enzymes, endothelial dysfunction, and upregulation of pro-inflammatory and pro-thrombotic mediators. A large body of data implicates OSA as playing a significant role in the occurrence and resistance to treatment of atrial fibrillation. Clinical trials have shown small to modest improvements in blood pressure associated with continuous positive airway pressure (CPAP) use, with smaller or uncontrolled studies suggesting that CPAP may improve cardiovascular outcomes or intermediate markers. Summary OSA and cardiovascular disease commonly co-aggregate. Multiple studies indicate that OSA contributes to or exacerbates cardiovascular disease, and thus may be a novel target for cardiovascular risk reduction. While the evidence supports screening and treatment of OSA in patients at risk for cardiovascular disease, it also underscores a need for well powered clinical trials to examine the role of CPAP and other therapies in these populations.
Monahan, Ken; Redline, Susan
Cardiovascular risk factors influence onset and progression of Alzheimer's disease. Among cognitively healthy people, changes in brain structure and function associated with high blood pressure, diabetes, or other vascular risks suggest differential regional susceptibility to neuronal damage. In patients with Alzheimer's disease, hippocampal and medial temporal lobe atrophy indicate early neuronal loss preferentially in key areas for learning and memory. We wanted to investigate whether this regional cortical thinning would be modulated by cardiovascular risk factors. We utilized high-resolution magnetic resonance imaging and a cortical unfolding technique to determine the cortical thickness of medial temporal subregions in 30 patients with Alzheimer's disease. Cardiovascular risk was assessed using a sex-specific multivariable risk score. Greater cardiovascular risk was associated with cortical thinning in the hippocampus CA2/3/dentate gyrus area but not other hippocampal and medial temporal subregions. APOE genotype, a family history of Alzheimer's disease, and age did not influence cortical thickness. Alzheimer's disease-related atrophy could mask the influence of genetic risk factors or age on regional cortical thickness in medial temporal lobe regions, whereas the impact of vascular risk factors remains detectable. This highlights the importance of cardiovascular disease prevention and treatment in patients with Alzheimer's disease.
Werner, Annett; Sauer, Cathrin; Nees, Josef A.; Meyer, Shirin; Donix, Katharina L.; Von Kummer, Rudiger; Holthoff, Vjera A.
Cardiovascular risk factors influence onset and progression of Alzheimer's disease. Among cognitively healthy people, changes in brain structure and function associated with high blood pressure, diabetes, or other vascular risks suggest differential regional susceptibility to neuronal damage. In patients with Alzheimer's disease, hippocampal and medial temporal lobe atrophy indicate early neuronal loss preferentially in key areas for learning and memory. We wanted to investigate whether this regional cortical thinning would be modulated by cardiovascular risk factors. We utilized high-resolution magnetic resonance imaging and a cortical unfolding technique to determine the cortical thickness of medial temporal subregions in 30 patients with Alzheimer's disease. Cardiovascular risk was assessed using a sex-specific multivariable risk score. Greater cardiovascular risk was associated with cortical thinning in the hippocampus CA2/3/dentate gyrus area but not other hippocampal and medial temporal subregions. APOE genotype, a family history of Alzheimer's disease, and age did not influence cortical thickness. Alzheimer's disease-related atrophy could mask the influence of genetic risk factors or age on regional cortical thickness in medial temporal lobe regions, whereas the impact of vascular risk factors remains detectable. This highlights the importance of cardiovascular disease prevention and treatment in patients with Alzheimer's disease. PMID:24228185
Donix, Markus; Scharf, Maria; Marschner, Kira; Werner, Annett; Sauer, Cathrin; Gerner, Antje; Nees, Josef A; Meyer, Shirin; Donix, Katharina L; Von Kummer, Rüdiger; Holthoff, Vjera A
A Newcastle disease epidemic in double-crested cormorants (Phalacrocorax auritus) occurred in July and August 1995, during a 1994-96 study of a breeding colony of this species on Doré Lake (Saskatchewan, Canada). Clinical signs and mortality were observed from a tunnel-and-blind system, and moribund and freshly dead birds were examined virologically. Yolks from cormorant eggs and sera from cormorants and other birds were tested for hemagglutination inhibiting antibodies to Newcastle disease virus (NDV). Evidence of Newcastle disease was limited to juvenile double-crested cormorants, despite close contact with other birds, including American white pelicans (Pelecanus erythrorhynchos) and gulls (Larus spp.). Clinical signs included limb, head or neck paralysis, head or body tremors, ataxia, and blindness; pathogenic NDV was isolated from affected birds. The mortality rate of juvenile cormorants was 32 to 64%, which was high relative to overall first-year mortality in years without epidemics. Thirty-seven of 63 (59%) cormorant sera collected during the epidemic tested positive for antibodies to NDV. Antibody status of cormorant egg yolks depended on stage of incubation, likely due to changes in the amount of water in the yolks. The departure of juvenile cormorants from their nests at 4 wk of age, resulting in an increased contact rate among individuals, may have been important in triggering the epidemic. PMID:9706555
Kuiken, T; Leighton, F A; Wobeser, G; Danesik, K L; Riva, J; Heckert, R A
Chronic renal disease is generally appreciated as a major and rapidly growing health problem. In the United States alone, as many as 19.5 million people may have markers of early renal disease, and more than 660,000 people are expected to require renal replacement therapy by the year 2010. By contrast, the presence and pathological role of renal disease in patients with cardiovascular disease are somewhat underrecognized. Evidence now shows that even minor impairments in renal function, as indicated by measures including glomerular filtration rate and microalbuminuria, are common in cardiovascular disease states and predictive of cardiovascular events. Indeed, microalbuminuria may be a marker of systemic vascular disease rather than kidney dysfunction alone. In patients with hypertension, diabetes, metabolic syndrome, acute coronary syndromes, and stroke, markers of renal disease have proved to be at least as predictive of morbidity and mortality as conventional risk factors. Yet, chart reviews in a variety of clinical settings reflect poor recognition and management of renal disease in at-risk patients. Models for renal protection are based on the control of risk factors, particularly blood pressure, that are associated with renal and cardiovascular outcomes. Screening protocols for markers of renal disease should recognize the potential inaccuracy of serum creatinine concentrations and the preferability of glomerular filtration rate estimates that take age and gender into account. Pilot programs for screening high-risk populations have shown efficacy in detecting renal disease. PMID:15785015
Baumelou, Alain; Bruckert, Eric; Bagnis, Corinne; Deray, Gilbert
This chapter presents a conceptual and selective review of the relationship between social support and cardiovascular illness and death. It is argued that cardio- vascular health is not only determined by biological factors but also by social and psychological factors. For decades, epidemiological studies have linked mortality rates to marital status and social networks, thus indicating a beneficial effect of
Ralf Schwarzer; Nina Rieckmann
Background The obesity epidemic brings with it an increase in related diseases, like diabetes mellitus, and subsequently cardiovascular\\u000a disease. Traditional dietary guidelines have focused on food composition rather than energy balance.\\u000a \\u000a \\u000a \\u000a Aims To identify promising approaches towards promoting healthy eating and lifestyle patterns. Implementation strategies were also\\u000a sought.\\u000a \\u000a \\u000a \\u000a Method A review of the pertinent literature based on MEDLINE searches.\\u000a \\u000a \\u000a \\u000a Results Weight loss subsequent to
C. von Schacky
The association between diagonal earlobe creases and fatal cardiovascular disease was investigated in a consecutive series of 303 coroner's necropsies. Those studied all died outside hospital in the Brighton Health District. Data were analysed on the cause of death and on the type of earlobe, the presence or absence of diagonal creases, age, sex, height, and any previous history of cardiovascular disease or diabetes mellitus. The age of nine men and six women was not known. Cardiovascular causes of death included ischaemic and hypertensive disease, calcific valvar stenosis, ruptured dissecting aneurysm of the thoracic aorta, and ruptured atheromatous aneurysm of the abdominal aorta. The mean (SD) age at death was 72 (15) and the male to female ratio was 1.3:1. Diagonal creases were present in 123 (72%) of 171 men and 88 (67%) of 132 women. A previous history of cardiovascular disease was present in 90 (30%) of the total of 303 and 74 (35%) of the 211 with diagonal creases. A cardiovascular cause of death was present in 154 (73%) of 211 with and 41 (45%) of 92 without diagonal creases and was associated with an increased risk of a cardiovascular cause of death of 1.55 in men and 1.74 in non-diabetic women. PMID:2713193
Kirkham, N; Murrells, T; Melcher, D H; Morrison, E A
Lyme disease is a controversial tick-borne illness that is estimated to be four times more common than AIDS in the United States. This paper outlines the challenges overcome in the healthcare response to human immunodeficiency virus (HIV) infection, the development of sensitive laboratory tests for the AIDS virus, and the promotion of long-term combination antimicrobial regimens to effectively treat HIV disease. We suggest that similar challenges need to be overcome before the chronic form of Lyme disease can be successfully treated. Currently, diagnosis and treatment of Lyme disease is hindered by the lack of a uniform case definition that adequately reflects the clinical presentation of the disease, poor laboratory test sensitivity, and high treatment failure rates using short-term monotherapy. Consequently the optimal treatment for patients with persistent symptoms of Lyme disease remains undefined. Although antibiotic monotherapy has been successful in treating early Lyme disease, the use of combination antibiotic therapy modelled on HIV treatment appears to be more effective for patients with persistent symptoms of tick-borne infection. Resolution of the controversy surrounding Lyme disease should lead to improved diagnosis and treatment modelled on the approach to HIV disease. PMID:21196901
Stricker, R B; Johnson, L
Elevated mortality associated with high ambient temperatures in summer represents one of the main impacts of weather extremes on human society. Increases in mortality during heat waves were examined in many European countries; much less is known about the effects of heat waves on morbidity, measured for example by the number of hospital admissions. Relatively less understood is also cold-related mortality and morbidity in winter, when the relationships between weather and human health are more complex, less direct, and confounded by other factors such as epidemics of influenza/acute respiratory infections. The present study examines links between hot and cold temperature extremes and daily hospital admissions for cardiovascular diseases in the population of the Czech Republic over 1994-2007. We make use of a recently completed database of all admissions for cardiovascular diseases to hospitals in the area of the Czech Republic since 1994, with a detailed classification of diseases and detailed information concerning each patient (in total 1,467,675 hospital admissions over 1994-2007). The main goals of the study are (i) to identify excess/deficit morbidity during and after periods of heat waves in summer and cold spells in winter, (ii) to compare the links for individual diseases (e.g. acute myocardial infarction, I21; angina pectoris, I20; cerebral infarction, I63; brain ischemia, I64) and to identify those diagnoses that are most closely linked to weather, (iii) to identify population groups most vulnerable to temperature extremes, and (iv) to compare the links to temperature extremes for morbidity and mortality. Periods when morbidity data were affected by epidemics of influenza and acute respiratory infections in winter were excluded from the analysis.
Davídkovová, H.; Kyselý, J.; K?íž, B.
In addition to conventional risk factors, environmental and occupational strain is an actor of the development and evolution of cardiovascular diseases. In industrialised countries, cardiovascular mortality is inversely correlated with the socio-economic level and type of occupation. In the French Ihpaf study, systemic hypertension and obesity were correlated with the socio-economic level. Among possible explanations for the importance of occupational environment, psychological stress at work, sedentary jobs, passive smoking and shift working may all play a role. Thus, beyond the conventional approach to individual risk factor management, it appears necessary to consider cardiovascular prevention through collective actions taking into account occupational environment. PMID:12608130
de Gaudemaris, R; Lang, T; Hamici, L; Dienne, E; Chatellier, G
Synopsis Migraine is positively associated with cardio- and cerebrovascular disorders and with structural heart anomalies. Migraine is more prevalent among people with right-to-left shunts via patent foramen ovale, atrial septal defects, and pulmonary arteriovenous malformations, and among those with altered cardiac anatomy such as mitral valve prolapse, atrial septal aneurysm, and congenital heart disease. Meanwhile, migraine increases the risk for cardiovascular disease and stroke. Although several hypotheses exist, explanation for these associations is lacking. This manuscript reviews data supporting the association of migraine with right-to-left shunt, structural heart anomalies, cardiovascular disease, and ischemic stroke.
Cardiovascular morbidity and mortality are becoming major health concerns for adults with inflammatory rheumatic diseases. The enhanced atherogenesis in this patient population is promoted by the exposure to traditional risk factors as well as nontraditional cardiovascular insults, such as corticosteroid therapy, chronic inflammation and autoantibodies. Despite definite differences between many adult-onset and pediatric-onset rheumatologic diseases, it is extremely likely that atherosclerosis will become the leading cause of morbidity and mortality in this pediatric patient population. Because cardiovascular events are rare at this young age, surrogate measures of atherosclerosis must be used. The three major noninvasive vascular measures of early atherosclerosis - namely, flow-mediated dilatation, carotid intima-media thickness and pulse wave velocity - can be performed easily on children. Few studies have explored the prevalence of cardiovascular risk factors and even fewer have used the surrogate vascular measures to document signs of early atherosclerosis in children with pediatric-onset rheumatic diseases. The objective of this review is to provide an overview on cardiovascular risk and early atherosclerosis in pediatric-onset systemic lupus erythematosus, juvenile idiopathic arthritis and juvenile dermatomyositis patients, and to review cardiovascular preventive strategies that should be considered in this population.
Cardiovascular problems are a major cause of morbidity and mortality in patients with autosomal-dominant polycystic kidney disease (ADPKD). Hypertension is a common early symptom of ADPKD, and occurs in approximately 60% of patients before renal function has become impaired. Hypertension is associated with an increased rate of progression to end-stage renal disease and is the most important potentially treatable variable in ADPKD. Left ventricular hypertrophy, which is a powerful, independent risk factor for cardiovascular morbidity and mortality, also occurs frequently in patients with ADPKD. Both hypertension and left ventricular hypertrophy have important roles in cardiovascular complications in these individuals. Moreover, biventricular diastolic dysfunction, endothelial dysfunction, increased carotid intima-media thickness, and impaired coronary flow velocity reserve are present even in young patients with ADPKD who have normal blood pressure and well-preserved renal function. These findings suggest that cardiovascular involvement starts very early in the course of ADPKD. Intracranial and extracranial aneurysms and cardiac valvular defects are other potential cardiovascular problems in patients with ADPKD. Early diagnosis and treatment of hypertension, with drugs that block the renin-angiotensin-aldosterone system, has the potential to decrease the cardiovascular complications and slow the progression of renal disease in ADPKD.
Ecder, Tevfik; Schrier, Robert W.
Cardiovascular disease (CVD) is globally considered as the leading cause of death with 80% of CVD related deaths being reported from low and middle income countries like India. The relatively early onset age of CVD in India in comparison to Western countries also implies that most productive ages of the patient's life are lost fighting the disease. Conventional cardiovascular risk is attributed to lifestyle changes and altered metabolic activity. This forms the basis of a 10-year risk prediction score inspired by the Framingham study. Since South Asians display considerable heterogeneity in risk factors as compared to developed countries, there is a need to identify risk factors which would not only help in primary prevention but also prevent their recurrence. We reviewed published data on novel risk factors and their potential to identify cardiovascular risk at an early stage, with special emphasis on the Indian population. Emerging risk factors were reviewed to identify their potential to prevent CVD progression independently as well as in association with other cardiovascular risk factors. The most commonly studied emerging cardiovascular risk factors included coronary artery calcium score, lipoprotein (a), apolipoproteins, homocysteine, thrombosis markers like fibrinogen, and plasminogen activator inhibitor 1, carotid intima-media thickness, genotypic variations, non-alcoholic fatty liver disease, C-reactive protein, platelets, and birth weight levels. Nonetheless, more studies on large sample size can ascertain the utility of these risk factors in estimation and analysis of cardiovascular risk especially in the Indian context. PMID:24083161
Gupta, Sushil; Gudapati, Ramesh; Gaurav, Kumar; Bhise, Manoj
Cardiovascular disease remains a leading cause of death in the United States and the world. In this we will paper focus on type 2 diabetes mellitus as a risk factor for coronary heart disease, review the mechanisms of atherogenesis in diabetics, the impact of hypertension and the treatment goals in diabetics, the guidelines for screening, and review the epidemiologic consequences of diabetes and heart disease on a global scale. The underlying premise to consider diabetes a cardiovascular disease equivalent will be explored as well as the recommendations for screening and cardiac testing for asymptomatic diabetic patients.
Chiha, Maguy; Njeim, Mario; Chedrawy, Edgar G.
Provides a rationale for the focus on working with youth in prevention of cardiovascular disease (CVD) targeting specific behavior patterns learned in childhood and youth that are implicated in the development of chronic diseases. Reviews promising community-wide strategies for youth and argues that they are efficacious and efficient for primary…
Perry, Cheryl L.; And Others
Objective: More than two-thirds of health expenditure is attributable to chronic conditions, of which a significant proportion are related to cardi- ovascular disease. This paper identifies and explores the factors cited by practice nurses as impacting on the development of their role in cardiovascular disease management. Methods: Sequential mixed methods design combining postal survey (n = 284) and telephone interviews
Elizabeth J Halcomb; Patricia M Davidson; Rhonda Griffiths; John Daly
BackgroundCardiovascular disease (CVD) incidence, complications and burden differ markedly between women and men. Although there is variation in the distribution of lifestyle factors between the genders, they do not fully explain the differences in CVD incidence and suggest the existence of gender-specific genetic risk factors. We aimed to estimate whether the genetic risk profiles of coronary heart disease (CHD), ischemic
Kaisa Silander; Mervi Alanne; Kati Kristiansson; Olli Saarela; Samuli Ripatti; Kirsi Auro; Juha Karvanen; Sangita Kulathinal; Matti Niemelä; Pekka Ellonen; Erkki Vartiainen; Pekka Jousilahti; Janna Saarela; Kari Kuulasmaa; Alun Evans; Markus Perola; Veikko Salomaa; Leena Peltonen; A. Cecile J. W. Janssens
The mammalian Natriuretic Peptide (NP) system consists of neuro-hormones, such as atrial natriuretic peptide (ANP), brain natriuretic peptide (BNP), c-type natriuretic peptide (CNP), and the N-Terminal fragment of BNP (NT-pro-BNP). In response to some cardiovascular derangement the heart (acting as an endocrine organ), brain and other structures secretes natriuretic peptides in an attempt to restore normal circulatory conditions. Their actions are modulated through membrane-bound guanylyl cyclased (GC) receptors. They induce diuresis, natriuresis and vasodilation in the presence of congestive heart failure. These neuro-hormones also play a role in the suppression of neointimal formation after vascular injury. In addition, they act as antifibrotic and antihypertrophic agents preventing cardiac remodeling after myocardial infarction. Further, NP have diagnostic and prognostic role in heart failure, vasoconstriction, left ventricular late remodeling after MI and others. At present, some drugs such as Nesiritide, NEP inhibitors and vasopeptidase inhibitors were synthetized from NP, to antagonize these cardiovascular derengements. In future, it will be possibile to elaborate some drugs similar to petidase inhibitors and some CNP-like drugs able to reduce many symptoms of cardiovascular derangements without significant side effects. PMID:21042458
In November 1973 Newcastle disease suddenly appeared in Northern Ireland, where the viscerotropic disease had not been seen in 3 1/2 years and the two Irelands had been regarded as largely disease free for 30 years. It was successfully controlled with only 36 confirmed affected layer flocks, plus 10 more slaughtered as 'dangerous contacts'. Contemporary investigations failed to reveal the source of the Irish epidemic. Using archival virus samples from most of the affected flocks, RT PCR was conducted with primers selected for all six NDV genes. Phylogenetic analyses of three genes, HN, M and F, confirmed vaccine as the cause of one of the outbreaks. The other six samples were identical and closely related to previous outbreaks in the United States and western Europe initiated by infected imported Latin American parrots. The probable cause of the epidemic followed from the importation from The Netherlands of bulk feed grains contaminated with infected pigeon faeces. PMID:15061512
O'Donoghue, K; Lomniczi, B; McFerran, B; Connor, T J; Seal, B; King, D; Banks, J; Manvell, R; White, P S; Richmond, K; Jackson, P; Hugh-Jones, M
A severe respiratory disease epidemic outbreak correlates with a high demand of specific supplies and specialized personnel to hold it back in a wide region or set of regions; these supplies would be beds, storage areas, hemodynamic monitors, and mechanical ventilators, as well as physicians, respiratory technicians, and specialized nurses. We describe an online cumulative sum based model named Overcrowd-Severe-Respiratory-Disease-Index based on the Modified Overcrowd Index that simultaneously monitors and informs the demand of those supplies and personnel in a healthcare network generating early warnings of severe respiratory disease epidemic outbreaks through the interpretation of such variables. A post hoc historical archive is generated, helping physicians in charge to improve the transit and future allocation of supplies in the entire hospital network during the outbreak. The model was thoroughly verified in a virtual scenario, generating multiple epidemic outbreaks in a 6-year span for a 13-hospital network. When it was superimposed over the H1N1 influenza outbreak census (2008–2010) taken by the National Institute of Medical Sciences and Nutrition Salvador Zubiran in Mexico City, it showed that it is an effective algorithm to notify early warnings of severe respiratory disease epidemic outbreaks with a minimal rate of false alerts.
Castanon-Gonzalez, Jorge Alberto; Macias, Alejandro E.; Samaniego, Jose Lino; Buhse, Thomas; Villanueva-Martinez, Sebastian
A severe respiratory disease epidemic outbreak correlates with a high demand of specific supplies and specialized personnel to hold it back in a wide region or set of regions; these supplies would be beds, storage areas, hemodynamic monitors, and mechanical ventilators, as well as physicians, respiratory technicians, and specialized nurses. We describe an online cumulative sum based model named Overcrowd-Severe-Respiratory-Disease-Index based on the Modified Overcrowd Index that simultaneously monitors and informs the demand of those supplies and personnel in a healthcare network generating early warnings of severe respiratory disease epidemic outbreaks through the interpretation of such variables. A post hoc historical archive is generated, helping physicians in charge to improve the transit and future allocation of supplies in the entire hospital network during the outbreak. The model was thoroughly verified in a virtual scenario, generating multiple epidemic outbreaks in a 6-year span for a 13-hospital network. When it was superimposed over the H1N1 influenza outbreak census (2008-2010) taken by the National Institute of Medical Sciences and Nutrition Salvador Zubiran in Mexico City, it showed that it is an effective algorithm to notify early warnings of severe respiratory disease epidemic outbreaks with a minimal rate of false alerts. PMID:24069063
Polanco, Carlos; Castañón-González, Jorge Alberto; Macías, Alejandro E; Samaniego, José Lino; Buhse, Thomas; Villanueva-Martínez, Sebastián
Theoretical studies of wildlife population dynamics have proved insightful for sustainable management, where the principal aim is to maximize short-term yield, without risking population extinction. Surprisingly, infectious diseases have not been accounted for in harvest models, which is a major oversight because the consequences of parasites for host population dynamics are well-established. Here, we present a simple general model for a host species subject to density dependent reproduction and seasonal demography. We assume this host species is subject to infection by a strongly immunizing, directly transmitted pathogen. In this context, we show that the interaction between density dependent effects and harvesting can substantially increase both disease prevalence and the absolute number of infectious individuals. This effect clearly increases the risk of cross-species disease transmission into domestic and livestock populations. In addition, if the disease is associated with a risk of mortality, then the synergistic interaction between hunting and disease-induced death can increase the probability of host population extinction.
Choisy, Marc; Rohani, Pejman
Atherosclerosis represents the most common pathological substrate of coronary heart disease (CHD), and the characterization of the disease as a chronic low-grade inflammatory condition is now largely accepted. A number of mediators of inflammation have been widely studied, both as surrogate biomarkers and as causal agents, in the pathophysiological network of atherogenesis and plaque vulnerability. The epidemiological observation that biomarkers of inflammation are associated with clinical cardiovascular risk supports the theory that targeted anti-inflammatory treatment appears to be a promising strategy in reducing residual cardiovascular risk on the background of traditional medical therapy. A large number of randomized controlled trials have shown that drugs commonly used in cardiovascular disease (CVD), such as statins, may be effective in the primary and secondary prevention of cardiovascular events through an anti-inflammatory effect. Moreover, several anti-inflammatory drugs are being tested for their potential to reduce residual cardiovascular risk on the background of validated medical therapy for atherosclerotic disease. In this paper, we review relevant evidence with regard to the relationship between inflammation and CVD, from pathogenesis to therapeutic strategies. PMID:25037581
Golia, Enrica; Limongelli, Giuseppe; Natale, Francesco; Fimiani, Fabio; Maddaloni, Valeria; Pariggiano, Ivana; Bianchi, Renatomaria; Crisci, Mario; D'Acierno, Ludovica; Giordano, Roberto; Di Palma, Gaetano; Conte, Marianna; Golino, Paolo; Russo, Maria Giovanna; Calabrò, Raffaele; Calabrò, Paolo
Lead has been shown to be associated with elevated blood pressure in males in the NHANES II survey and in numerous other studies. This study confirms the association in males aged 20 to 74 and documents a significant, although weaker, association in females as well. Prospective cardiovascular disease studies such as the Framingham study indicate that increases in blood pressure should be associated with increased risk of cardiovascular disease. Using electrocardiogram data from NHANES II, this study confirms the expected association of lead with left ventricular hypertrophy (p less than 0.01). Such an association with permanent cardiovascular changes adds weight to the blood pressure findings. The logistic risk coefficients from the Framingham study can be combined with the study's association between lead and blood pressure to examine its implication for more serious outcomes. The results suggest that a halving of the population mean blood lead level would reduce myocardial infarctions by approximately 24,000 events per year and incidence of all cardiovascular disease by over 100,000. These numbers suggest a small attributable risk compared to the vast incidence of cardiovascular disease in the U.S., but a large attributable risk compared to most environmental toxins. Several biological mechanisms have been identified, with different implications for the use of bone lead as an exposure measure.
This systematic review investigates the effectiveness of exercise interventions in improving disease-related characteristics in patients with rheumatoid arthritis (RA). It also provides suggestions for exercise programmes suitable for improving the cardiovascular profile of RA patients and proposes areas for future research in the field. Six databases (Medline, Cochrane Library, CINAHL, Google Scholar, EMBASE and PEDro) were searched to identify publications from 1974 to December 2006 regarding RA and exercise interventions. The quality of the studies included was determined by using the Jadad scale. Initial searches identified 1342 articles from which 40 met the inclusion criteria. No studies were found investigating exercise interventions in relation to cardiovascular disease in RA. There is strong evidence suggesting that exercise from low to high intensity of various modes is effective in improving disease-related characteristics and functional ability in RA patients. Future studies are required to investigate the effects of exercise in improving the cardiovascular status of this patient population. PMID:18045810
Metsios, G S; Stavropoulos-Kalinoglou, A; Veldhuijzen van Zanten, J J C S; Treharne, G J; Panoulas, V F; Douglas, K M J; Koutedakis, Y; Kitas, G D
Although the annual mortality rate for end-stage renal disease (ESRD) is decreasing, likely due to an increase in kidney transplantation rate, the survival probability for ESRD patients from day one of dialysis has not changed, and is still poor with a 5-year survival rate of approximately 34%. This is contributed to by a high prevalence of cardiovascular disease, which is the leading cause of death in ESRD patients. In order to improve survival outcomes, patients at high risk of cardiovascular related mortality need to be identified. Heart rate variability (HRV), baroreceptor sensitivity, and baroreceptor reflex effectiveness index can be used to assess heart rate control and may predict cardiovascular mortality. This paper will discuss how HRV, baroreceptor sensitivity, and baroreceptor reflex effectiveness index are altered in renal disease and the utility of these indices as markers of cardiac risk in this patient population.
Hildreth, Cara M.
Prostacyclin (PGI2) inhibits platelet aggregation and vasoconstriction. PGI2 synthase (PTGIS), a catalyst of PGI2 synthesis from prostaglandin H2, is widely distributed and predominantly found in vascular endothelial and smooth muscle cells. The PTGIS gene is localized to 20q13.11-13 and a candidate gene for cardiovascular disease. We discovered mutations and polymorphisms in this gene and reported that they were associated with essential hypertension, myocardial infarction, and cerebral infarction. These results suggest that PGI2 function depends on the different alleles of the PTGIS gene and that they may influence the risk of cardiovascular disease. Thus, individualized management strategies, such as the administration of PGI2 analogues, could be selected for variants of this gene, to help prevent the development of cardiovascular disease. PMID:20357747
The current search for new markers of cardiovascular diseases (CVDs) is explained by the high morbidity and mortality still observed in developed and developing countries due to cardiovascular events. Recently, microRNAs (miRNAs or miRs) have emerged as potential new biomarkers and are small sequences of RNAs that regulate gene expression at posttranscriptional level by inhibiting translation or inducing degradation of the target mRNAs. Circulating miRNAs are involved in the regulation of signaling pathways associated to aging and can be used as novel diagnostic markers for acute and chronic diseases such as cardiovascular pathologies. This review summarizes the biogenesis, maturation, and stability of miRNAs and their use as potential biomarkers for coronary artery disease (CAD), myocardial infarction (MI), and heart failure (HF).
Background Cardiovascular diseases estimate to be the leading cause of death and loss of disability-adjusted life years globally. Conventional risk factors for cardiovascular diseases only partly account for the social gradient. The purpose of this study was to compare the occurrence of the most frequent cardiovascular diseases and cardiovascular mortality in two close cities, the Twin cities. Methods We focused on the total population in two neighbour and equally sized cities with a population of around 135 000 inhabitants each. These twin cities represent two different social environments in the same Swedish county. According to their social history they could be labelled a "blue-collar" and a "white-collar" city. Morbidity data for the two cities was derived from an administrative health care register based on medical records assigned by the physicians at both hospitals and primary care. The morbidity data presented are cumulative incidence rates and the data on mortality for ischemic heart diseases is based on official Swedish statistics. Results The cumulative incidence of different cardiovascular diagnoses for younger and also elderly men and women revealed significantly differences for studied cardiovascular diagnoses. The occurrence rates were in all aspects highest in the population of the "blue-collar" twin city for both sexes. Conclusions This study revealed that there are significant differences in risk for cardiovascular morbidity and mortality between the populations in the studied different social environments. These differences seem to be profound and stable over time and thereby give implication for public health policy to initiate a community intervention program in the "blue-collar" twin city.
This review focuses on the role of adipokines in the maintenance of a healthy cardiovascular system, and the mechanisms by which these factors mediate the development of cardiovascular disease in obesity. Adipocytes are the major cell type comprising the adipose tissue. These cells secrete numerous factors, termed adipokines, into the blood, including adiponectin, leptin, resistin, chemerin, omentin, vaspin, and visfatin. Adipose tissue is a highly vascularised endocrine organ, and different adipose depots have distinct adipokine secretion profiles, which are altered with obesity. The ability of many adipokines to stimulate angiogenesis is crucial for adipose tissue expansion; however, excessive blood vessel growth is deleterious. As well, some adipokines induce inflammation, which promotes cardiovascular disease progression. We discuss how these 7 aforementioned adipokines act upon the various cardiovascular cell types (endothelial progenitor cells, endothelial cells, vascular smooth muscle cells, pericytes, cardiomyocytes, and cardiac fibroblasts), the direct effects of these actions, and their overall impact on the cardiovascular system. These were chosen, as these adipokines are secreted predominantly from adipocytes and have known effects on cardiovascular cells. PMID:22646022
Northcott, Josette M; Yeganeh, Azadeh; Taylor, Carla G; Zahradka, Peter; Wigle, Jeffrey T
Astaxanthin is a xanthophyll carotenoid present in microalgae, fungi, complex plants, seafood, flamingos and quail. It is an antioxidant with anti-inflammatory properties and as such has potential as a therapeutic agent in atherosclerotic cardiovascular disease. Synthetic forms of astaxanthin have been manufactured. The safety, bioavailability and effects of astaxanthin on oxidative stress and inflammation that have relevance to the pathophysiology of atherosclerotic cardiovascular disease, have been assessed in a small number of clinical studies. No adverse events have been reported and there is evidence of a reduction in biomarkers of oxidative stress and inflammation with astaxanthin administration. Experimental studies in several species using an ischaemia-reperfusion myocardial model demonstrated that astaxanthin protects the myocardium when administered both orally or intravenously prior to the induction of the ischaemic event. At this stage we do not know whether astaxanthin is of benefit when administered after a cardiovascular event and no clinical cardiovascular studies in humans have been completed and/or reported. Cardiovascular clinical trials are warranted based on the physicochemical and antioxidant properties, the safety profile and preliminary experimental cardiovascular studies of astaxanthin.
Fassett, Robert G.; Coombes, Jeff S.
Astaxanthin is a xanthophyll carotenoid present in microalgae, fungi, complex plants, seafood, flamingos and quail. It is an antioxidant with anti-inflammatory properties and as such has potential as a therapeutic agent in atherosclerotic cardiovascular disease. Synthetic forms of astaxanthin have been manufactured. The safety, bioavailability and effects of astaxanthin on oxidative stress and inflammation that have relevance to the pathophysiology of atherosclerotic cardiovascular disease, have been assessed in a small number of clinical studies. No adverse events have been reported and there is evidence of a reduction in biomarkers of oxidative stress and inflammation with astaxanthin administration. Experimental studies in several species using an ischaemia-reperfusion myocardial model demonstrated that astaxanthin protects the myocardium when administered both orally or intravenously prior to the induction of the ischaemic event. At this stage we do not know whether astaxanthin is of benefit when administered after a cardiovascular event and no clinical cardiovascular studies in humans have been completed and/or reported. Cardiovascular clinical trials are warranted based on the physicochemical and antioxidant properties, the safety profile and preliminary experimental cardiovascular studies of astaxanthin. PMID:21556169
Fassett, Robert G; Coombes, Jeff S
Estimates of a disease's basic reproductive rate R0 play a central role in understanding outbreaks and planning intervention strategies. In many calculations of R0, a simplifying assumption is that different host populations have effectively identical transmission rates. This assumption can lead to an underestimate of the overall uncertainty associated with R0, which, due to the non-linearity of epidemic processes, may result in a mis-estimate of epidemic intensity and miscalculated expenditures associated with public-health interventions. In this paper, we utilize a Bayesian method for quantifying the overall uncertainty arising from differences in population-specific basic reproductive rates. Using this method, we fit spatial and non-spatial susceptible-exposed-infected-recovered (SEIR) models to a series of 13 smallpox outbreaks. Five outbreaks occurred in populations that had been previously exposed to smallpox, while the remaining eight occurred in Native-American populations that were naïve to the disease at the time. The Native-American outbreaks were close in a spatial and temporal sense. Using Bayesian Information Criterion (BIC), we show that the best model includes population-specific R0 values. These differences in R0 values may, in part, be due to differences in genetic background, social structure, or food and water availability. As a result of these inter-population differences, the overall uncertainty associated with the "population average" value of smallpox R0 is larger, a finding that can have important consequences for controlling epidemics. In general, Bayesian hierarchical models are able to properly account for the uncertainty associated with multiple epidemics, provide a clearer understanding of variability in epidemic dynamics, and yield a better assessment of the range of potential risks and consequences that decision makers face. PMID:24021521
Elderd, Bret D; Dwyer, Greg; Dukic, Vanja
One-quarter of the 3 million new cases of sexually transmitted diseases (STDs) each year occur in teenagers. Teens are at high risk because of biological, age, and behavioral factors. Education is the best weapon against STDs. As their children's first sex educators, parents must make every effort to promote STD education at home and school. (SM)
Accelerated cardiovascular disease is a frequent complication of renal disease. Chronic kidney disease promotes hypertension and dyslipidemia, which in turn can contribute to the progression of renal failure. Furthermore, diabetic nephropathy is the leading cause of renal failure in developed countries. Together, hypertension, dyslipidemia, and diabetes are major risk factors for the development of endothelial dysfunction and progression of atherosclerosis. Inflammatory mediators are often elevated and the renin-angiotensin system is frequently activated in chronic kidney disease, which likely contributes through enhanced production of reactive oxygen species to the accelerated atherosclerosis observed in chronic kidney disease. Promoters of calcification are increased and inhibitors of calcification are reduced, which favors metastatic vascular calcification, an important participant in vascular injury associated with end-stage renal disease. Accelerated atherosclerosis will then lead to increased prevalence of coronary artery disease, heart failure, stroke, and peripheral arterial disease. Consequently, subjects with chronic renal failure are exposed to increased morbidity and mortality as a result of cardiovascular events. Prevention and treatment of cardiovascular disease are major considerations in the management of individuals with chronic kidney disease. PMID:17606856
Schiffrin, Ernesto L; Lipman, Mark L; Mann, Johannes F E
Cardiovascular disease is the major cause of death as well as a leading cause of disability and impaired quality of life in older adults with diabetes. Therefore, preventing cardiovascular events in this population is an important goal of care. Available evidence supports the use of lipid-lowering agents and treatment of hypertension as effective measures to reduce cardiovascular risk in older adults with diabetes. Glucose control, smoking cessation, weight control, regular physical activity, and a prudent diet are also recommended, although data supporting the efficacy of these interventions are limited. While reducing cardiovascular morbidity and mortality remains a primary objective of preventive cardiology in older adults with diabetes, the impact of these interventions on functional well-being, cognition, and other geriatric syndromes requires further study. PMID:19944264
Cigolle, Christine T; Blaum, Caroline S; Halter, Jeffrey B
... it is related to a higher risk of coronary heart disease, stroke and peripheral vascular disease (fatty deposits in peripheral arteries). Evidence suggests that homocysteine may promote atherosclerosis (fatty ...
Posttranslational modification (PTM) is a term that implies dynamic modification of proteins after their translation. PTM is involved not only in homeostasis but also in pathologic conditions related to diverse diseases. Histone deacetylases (HDACs), which are known as transcriptional regulators, are one example of posttranslational modifiers with diverse roles in human pathophysiology, including cardiovascular diseases. In experimental models, HDAC inhibitors are beneficial in supraventricular arrhythmia, myocardial infarction, cardiac remodeling, hypertension, and fibrosis. In addition, HDACs are closely related to other vascular diseases such as neointima formation, atherosclerosis, and vascular calcification. Currently, HDACs are classified into four different classes. The class IIa HDACs work as transcriptional regulators mainly by direct association with other transcription factors to their target binding elements in a phosphorylation-dependent manner. Class I HDACs, by contrast, have much greater enzymatic activity than the class II HDACs and target various non-histone proteins as well as the histone-core complex. Class I HDACs undergo PTMs such as phosphorylation, sumoylation, and S-nitrosylation. Considering the growing evidence for the role of HDACs in cardiovascular diseases, the PTMs of the HDACs themselves as well as HDAC-mediated PTM of their targets should be considered for future potential therapeutic targets. In this review, we discuss 1) the roles of each HDAC in specific cardiovascular diseases and 2) the PTM of HDACs, 3) and the implications of such modifications for cardiovascular diseases. PMID:24594235
Eom, Gwang Hyeon; Kook, Hyun
Cardiovascular complications are more common in human immunodeficiency virus–infected individuals than in age-matched uninfected individuals. Antiretroviral therapy reduces the risk of cardiovascular complications, suggesting that viral replication directly or indirectly causes vascular disease. Long-term effective antiretroviral therapy does not fully restore vascular health, and treated adults continue to have higher-than-expected rates of disease progression. Although this excess risk during therapy is likely due to multiple factors, a growing body of evidence suggests that chronic inflammation, which persists during effective antiretroviral therapy, is directly and causally associated with vascular dysfunction and the accelerated development of atherosclerosis.
Hsue, Priscilla Y.; Hunt, Peter W.
The pericardium and pericardial diseases in particular have received, in contrast to other topics in the field of cardiology, relatively limited interest. Today, despite improved knowledge of pathophysiology of pericardial diseases and the availability of a wide spectrum of diagnostic tools, the diagnostic challenge remains. Not only the clinical presentation may be atypical, mimicking other cardiac, pulmonary or pleural diseases;
Jan Bogaert; Marco Francone
Evidence is emerging that disturbances in sleep and sleep disorders play a role in the morbidity of chronic con- ditions. However, the relationship between sleep processes, disease development, disease progression and disease man- agement is often unclear or understudied. Numerous common medical conditions can have an affect on sleep. For example, diabetes or inflammatory conditions such as arthritis can lead
Michelle A. Miller; Francesco P. Cappuccio
Patients with chronic kidney disease (CKD) show a high cardiovascular morbidity and mortality. This seems to be consequence of the cardiovascular risk factor clustering in CKD patients. Non traditional risk factors such as oxidative stress and inflammation are also far more prevalent in this population than in normal subjects. Renal disease is associated with a graded increase in oxidative stress
Victoria Cachofeiro; Marian Goicochea; Soledad García de Vinuesa; Pilar Oubiña; Vicente Lahera; José Luño
An elevated uric acid level is associated with cardiovascular disease. Hyperuricemia is predictive for the development of both hypertension and coronary artery disease; it is increased in patients with hypertension, and, when present in hypertension, an elevated uric acid level is associated with increased cardiovascular morbidity and mortality. Serum uric acid level should be measured in patients at risk for
Richard J. Johnson; Salah D. Kivlighn; Yoon-Goo Kim; Shinichi Suga; Agnes B. Fogo
Patients with chronic kidney disease (CKD) have a reduced lifespan, and a substantial proportion of these individuals die from cardiovascular disease. Although a large percentage of patients with CKD have traditional cardiac risk factors such as diabetes, hypertension and abnormalities in cholesterol, interventions to address these factors—which have significantly decreased cardiovascular mortality in the general population—have not shown such benefit
Jessica Kendrick; Michel B Chonchol
During the 1990s, Cuba was struck by a rare epidemic disease. Up to 50,000 people were affected by a pathology compromising primarily the optic nerve but also peripheral nerves and even spinal cord. This is a testimony from a direct witness and participant in the initial study of the epidemics showing that in spite of claims of a “multifactorial” etiology, still in the literature, the root cause of this disease is just result of the deliberate deprivation of the most elementary economic rights by extreme Government control over a population left unable to tend to its elementary survival by itself, in spite of a thorough Government-sponsored, universally celebrated Universal Healthcare System.
Models for control of epidemics on local, global and small-world networks are considered, with only partial information accessible about the status of individuals and their connections. The main goal of an effective control measure is to stop the epidemic at a lowest possible cost, including treatment and cost necessary to track the disease spread. We show that delay in detection of infectious individuals and presence of long-range links are the most important factors determining the cost. However, the details of long-range links are usually the least-known element of the social interactions due to their occasional character and potentially short life-span. We show that under some conditions on the probability of disease spread, it is advisable to attempt to track those links, even if this involves additional costs. Thus, collecting some additional knowledge about the network structure might be beneficial to ensure a successful and cost-effective control.
Kleczkowski, A.; Dybiec, B.; Gilligan, C. A.
Clinical and molecular genetics are inextricably linked. In the last two decades genetic studies have revealed the causes of several forms of structural heart disease. Recent work is extending the insights from inherited arrhythmias and cardiomyopathies to other forms of heart disease. In this review we outline the current state of the art for the genetics of adult structural heart disease, in particular the cardiomyopathies, valvular heart disease and aortic disease. The general approaches are described with a focus on clinical relevance, while potential areas for imminent innovation in diagnosis and therapeutics are highlighted. PMID:24046092
MacRae, Calum A
Dyslipidemia is an important risk factor for cardiovascular disease (CVD) and atherosclerosis. When dyslipidemia coincides with other metabolic disorders such as obesity, hypertension, and glucose intolerance, defined as the metabolic syndrome (MS), individuals present an elevated risk to develop type 2 diabetes (T2D) as well as CVD. Because the MS epidemic represents a growing public health problem worldwide, the development of therapies remains a major challenge. Alterations of bile acid pool regulation in T2D have revealed a link between bile acid and metabolic homeostasis. The bile acid receptors farnesoid X receptor (FXR) and TGR5 both regulate lipid, glucose, and energy metabolism, rendering them potential pharmacological targets for MS therapy. This review discusses the mechanisms of metabolic regulation by FXR and TGR5 and the utility relevance of natural and synthetic modulators of FXR and TGR5 activity, including bile acid sequestrants, in the treatment of the MS.
Porez, Geoffrey; Prawitt, Janne; Gross, Barbara; Staels, Bart
Dyslipidemia is an important risk factor for cardiovascular disease (CVD) and atherosclerosis. When dyslipidemia coincides with other metabolic disorders such as obesity, hypertension, and glucose intolerance, defined as the metabolic syndrome (MS), individuals present an elevated risk to develop type 2 diabetes (T2D) as well as CVD. Because the MS epidemic represents a growing public health problem worldwide, the development of therapies remains a major challenge. Alterations of bile acid pool regulation in T2D have revealed a link between bile acid and metabolic homeostasis. The bile acid receptors farnesoid X receptor (FXR) and TGR5 both regulate lipid, glucose, and energy metabolism, rendering them potential pharmacological targets for MS therapy. This review discusses the mechanisms of metabolic regulation by FXR and TGR5 and the utility relevance of natural and synthetic modulators of FXR and TGR5 activity, including bile acid sequestrants, in the treatment of the MS. PMID:22550135
Porez, Geoffrey; Prawitt, Janne; Gross, Barbara; Staels, Bart
Having analyzed the current status and existing problems of Geographic Information Systems (GIS) applications in epidemiology,\\u000a this chapter proposes a method to establish a spatial decision support system (SDSS) for the prevention of epidemic diseases\\u000a by integrating the COM GIS, spatial database, gps, remote sensing, and communication technologies, as well as ASP and ActiveX\\u000a software development technologies. One important issue
Kun Yang; Shung-yun Peng; Quan-li Xu; Yan-bo Cao
The foot-and-mouth disease epidemic in Dumfries and Galloway in south-west Scotland comprised 177 infected premises (IPs) in 24 geographical clusters, and ran from March 1 until May 23, 2001. Initial seeding of infection was by livestock (predominantly sheep) that had passed through Longtown Market in adjacent Cumbria. Thereafter, spread within existing, and to new, clusters was associated with the movement
M. Thrusfield; L. Mansley; P. Dunlop; J. Taylor; A. Pawson; L. Stringer
Peripheral arterial disease (PAD) is a common manifestation of atherosclerotic vascular disease. Its incidence increases with age and in the presence of known cardiovascular risk factors (eg, smoking and diabetes). PAD frequently coexists with coronary and/or cerebrovascular disease, probably because of common risk factors. Asymptomatic PAD of the lower limbs (defined as an ankle-brachial index of less than 0.9) is believed to be approximately three to four times more common than symptomatic PAD. Both symptomatic and asymptomatic diseases are associated with high risk of cardiovascular mortality and morbidity. Therefore, patients with PAD are candidates for preventive strategies for cardiovascular events. Platelet activation and aggregation is believed to significantly contribute to atherothrombotic events. Thus, patients with PAD can benefit from antiplatelet therapy. Both acetylsalicylic acid and clopidogrel decrease serious cardiovascular events in patients with PAD. However, acetylsalicylic acid is the preferred agent because of its low cost and wide availability. Cilostazol is recommended for use in patients with severe and disabling symptoms but not for asymptomatic or less disabling disease. Currently, there is insufficient evidence to recommend routine use of newer agents such as picotamide in patients with PAD.
Sethi, Ankur; Arora, Rohit R
Cardiovascular disease has become the main factor of death and birth defects in the world. There are some therapeutic structures and drugs for curative and palliative therapy of the disease, but to the aim of accessing reliable therapy or to postpone onset of disease, especially for individuals with heritable coronary artery disease in their pedigree Genetic engineering technologies are making advances in the field by identifying oligonucleotides with higher potencies which can be easily targeted against almost any gene, particularly interfering RNA (RNAi). Recently, the focus of RNAi approaches has encompassed the use of synthetic sequences to mimic or silence endogenous microRNAs (miRNAs) that are abruptly dysregulated following cardiovascular diseases. In this review, we summarize the role of miRNAs in heart development and vascular system as two main factors of birth defects and adult morbidity and mortality and miRNAS as new therapeutic agents.
Aghabozorg Afjeh, Sarah Sadat; Ghaderian, Sayyed Mohammad Hossein
The incidence of coronary heart disease in premenopausal women is lower than in men because of their hormonal protection. Angina pectoris occurs in women about 10 years later than in men. However, mortality from ischaemic heart disease remains higher in women than in men. Current studies are focusing on novel cardiovascular risk biomarkers because it seems that traditional cardiovascular risk factors and their assessment scores underestimate the risk in females. Increased plasma levels of these newly established biomarkers of risk have been found to worsen endothelial dysfunction and inflammation, both of which play a key role in the pathogenesis of microvascular angina, which is very common in women. These novel cardiovascular risk markers can be classified into three categories: inflammatory markers, markers of haemostasis, and other biomarkers. PMID:25000444
Pop, D; D?dârlat, A; Zdrenghea, D
Fibrinogen (Fg) is a high molecular weight plasma adhesion protein and a biomarker of inflammation. Many cardiovascular and cerebrovascular disorders are accompanied by increased blood content of Fg. Increased levels of Fg result in changes in blood rheological properties such as increases in plasma viscosity, erythrocyte aggregation, platelet thrombogenesis, alterations in vascular reactivity and compromises in endothelial layer integrity. These alterations exacerbate the complications in peripheral blood circulation during cardiovascular diseases such as hypertension, diabetes and stroke. In addition to affecting blood viscosity by altering plasma viscosity and erythrocyte aggregation, growing experimental evidence suggests that Fg alters vascular reactivity and impairs endothelial cell layer integrity by binding to its endothelial cell membrane receptors and activating signalling mechanisms. The purpose of this review is to discuss experimental data, which demonstrate the effects of Fg causing vascular dysfunction and to offer possible mechanisms for these effects, which could exacerbate microcirculatory complications during cardiovascular diseases accompanied by increased Fg content.
Lominadze, D.; Dean, W. L.; Tyagi, S. C.; Roberts, A. M.
Angiotensin-converting enzyme (ACE) is a major target in the treatment of cardiovascular diseases (CVDs). In addition to ACE, ACE2 – which is a homolog of ACE and promotes the degradation of angiotensin II (AngII) to Ang (1–7) – has been recognized recently as a potential therapeutic target in the management of CVDs. This article reviews different metabolic pathways of ACE and ACE2 (AngI-AngII-AT1 receptors and AngI-Ang (1–7)-Mas receptors) in the regulation of cardiovascular function and their potential in new drug development in the therapy of CVDs. In addition, recent progress in the study of angiotensin and ACE in fetal origins of cardiovascular disease, which might present an interesting field in perinatal medicine and preventive medicine, is briefly summarized.
Shi, Lijun; Mao, Caiping; Xu, Zhice; Zhang, Lubo
The term "Non-alcoholic fatty liver disease" (NAFLD) covers a series of liver lesions similar to those induced by alcohol, but not caused by alcohol use. The importance of NAFLD lies in the high prevalence in Western societies and, from the point of view of the liver, in its progression from steatosis to cirrhosis and liver cancer. More recently, NAFLD has been found to be associated with lipid metabolism disorders, the deposition of fat outside of the adipocytes, insulin resistance and Metabolic Syndrome. Also attributed to NAFLD is a heightened systemic pro-inflammatory state, which accelerates arteriosclerosis, thereby increasing cardiovascular risk and associated cardiovascular events. Here we provide an update to the etiopathogenesis of NAFLD, its influence on cardiovascular disease, and the treatment options. PMID:23141876
Brea, Angel; Puzo, José
The oak processionary caterpillar (Thaumetopoea processionea Lepidoptera) is found in several European countries. It usually lives in oak forests or on single-standing oak trees. The larva of from the 3rd to 6th developmental stage (instar) develops poisonous hair (setae), filled with an urticating toxin that may lead to serious dermatitis, conjunctivitis, and pulmonary affection (summarized as lepidopterism) on contact with the setae. In June 2004 more than 40 people including young children developed symptoms of lepidopterism after resting within 20 m of an infested oak tree. Only a few people had touched the caterpillars. All those with clinical symptoms of lepidopterism could be treated as outpatients, but several needed systemic steroids because of the severity of their complaints. Lepidopterism, an airborne disease caused by the setae of the processionary caterpillar, is a growing public health problem because of the increasing numbers of outbreaks. PMID:16445416
Gottschling, Sven; Meyer, Sascha
This study examined how outbreaks and the occurrence of Anthrax, Ebola, Monkeypox and Trypanosomiasis may differentially affect the distribution of bonobos (Pan paniscus). Using a combination of mapping, Jaccard overlapping coefficients and binary regressions, the study determined how each disease correlated with the extent of occurrence of, and the areas occupied by, bonobos. Anthrax has only been reported to occur outside the range of bonobos and so was not considered further. Ebola, Monkeypox and Trypanosomiasis were each reported within the area of occupancy of bonobos. Their respective overlap coefficients were: J?=?0.10; Q??=?0.05?=?2.00 (odds ratios?=?0.0001, 95% CI?=?0.0057; Z?=??19.41, significant) for Ebola; J?=?1.00; Q??=?0.05?=?24.0 (odds ratios?=?1.504, 95% CI?=?0.5066–2.6122) for Monkeypox; and, J?=?0.33; Q??=?0.05?=?11.5 (Z?=?1.14, significant) for Trypanosomiasis. There were significant relationships for the presence and absence of Monkeypox and Trypanosomiasis and the known extent of occurrence of bonobos, based on the equations y?=?0.2368Ln(x)+0.8006 (R2?=?0.9772) and y?=??0.2942Ln(x)+0.7155 (R2?=?0.698), respectively. The positive relationship suggested that bonobos tolerated the presence of Monkeypox. In contrast, the significant negative coefficient suggested that bonobos were absent in areas where Trypanosomiasis is endemic. Our results suggest that large rivers may have prevented Ebola from spreading into the range of bonobos. Meanwhile, Trypanosomiasis has been recorded among humans within the area of occurrence of bonobos, and appears the most important disease in shaping the area of occupancy of bonobos within their overall extent of occupancy.
Inogwabini, Bila-Isia; Leader-Williams, Nigel
This study examined how outbreaks and the occurrence of Anthrax, Ebola, Monkeypox and Trypanosomiasis may differentially affect the distribution of bonobos (Pan paniscus). Using a combination of mapping, Jaccard overlapping coefficients and binary regressions, the study determined how each disease correlated with the extent of occurrence of, and the areas occupied by, bonobos. Anthrax has only been reported to occur outside the range of bonobos and so was not considered further. Ebola, Monkeypox and Trypanosomiasis were each reported within the area of occupancy of bonobos. Their respective overlap coefficients were: J = 0.10; Q(? = 0.05)?= 2.00 (odds ratios = 0.0001, 95% CI = 0.0057; Z =?-19.41, significant) for Ebola; J = 1.00; Q(? = 0.05)?= 24.0 (odds ratios = 1.504, 95% CI = 0.5066-2.6122) for Monkeypox; and, J = 0.33; Q(? = 0.05)?= 11.5 (Z = 1.14, significant) for Trypanosomiasis. There were significant relationships for the presence and absence of Monkeypox and Trypanosomiasis and the known extent of occurrence of bonobos, based on the equations y = 0.2368Ln(x)+0.8006 (R(2)?= 0.9772) and y =?-0.2942Ln(x)+0.7155 (R(2)?= 0.698), respectively. The positive relationship suggested that bonobos tolerated the presence of Monkeypox. In contrast, the significant negative coefficient suggested that bonobos were absent in areas where Trypanosomiasis is endemic. Our results suggest that large rivers may have prevented Ebola from spreading into the range of bonobos. Meanwhile, Trypanosomiasis has been recorded among humans within the area of occurrence of bonobos, and appears the most important disease in shaping the area of occupancy of bonobos within their overall extent of occupancy. PMID:23251431
Inogwabini, Bila-Isia; Leader-Williams, Nigel
Despite a worse cardiovascular disease (CVD) risk profile, Hispanics have lower CVD mortality than non- Hispanic Whites in studies based on death certificates. This study examined 310 deaths that occurred between 1984 and 1998 among 1,862 Hispanic and non-Hispanic White participants in the San Luis Valley Diabetes Study, using medical records to classify cause of death. Among persons without diabetes,
Carolyn J. Swenson; Mary Jo Trepka; Marian J. Rewers; Sharon Scarbro; William R. Hiatt; Richard F. Hamman
Niacin has been widely used as a pharmacologic agent to regulate abnormalities in plasma lipid and lipoprotein metabolism and in the treatment of atherosclerotic cardiovascular disease. Although the use of niacin in the treatment of dyslipidemia has been reported as early as 1955, only recent studies have yielded an understanding about the cellular and molecular mechanism of action of niacin
Shobha H. Ganji; Vaijinath S. Kamanna; Moti L. Kashyap
Objectives: This study examines intrasibling correlations at 2 points during childhood for African American siblings with the same father, different fathers, a father present in the home, and no father present in the home.Study design: Cardiovascular disease (CVD) risk factors were assessed in 267 pairs of African American siblings (visit 1) and in 79 of these siblings approximately 28 months
Ronald J Iannotti; Alan E Zuckerman; Nader Rifai
Cardiovascular diseases (CVD) are leading causes of premature mortality in India. Evidence from developed countries shows that mortality from these can be substantially prevented using population-wide and individual-based strategies. Policy initiatives for control of CVD in India have been suggested but evidence of efficacy has emerged only recently. These initiatives can have immediate impact in reducing morbidity and mortality. Of
Rajeev Gupta; Soneil Guptha; Rajnish Joshi; Denis Xavier
Omega-3 polyunsaturated fatty acid (-3 PUFA) therapy continues to show great promise in primary and, particu- larly in secondary prevention of cardiovascular (CV) diseases. The most compelling evidence for CV benefits of -3 PUFA comes from 4 controlled trials of nearly 40,000 participants randomized to receive eicosapentaenoic acid (EPA) with or without docosahexaenoic acid (DHA) in studies of patients in
Carl J. Lavie; Richard V. Milani; Mandeep R. Mehra; Hector O. Ventura
Objective: Explore the relationship between eating competence (EC) and biomarkers of risk for cardiovascular disease (CVD). Design: Secondary analysis of data collected for a larger, 2-way crossover clinical trial. Setting: Outpatient clinical research center. Participants: Forty-eight hypercholesterolemic (LDL cholesterol [greater than or equal]…
Psota, Tricia L.; Lohse, Barbara; West, Sheila G.
THE AGEING CARDIOVASCULAR SYSTEM Increased life expectancy is a common scenario for dogs living in the third millennium, since many advances in canine medicine and surgery, as well as in nutrition and preventive health care, have taken place over the last few decades. According to a study conducted on a population of 9248 subjects, cardiac diseases are the second most
This study assessed the hypothesis that greater magnesium intake is associated with reduced risk for cardiovascular disease (CVD), including myocardial infarction (MI) and stroke, in a large prospective cohort of women. In 1993, a semi-quantitative food frequency questionnaire was used to assess magnesium intake in 39,876 female health professionals aged 39 to 89 years who had no history of CVD
Yiqing Song; JoAnn E. Manson; Nancy R. Cook; Christine M. Albert; Julie E. Buring; Simin Liu
Caveolae are curved lipid raft regions rich in cholesterol and sphingolipids found abundantly in vascular endothelial cells, adipocytes, smooth muscle cells and fibroblasts. They are multifunctional organelles with roles in clathrin-independent endocytosis, cholesterol transport, mechanosensing and signal transduction. Caveolae provide an environment where multiple receptor signalling components are sequestered, clustered and compartmentalized for efficient signal transduction. Many of these receptors, including cytokine signal transducer gp130 (glycoprotein 130), are mediators of chronic inflammation during atherogenesis. Subsequently, disruption of these organelles is associated with a broad range of disease states including cardiovascular disease and cancer. Cavin-1 is an essential peripheral component of caveolae that stabilizes caveolin-1, the main structural/integral membrane protein of caveolae. Caveolin-1 is an essential regulator of eNOS (endothelial nitric oxide synthase) and its disruption leads to endothelial dysfunction which initiates a range of cardiovascular and pulmonary disorders. Although dysfunctional cytokine signalling is also a hallmark of cardiovascular disease, knowledge of caveolae-dependent cytokine signalling is lacking as is the role of cavin-1 independent of caveolae. The present review introduces caveolae, their structural components, the caveolins and cavins, their regulation by cAMP, and their potential role in cardiovascular disease. PMID:24646232
Williams, Jamie J L; Palmer, Timothy M
Oxidative stress resulting from imbalance between reactive oxygen species (ROS) generation and antioxidant mechanisms is important in the pathogenesis of cardiovascular diseases such as atherosclerosis, ischemic heart disease, heart failure, stroke, hypertension and diabetes. Paradoxically, antioxidant therapy such as vitamin E has not been shown on large randomized clinical trials to favorably affect clinical outcomes. Since mitochondria are involved not only with bioenergetics but also with oxidative damage through ROS generation and cell signaling leading to apoptosis, antioxidants targeted at the mitochondria are appealing novel agents to attenuate oxidative stress. In particular, antioxidants conjugated with triphenylphosphonium cation such as mitoquinone, mitovitamin E and mitophenyltertbutyline achieve concentrations in the mitochondrial matrix several-fold greater than those achieved in the cytosol because of the high negative membrane potential of the inner mitochondrial membrane. We review preliminary experiments and also some patents on cell and animal models of cardiovascular diseases where mitochondrially targeted antioxidants have been used and were shown to reduce ROS production and the effects of oxidative stress due to ROS, apoptosis and improve cardiac function. Although ongoing human clinical studies involve only non-cardiovascular applications at this time, preclinical studies show promise for eventual human trials for cardiovascular diseases. PMID:19807685
Subramanian, Sharath; Kalyanaraman, Balaraman; Migrino, Raymond Q
Lead has been shown to be associated with elevated blood pressure in males in the NHANES 2 survey and in numerous other studies. This study confirms the association in males ages 20 to 74 and documents a singificant, although weaker, association in females as well. Prospective cardiovascular disease studies such as the Framingham study indicate that increases in blood pressure should be associated with increased risk of cardiovascular disease. Using electrocardiogram data from NHANES 2, this study confirms the expected association oflead with left ventricular hypertrophy. The logistic risk coefficients from the Framingham study can be combined with the study's association between lead and blood pressure to examine its implication for more serious outcomes. The results suggest that a halving of the population mean blood lead level would reduce myocardial infarctions by approximately 24,000 events per year and incidence of all cardiovascular disease by over 100,000. These numbers suggest a small attributable risk compared ot the vast incidence of cardiovascular disease in the US, but a large attributable risk compared to most environmental toxins. Several biological mechanisms have been identified, with different implications for the use of bone lead as an exposure measure.
Schwartz, J. (Environmental Protection Agency, Washington, DC (United States))
Iron is the second most abundant metal in the Earth’s crust. Despite being present in trace amounts, it is an essential trace element for the human body, although it can also be toxic due to oxidative stress generation by the Fenton reaction, causing organic biomolecule oxidation. This process is the basis of numerous pathologies, including cardiovascular diseases (CVD). The relationship between iron and cardiovascular disease was proposed in 1981 by Jerome Sullivan. Since then, numerous epidemiological studies have been conducted to test this hypothesis. The aim of this review is to present the main findings of the chief epidemiological studies published during the last 32 years, since Sullivan formulated his iron hypothesis, suggesting that this element might act as a risk factor for cardiovascular disease. We have analyzed 55 studies, of which 27 supported the iron hypothesis, 20 found no evidence to support it and eight were contrary to the iron hypothesis. Our results suggest that there is not a high level of evidence which supports the hypothesis that the iron may be associated with CVD. Despite the large number of studies published to date, the role of iron in cardiovascular disease still generates a fair amount of debate, due to a marked disparity in results.
Munoz-Bravo, Carlos; Gutierrez-Bedmar, Mario; Gomez-Aracena, Jorge; Garcia-Rodriguez, Antonio; Fernandez-Crehuet Navajas, Joaquin
Heart rate and blood pressure are elevated at the onset and throughout the duration of dynamic or static exercise. These neurally mediated cardiovascular adjustments to physical activity are regulated, in part, by a peripheral reflex originating in contracting skeletal muscle termed the exercise pressor reflex. Mechanically sensitive and metabolically sensitive receptors activating the exercise pressor reflex are located on the unencapsulated nerve terminals of group III and group IV afferent sensory neurons, respectively. Mechanoreceptors are stimulated by the physical distortion of their receptive fields during muscle contraction and can be sensitized by the production of metabolites generated by working skeletal myocytes. The chemical by-products of muscle contraction also stimulate metaboreceptors. Once activated, group III and IV sensory impulses are transmitted to cardiovascular control centers within the brain stem where they are integrated and processed. Activation of the reflex results in an increase in efferent sympathetic nerve activity and a withdrawal of parasympathetic nerve activity. These actions result in the precise alterations in cardiovascular hemodynamics requisite to meet the metabolic demands of working skeletal muscle. Coordinated activity by this reflex is altered after the development of cardiovascular disease, generating exaggerated increases in sympathetic nerve activity, blood pressure, heart rate, and vascular resistance. The basic components and operational characteristics of the reflex, the techniques used in human and animals to study the reflex, and the emerging evidence describing the dysfunction of the reflex with the advent of cardiovascular disease are highlighted in this review.
Murphy, Megan N.; Mizuno, Masaki; Mitchell, Jere H.
Electrocardiography is a method which can not be replaced by any other examination in arrhythmias. It also plays a crucial role in the diagnosis of arrhythmic rare diseases by providing not only diagnostic data, but also paving the way for treatment. This article presents some characteristic examples of ECG in arrhythmic rare diseases (i.e., polimorphic ventricular tachycardia, Brugada syndrome, Coumela syndrome, nonreentrant supraventricular tachycardia with double ventricular response). PMID:24490460
Lelakowski, Jacek; Pudlo, Joanna; Lelakowska-Piela, Maria; Engel, Anna; Hardzina, Malgorzata
For more than 60 years, the Centers for Disease Control and Prevention (CDC) has used its scientific expertise to help people throughout the world live healthier, safer, longer lives through science-based health action. In 1951, CDC officially established the Epidemic Intelligence Service to help build public health capacity. During 1950-2005, CDC's Epidemic Intelligence Service officers conducted 462 international epidemiologic field investigations in 131 foreign countries and 7 territories. Investigations have included responding to emerging infectious and noninfectious disease outbreaks, assisting in disaster response, and evaluating core components of public health programs worldwide. Approximately 81% of investigations were responses to infectious disease outbreaks, but the proportion of investigations related to chronic and other noninfectious conditions increased 7-fold (6%-45%). These investigations have contributed to detecting and characterizing new pathogens (e.g., severe acute respiratory syndrome-associated coronavirus) and conditions, provided insights regarding factors that cause or contribute to disease acquisition (e.g., Ebola hemorrhagic fever), led to development of new diagnostics and surveillance technologies, and provided information upon which global health policies and regulations can be based. CDC's disease detectives will undoubtedly continue to play a critical role in global health and in responding to emerging global disease threats. PMID:22135398
Rolle, Italia V; Pearson, Michele L; Nsubuga, Peter
Background Consumption of chocolate has been often hypothesized to reduce the risk of cardiovascular disease (CVD) due to chocolate's high levels of stearic acid and antioxidant flavonoids. However, debate still lingers regarding the true long term beneficial cardiovascular effects of chocolate overall. Methods We reviewed English-language MEDLINE publications from 1966 through January 2005 for experimental, observational, and clinical studies of relations between cocoa, cacao, chocolate, stearic acid, flavonoids (including flavonols, flavanols, catechins, epicatechins, and procynadins) and the risk of cardiovascular disease (coronary heart disease (CHD), stroke). A total of 136 publications were selected based on relevance, and quality of design and methods. An updated meta-analysis of flavonoid intake and CHD mortality was also conducted. Results The body of short-term randomized feeding trials suggests cocoa and chocolate may exert beneficial effects on cardiovascular risk via effects on lowering blood pressure, anti-inflammation, anti-platelet function, higher HDL, decreased LDL oxidation. Additionally, a large body of trials of stearic acid suggests it is indeed cholesterol-neutral. However, epidemiologic studies of serum and dietary stearic acid are inconclusive due to many methodologic limitations. Meanwhile, the large body of prospective studies of flavonoids suggests the flavonoid content of chocolate may reduce risk of cardiovascular mortality. Our updated meta-analysis indicates that intake of flavonoids may lower risk of CHD mortality, RR = 0.81 (95% CI: 0.71–0.92) comparing highest and lowest tertiles. Conclusion Multiple lines of evidence from laboratory experiments and randomized trials suggest stearic acid may be neutral, while flavonoids are likely protective against CHD mortality. The highest priority now is to conduct larger randomized trials to definitively investigate the impact of chocolate consumption on long-term cardiovascular outcomes.
Ding, Eric L; Hutfless, Susan M; Ding, Xin; Girotra, Saket
\\u000a Over 80 million people in the United States exhibit one or more forms of cardiovascular disease (CVD), and atherosclerotic\\u000a CVD (mainly coronary heart disease and stroke) is, by far, the leading cause of death among men and women. More women die\\u000a from CVD in the United States each year than men. Atherosclerotic CVD has become a worldwide pandemic. While CVD
Kevin C. Maki; Martyn R. Rubin
Background EpiFlex is a flexible, easy to use computer model for a single computer, intended to be operated by one user who need not be an expert. Its purpose is to study in-silico the epidemic behavior of a wide variety of diseases, both known and theoretical, by simulating their spread at the level of individuals contracting and infecting others. To understand the system fully, this paper must be read together in conjunction with study of the software and its results. EpiFlex is evaluated using results from modeling influenza A epidemics and comparing them with a variety of field data sources and other types of modeling. EpiFlex is an object-oriented Monte Carlo system, allocating entities to correspond to individuals, disease vectors, diseases, and the locations that hosts may inhabit. EpiFlex defines eight different contact types available for a disease. Contacts occur inside locations within the model. Populations are composed of demographic groups, each of which has a cycle of movement between locations. Within locations, superspreading is defined by skewing of contact distributions. Results EpiFlex indicates three phenomena of interest for public health: (1) R0 is variable, and the smaller the population, the larger the infected fraction within that population will be; (2) significant compression/synchronization between cities by a factor of roughly 2 occurs between the early incubation phase of a multi-city epidemic and the major manifestation phase; (3) if better true morbidity data were available, more asymptomatic hosts would be seen to spread disease than we currently believe is the case for influenza. These results suggest that field research to study such phenomena, while expensive, should be worthwhile. Conclusion Since EpiFlex shows all stages of disease progression, detailed insight into the progress of epidemics is possible. EpiFlex shows the characteristic multimodality and apparently random variation characteristic of real world data, but does so as an emergent property of a carefully constructed model of disease dynamics and is not simply a stochastic system. EpiFlex can provide a better understanding of infectious diseases and strategies for response.
We reformulate several recent analyses of infection processes on highly heterogeneous networks (e.g., scale-free networks) which conclude that diseases will spread and persist even for vanishingly small transmission probabilities. The results of these latter studies contrast with conventional epidemiological models where there are clear threshold effects, namely, should the transmission probability fall below a critical threshold level the disease is expected to die out. Here we show that epidemic propagation depends equally on the infection scheme as well as the network structure. Connectivity-dependent infection schemes can yield threshold effects even in scale-free networks where they would otherwise be unexpected.
Olinky, Ronen; Stone, Lewi
Models of plant virus epidemics have received less attention than those caused by fungal pathogens. Intuitively, the fact that virus diseases are systemic means that the individual diseased plant can be considered as the population unit which simplifies modelling. However, the fact that a vector is required in the vast majority of cases for virus transmission, means that explicit consideration must be taken of the vector, or, the involvement of the vector in the transmission process must be considered implicitly. In the latter case it is also important that within-plant processes, such as virus multiplication and systemic movement, are taken into account. In this paper we propose an approach based on the linking of transmission at the population level with virus multiplication within plants. The resulting models are parameter-sparse and hence simplistic. However, the range of model outcomes is representative of field observations relating to the apparent limitation of epidemic development in populations of healthy susceptible plants. We propose that epidemic development can be constrained by virus limitation in the early stages of an epidemic when the availability of healthy susceptible hosts is not limiting. There is an inverse relationship between levels of transmission in the population and the mean virus titre/infected plant. In the case of competition between viruses, both virus and host limitation are likely to be important in determining whether one virus can displace another or whether both viruses can co-exist in a plant population. Lotka-Volterra type equations are derived to describe density-dependent competition between two viruses multiplying within plants, embedded within a population level epidemiological model. Explicit expressions determining displacement or co-existence of the viruses are obtained. Unlike the classical Lotka-Volterra competition equations, the co-existence requirement for the competition coefficients to be both less than 1 can be relaxed. PMID:21621567
Jeger, M J; van den Bosch, F; Madden, L V
Background Poor sleep is prospectively linked to all-cause and cardiovascular mortality. Inflammatory processes may be an important biological\\u000a mechanism linking poor sleep to cardiovascular disease. Such processes involve active participation of signaling molecules\\u000a called cytokines in development of atherosclerotic plaques.\\u000a \\u000a \\u000a \\u000a \\u000a Purpose I review evidence from experimental sleep deprivation and clinical observational studies suggesting a bidirectional relationship\\u000a between sleep and inflammatory cytokines.\\u000a \\u000a \\u000a \\u000a \\u000a Results Findings
Sarosh J. Motivala
The last decade has witnessed major advances in our understanding of the epidemiology and pathophysiology of HIV-related cardiovascular disease in sub-Saharan Africa. In this review, we summarise these and discuss clinically relevant advances in diagnosis and treatment. In the Heart of Soweto Study, 10% of patients with newly diagnosed cardiovascular disease were HIV positive, and the most common HIV-related presentations were cardiomyopathy (38%), pericardial disease (13%) and pulmonary arterial hypertension (8%). HIV-related cardiomyopathy is more common with increased immunosuppression and HIV viraemia. With adequate antiretroviral therapy, the prevalence is low. Contributing factors such as malnutrition and genetic predisposition are under investigation. In other settings, pericardial disease is the most common presentation of HIV-related cardiovascular disease (over 40%), and over 90% of pericardial effusions are due to Mycobacterium tuberculosis (TB) pericarditis. HIV-associated TB pericarditis is associated with a greater prevalence of myopericarditis, a lower rate of progression to constriction, and markedly increased mortality. The role of steroids is currently under investigation in the form of a randomised controlled trial. HIV-associated pulmonary hypertension is significantly more common in sub-Saharan Africa than in developed countries, possibly as a result of interactions between HIV and other infectious agents, with very limited treatment options. It has recently been recognised that patients with HIV are at increased risk of sudden death. Infection with HIV is independently associated with QT prolongation, which is more marked with hepatitis C co-infection and associated with a 4.5-fold higher than expected rate of sudden death. The contribution of coronary disease to the overall burden of HIV-associated cardiovascular disease is still low in sub-Saharan Africa. PMID:23680889
Syed, Faisal F; Sani, Mahmoud Umar
Oxidant stress has been implicated in the etiology and pathogenesis of atherothrombotic vascular disease. Elevated levels of reactive oxygen species, resulting from increased production and/or decreased antioxidant capacity, modulate the vessel wall phenotype to create an environment that facilitates the progression of atherosclerosis. Herein, we review a number of biochemical mechanisms by which oxidant stress mediates atherosclerotic lesion formation and progression.
Leopold, Jane A.; Loscalzo, Joseph
Over 30 million people are currently living with human immunodeficiency virus (HIV) infection, and over 2 million new infections occur per year. HIV has been found to directly affect vascular biology resulting in an increased risk of cardiovascular disease compared to uninfected persons. Although HIV infection can now be treated effectively with combination antiretroviral medications, significant toxicities such as hyperlipidemia, diabetes, and excess cardiovascular co-morbidity; as well as the potential for significant drug-drug interactions between HIV and cardiovascular medications, present new challenges for the management of persons infected with HIV. We first review basic principles of HIV pathogenesis and treatment and then discuss relevant clinical management strategies that will be useful for cardiologists who might be involved in the care of HIV infected patients.
Dau, Birgitt; Holodniy, Mark
Antisense oligonucleotides and small interfering RNAs, which suppress the translation of specific mRNA target proteins, are emerging as important therapeutic modalities for the treatment of cardiovascular disease. Over the last 25 years, the advances in all aspects of antisense technology, as well as a detailed understanding of the mechanism of action of antisense drugs, have enabled their use as therapeutic agents. These advancements culminated in the FDA approval of the first chronically administered cardiovascular antisense therapeutic, mipomersen, which targets hepatic apolipoprotein B mRNA. This review provides a brief history of antisense technology, highlights the progression of mipomersen from preclinical studies to multiple Phase III registration trials, and gives an update on the status of other cardiovascular antisense therapeutics currently in the clinic. PMID:23856914
Lee, Richard G; Crosby, Jeff; Baker, Brenda F; Graham, Mark J; Crooke, Rosanne M
No consensus exists whether subclinical thyroid disease should be treated or just observed. Untreated overt thyroid disease is associated with increased risk of cardiovascular disease, and this study was conducted to assess the risk of cardiovascular events in subclinical thyroid disease. The population-based prospective study was conducted in Denmark. A total of 609 subjects from general practice aged 50 years or above with normal left ventricular function were examined. During a median of 5 years of follow-up, major cardiovascular events were documented. In subjects with abnormal TSH at baseline, information about potential thyroid treatment during follow-up was obtained from case reports and mailings. At baseline, 549 (90.7%) were euthyroid (TSH 0.40-4.00?mU/l), 31 (5.1%) were subclinical hypothyroid (TSH>4.00?mU/l), and 25 (4.1%) were subclinical hyperthyroid (TSH<0.40?mU/l). 1 overt hyperthyroid and 3 overt hypothyroid participants were excluded from the analyses. At baseline, the levels of NT-proBNP were inversely associated with the levels of TSH; the lower the levels of TSH, the higher the NT-proBNP concentration. During follow-up, 88 participants died, 81 had a major cardiovascular event, and 28 had a stroke. The incidence of stroke was increased among subjects with subclinical hyperthyroidism, HR 3.39 (95% CI 1.15-10.00, p=0.027) after adjusting for sex, age, and atrial fibrillation. Subclinical hypothyroidism was not related with any of the outcome measurements. Subclinical hyperthyroidism seems to be a risk factor of developing major cardiovascular events, especially stroke in older adults from the general population with normal left ventricular function. PMID:21823062
Schultz, M; Kistorp, C; Raymond, I; Dimsits, J; Tuxen, C; Hildebrandt, P; Faber, J
BACKGROUND There is debate about the value of assessing levels of C-reactive protein (CRP) and other biomarkers of inflammation for the prediction of first cardiovascular events. METHODS We analyzed data from 52 prospective studies that included 246,669 participants without a history of cardiovascular disease to investigate the value of adding CRP or fibrinogen levels to conventional risk factors for the prediction of cardiovascular risk. We calculated measures of discrimination and reclassification during follow-up and modeled the clinical implications of initiation of statin therapy after the assessment of CRP or fibrinogen. RESULTS The addition of information on high-density lipoprotein cholesterol to a prognostic model for cardiovascular disease that included age, sex, smoking status, blood pressure, history of diabetes, and total cholesterol level increased the C-index, a measure of risk discrimination, by 0.0050. The further addition to this model of information on CRP or fibrinogen increased the C-index by 0.0039 and 0.0027, respectively (P<0.001), and yielded a net reclassification improvement of 1.52% and 0.83%, respectively, for the predicted 10-year risk categories of “low” (<10%), “intermediate” (10% to <20%), and “high” (?20%) (P<0.02 for both comparisons). We estimated that among 100,000 adults 40 years of age or older, 15,025 persons would initially be classified as being at intermediate risk for a cardiovascular event if conventional risk factors alone were used to calculate risk. Assuming that statin therapy would be initiated in accordance with Adult Treatment Panel III guidelines (i.e., for persons with a predicted risk of ?20% and for those with certain other risk factors, such as diabetes, irrespective of their 10-year predicted risk), additional targeted assessment of CRP or fibrinogen levels in the 13,199 remaining participants at intermediate risk could help prevent approximately 30 additional cardiovascular events over the course of 10 years. CONCLUSIONS In a study of people without known cardiovascular disease, we estimated that under current treatment guidelines, assessment of the CRP or fibrinogen level in people at intermediate risk for a cardiovascular event could help prevent one additional event over a period of 10 years for every 400 to 500 people screened. (Funded by the British Heart Foundation and others.)
Taurine (2-aminoethanesulphonic acid), a sulphur-containing amino acid, is found in most mammalian tissues. Although it can be synthesized endogenously, the major source of taurine is from the diet. Taurine was found to exhibit diverse biological actions, including protection against ischemia-reperfusion injury, modulation of intracellular calcium concentration, and antioxidant, antiatherogenic and blood pressure-lowering effects. The present review will address the potential beneficial actions of taurine in congestive heart failure, hypertension, ischemic heart disease, atherosclerosis and diabetic cardiomyopathy. There is a wealth of experimental information and some clinical evidence available in the literature suggesting that taurine could be of benefit in cardiovascular disease of different etiologies. However, double-blind long-term clinical trials need to be conducted before taurine can be unequivocally recommended as a nutritional intervention for the prevention and/or treatment of cardiovascular disease.
Xu, Yan-Jun; Arneja, Amarjit S; Tappia, Paramjit S; Dhalla, Naranjan S
Fetuin-A (also known as ?2-Heremans-Schmid glycoprotein) is a multifunctional molecule secreted by the liver. It is a negative acute phase reactant with a debated role in subclinical inflammation. Fetuin-A is an inhibitor of the insulin receptor and its serum level correlates with insulin resistance. The protein has been implicated in adipocyte dysfunction and it is associated with obesity and non-alcoholic fatty liver disease. Although all these properties seem to promote atherosclerosis, the role of fetuin-A in cardiovascular diseases is more complex. As a natural inhibitor of tissue and vascular calcification, fetuin-A also acts as a protective factor in atherosclerosis. The potential role and prognostic value of fetuin-A in arterial calcification and cardiovascular diseases is discussed in this review, along with explanations for seemingly contradicting results in the literature and possible directions for future research. PMID:24379092
Vörös, Krisztián; Cseh, Károly; Kalabay, László
A group of academic and industry experts in the fields of nutrition, cardiology, epidemiology, food science, bone health, and integrative medicine examined the data on the relationship between calcium supplement use and risk of cardiovascular events, with an emphasis on 4 of the Bradford Hill criteria for causal inference: strength, consistency, dose-response, and biological plausibility. Results from 2 epidemiological studies and a meta-analysis of randomized, controlled clinical trials, including a subgroup analysis from the Women’s Health Initiative, have prompted concern about a potential association between calcium supplement use and a small increase in the risk of adverse cardiovascular events. However, a number of issues with the studies, such as inadequate compliance with the intervention, use of nontrial calcium supplements, potential bias in event ascertainment, and lack of information on and adjustment for known cardiovascular risk determinants, suggest that bias and confounding cannot be excluded as explanations for the reported associations. Findings from other cohort studies also suggest no detrimental effect of calcium from diet or supplements, with or without vitamin D, on cardiovascular disease risk. In addition, little evidence exists for plausible biological mechanisms to link calcium supplement use with adverse cardiovascular outcomes. The authors do not believe that the evidence presented to date regarding the hypothesized relationship between calcium supplement use and increased cardiovascular disease risk is sufficient to warrant a change in the Institute of Medicine recommendations, which advocate use of supplements to promote optimal bone health in individuals who do not obtain recommended intakes of calcium through dietary sources.
Heaney, Robert P.; Kopecky, Stephen; Maki, Kevin C.; Hathcock, John; MacKay, Douglas; Wallace, Taylor C.
Endocannabinoids are endogenous bioactive lipid mediators present both in the brain and various peripheral tissues, which exert their biological effects via interaction with specific G-protein-coupled cannabinoid receptors, the CB1 and CB2. Pathological overactivation of the endocannabinoid system (ECS) in various forms of shock and heart failure may contribute to the underlying pathology and cardiodepressive state by the activation of the cardiovascular CB1 receptors. Furthermore, tonic activation of CB1 receptors by endocannabinoids has also been implicated in the development of various cardiovascular risk factors in obesity/metabolic syndrome and diabetes, such as plasma lipid alterations, abdominal obesity, hepatic steatosis, inflammation, and insulin and leptin resistance. In contrast, activation of CB2 receptors in immune cells exerts various immunomodulatory effects, and the CB2 receptors in endothelial and inflammatory cells appear to limit the endothelial inflammatory response, chemotaxis, and inflammatory cell adhesion and activation in atherosclerosis and reperfusion injury. Here, we will overview the cardiovascular actions of endocannabinoids and the growing body of evidence implicating the dysregulation of the ECS in a variety of cardiovascular diseases. We will also discuss the therapeutic potential of the modulation of the ECS by selective agonists/antagonists in various cardiovascular disorders associated with inflammation and tissue injury, ranging from myocardial infarction and heart failure to atherosclerosis and cardiometabolic disorders.
Drugs that are used to treat Alzheimer's disease include the acetyl cholinesterase inhibitors (ACHIs) donepezil, rivastigmine and galantamine and the NMDA receptor antagonist memantine. Adverse cardiovascular events with these drugs are very uncommon. However, there is evidence that ACHI therapy is associated with a small but significant increase in the risk of syncope and bradycardia. There are also a few reports that these drugs may occasionally be associated with QT prolongation and torsades de pointes ventricular tachycardia. Adverse cardiovascular effects of ACHIs including syncope and bradycardia are less common than their adverse gastrointestinal effects, but they remain important considerations in susceptible individuals. In contrast, animal studies and some observational studies suggest that ACHIs may reduce myocardial infarction and cardiovascular mortality and have favourable effects on hemodynamics and survival in heart failure. Further research is required to confirm these potential beneficial effects. Little is known about the cardiovascular effects of memantine but there have been reports of bradycardia and reduced cardiovascular survival associated with its use. PMID:24777654
Howes, Laurence Guy
The aim of this study was to conduct a systematic review of the literature regarding the prevalence of sexual dysfunction in patients with cardiovascular diseases. An article search of the ISI Web of Science and PubMed databases using the search terms "sexual dysfunction", "cardiovascular diseases", "coronary artery disease", "myocardial infarct" and "prevalence" was performed. In total, 893 references were found. Non-English-language and repeated references were excluded. After an abstract analysis, 91 references were included for full-text reading, and 24 articles that evaluated sexual function using validated instruments were selected for this review. This research was conducted in October 2012, and no time restrictions were placed on any of the database searches. Reviews and theoretical articles were excluded; only clinical trials and epidemiological studies were selected for this review. The studies were mostly cross-sectional, observational and case-control in nature; other studies used prospective cohort or randomized clinical designs. In women, all domains of sexual function (desire, arousal, vaginal lubrication, orgasm, sexual dissatisfaction and pain) were affected. The domains prevalent in men included erectile dysfunction and premature ejaculation and orgasm. Sexual dysfunction was related to the severity of cardiovascular disease. When they resumed sexual activity, patients with heart disease reported significant difficulty, including a lack of interest in sex, sexual dissatisfaction and a decrease in the frequency of sexual activity. PMID:24270960
Nascimento, Elisabete Rodrigues; Maia, Ana Claudia Ornelas; Pereira, Valeska; Soares-Filho, Gastão; Nardi, Antonio Egidio; Silva, Adriana Cardoso
Throughout their lifetime, an individual may sustain many injuries and recover spontaneously over a period of time, without even realizing the injury in the first place. Wound healing occurs due to a proliferation of stem cells capable of restoring the injured tissue. The ability of adult stem cells to repair tissue is dependent upon the intrinsic ability of tissues to proliferate. The amazing capacity of embryonic stem cells to give rise to virtually any type of tissue has intensified the search for similar cell lineage in adults to treat various diseases including cardiovascular diseases. The ability to convert adult stem cells into pluripotent cells that resemble embryonic cells, and to transplant those in the desired organ for regenerative therapy is very attractive, and may offer the possibility of treating harmful disease-causing mutations. The race is on to find the best cells for treatment of cardiovascular disease. There is a need for the ideal stem cell, delivery strategies, myocardial retention, and time of administration in the ideal patient population. There are multiple modes of stem cell delivery to the heart with different cell retention rates that vary depending upon method and site of injection, such as intra coronary, intramyocardial or via coronary sinus. While there are crucial issues such as retention of stem cells, microvascular plugging, biodistribution, homing to myocardium, and various proapoptotic factors in the ischemic myocardium, the regenerative potential of stem cells offers an enormous impact on clinical applications in the management of cardiovascular diseases.
Sharma, Rakesh K; Voelker, Donald J; Sharma, Roma; Reddy, Hanumanth K
The aim of this study was to conduct a systematic review of the literature regarding the prevalence of sexual dysfunction in patients with cardiovascular diseases. An article search of the ISI Web of Science and PubMed databases using the search terms "sexual dysfunction”, “cardiovascular diseases”, “coronary artery disease", “myocardial infarct" and “prevalence” was performed. In total, 893 references were found. Non-English-language and repeated references were excluded. After an abstract analysis, 91 references were included for full-text reading, and 24 articles that evaluated sexual function using validated instruments were selected for this review. This research was conducted in October 2012, and no time restrictions were placed on any of the database searches. Reviews and theoretical articles were excluded; only clinical trials and epidemiological studies were selected for this review. The studies were mostly cross-sectional, observational and case-control in nature; other studies used prospective cohort or randomized clinical designs. In women, all domains of sexual function (desire, arousal, vaginal lubrication, orgasm, sexual dissatisfaction and pain) were affected. The domains prevalent in men included erectile dysfunction and premature ejaculation and orgasm. Sexual dysfunction was related to the severity of cardiovascular disease. When they resumed sexual activity, patients with heart disease reported significant difficulty, including a lack of interest in sex, sexual dissatisfaction and a decrease in the frequency of sexual activity.
Nascimento, Elisabete Rodrigues; Maia, Ana Claudia Ornelas; Pereira, Valeska; Soares-Filho, Gastao; Nardi, Antonio Egidio; Silva, Adriana Cardoso
STUDY OBJECTIVE--The aim was to explore the relationships between five socioeconomic variables and three main cardiovascular diseases (ischaemic heart disease, hypertensive disease, and cerebrovascular disease) in Hong Kong. DESIGN--This cross sectional study used data from the 1986 by-census and registered death data for 1985 to 1987 in Hong Kong. For each of 24 districts, the correlation coefficients between log standardised mortality ratios for the three cardiovascular diseases and the percentages of professional and administrative workers, production and agricultural workers, persons aged 15 and over having tertiary education, households with higher income, and people living in private residential blocks were calculated. Besides simple linear regression and correlation, factor analysis was used to produce a new single surrogate measure summarising the five most useful variables in 24 sets of districts. SETTING--The whole Hong Kong area (population approximately 5.5 million) was divided into 24 districts, which were the study units. MEASUREMENTS AND MAIN RESULTS--For ischaemic heart disease in men, the correlation coefficients of the log standardised mortality ratios with the five socioeconomic variables as well as with the factor score were all statistically significant. For women, statistical significance was obtained in only two of five socioeconomic variables. No such trends were obtained for the other two cardiovascular diseases for either men or women. CONCLUSIONS--The study suggests that in Hong Kong in recent years, a higher level of socioeconomic status is associated with higher risk of death from ischaemic heart disease; but this association is not present for hypertensive disease and cerebrovascular disease.
Wong, S L; Donnan, S P
In summarizing the evidence, it becomes apparent that several psychologic and social variables are related to coronary heart\\u000a disease (CHD). Coronary prone behavior pattern, in particular the hostility component, appears to be related to the development\\u000a and perhaps expression of CHD, whereas it is not reliably related to outcomes after CHD is manifest. Depression clearly has\\u000a been shown to be
Kathleen B. King
Infections have been recognized as significant causes of cardiac diseases for many decades. Various microorganisms have been implicated in the etiology of these diseases involving all classes of microbial agents. All components of the heart structure can be affected by infectious agents, i.e. pericardium, myocardium, endocardium, valves, autonomic nervous system, and some evidence of coronary arteries. A new breed of infections have evolved over the past three decades involving cardiac implants and this group of cardiac infectious complications will likely continue to increase in the future, as more mechanical devices are implanted in the growing ageing population. This article will review the progress made in the past decade on understanding the pathobiology of these infectious complications of the heart, through advances in genomics and proteomics, as well as potential novel approach for therapy. An up-to-date, state-of-the-art review and controversies will be outlined for the following conditions: (i) perimyocarditis; (ii) infective endocarditis; (iii) cardiac device infections; (iv) coronary artery disease and potential role of infections.
Fong, Ignatius W
The high prevalence of cardiovascular disease (CVD) in patients with kidney disease is well described. This Canadian, multicenter, observational cohort study reports the prevalence and risk factors of CVD associated with kidney disease, in a cohort of patients with established chronic kidney disease (CKD), who are followed-up by nephrologists. This analysis sought to answer 2 questions: (1) in patients with
Adeera Levin; Ognjenka Djurdjev; Brendan Barrett; Ellen Burgess; Euan Carlisle; Jean Ethier; Kailash Jindal; David Mendelssohn; Sheldon Tobe; Joel Singer; Christopher Thompson
In the future, transfer of vital sensor data from patients to the public health care system is likely to become commonplace. Systems for automatic transfer of sensor data are now at the prototype stage. As electronic health record (EHR) systems adapt such functionality, widespread use may become an actuality in the foreseeable future.To prevent spreading of diseases, an early detection of infection is important. At the time an outbreak is diagnosed, many people may already be infected due to the incubation period. This study suggests an approach for detecting an epidemic outbreak at an early stage by monitoring blood glucose data collected from people with diabetes. Continuous analysis of blood glucose data may have the potential to prevent large outbreaks of infectious diseases, such as different strains of Influenza, Cholera, Plague, Ebola, Anthrax and SARS.When a person gets infected, the blood glucose value increases. If the blood glucose data from a large number of patients with diabetes are collected in a central database, it may be possible to detect an epidemic disease outbreak at an early stage. Advanced data analysis on the data may detect predominant numbers of incidences, indicating a possible outbreak. This gives the health authorities the possibilities to take actions to limit the outbreak and its consequences for all the inhabitants in an affected area.At the Norwegian Centre for Telemedicine, a mobile system for automatic transfer of blood glucose values has been constructed. By using wireless communication standards such as Bluetooth and GSM, the system transfers blood glucose data to an electronic health record system. Combined with a system accessing and querying data from EHR systems for patient surveillance we are extending our work into an Epidemic Disease Detection using blood Glucose (EDDG) system. PMID:16160262
Arsand, Eirik; Walseth, Ole Anders; Andersson, Niklas; Fernando, Ruchith; Granberg, Ove; Bellika, Johan G; Hartvigsen, Gunnar
The conditions of depression, erectile dysfunction (ED), and cardiovascular disease may seem at a superficial level as independent medical problems managed by 3 separate and unrelated healthcare disciplines. Various studies, however, have revealed significant associations between depression and cardiovascular disease, ED and cardiovascular disease, and depression and ED. The purpose of this research was to identify whether the 3 medical
Recognizing the contribution and interrelatedness of lipoprotein risk factors is critical to prioritizing treatment strategies for cardiovascular risk reduction. Lipoprotein factors still dominate risk for developing cardiovascular disease, including myocardial infarction. Some emerging risk factors such as C-reactive protein are gaining acceptance due to recent prospective clinical trials demonstrating clinical benefit in reducing these markers. Other emerging risk factors, including lipoprotein particle size, remain to be validated. In this second article of a 2-part series, we will begin with a review of formal risk assessment, discussing the contribution of multiple “risky” and “healthy” components that play a part in overall cardiovascular health. Following risk assessment, we will discuss evidence-based integrative therapies that can be used to modify any risky lipoprotein and inflammatory patient profiles, including medications, functional foods, supplements, and lifestyle approaches. The focus is on low-density lipoproteins, high-density lipoproteins, triglycerides, and C-reactive protein. Understanding the interrelatedness of lipoprotein risk factors, and finding efficient methods of treating multiple risk factors simultaneously, will not only improve the long-term health of patients but will also save on the expenditure of healthcare dollars for unnecessary testing and ineffective treatments. Integrative practitioners who understand the contribution of lifestyle factors, and who have numerous effective treatment options at their disposal, are well positioned to counsel patients on cardiovascular disease prevention.
Bradley, Ryan; Oberg, Erica
The question whether prevention in the elderly or in the old is still worthwhile arises frequently in clinical practice. The life expectancy (LE) of elderly persons is often underestimated and ranges for a 65-year-old European person from 17 to 23 years and for an 80-year-old from 8 and 11 years. In the elderly patients with cardiovascular disease, preventive measures are of great benefit. Smoking cessation results in substantial gains in LE and is more effective than most other interventions. Lipid lowering with statins is cost effective and the intensity of low-density lipoprotein cholesterol lowering correlates with the risk reduction of cardiac events and stroke without increasing the risk of cancer. A quality-adjusted life year costs US $ 18,800, less than the costs of a nursing home for 1 year. Exercise training decreases cardiovascular events and improves quality of life. The benefits of the Mediterranean diet are based on a small randomized trial, which is supplemented by a large observational database. A reduction in all-cause, cardiovascular disease, and cancer mortality is highly likely. Blood pressure lowering reduces stroke and all-cause mortality above the age of 80; however, the target blood pressure should be around 150/80 mmHg or slightly lower. Annual vaccination against influenza is one of the most cost-effective methods to prolong life and should not be forgotten in patients with cardiovascular disease above the age of 65. Thus a number of options are available to add quality-adjusted life years in the elderly by adhering to the general guidelines for cardiovascular prevention. PMID:22089892
The development of agents for the simultaneous detection and treatment of disease has recently gained significant attention. These multifunctional theranostic agents posses a number of advantages over their monofunctional counterparts, as they potentially allow for the concomitant determination of agent localization, release, and efficacy. Whereas the development of these agents for use in cancers has received the majority of the attention, their use in cardiovascular disease is steadily increasing. As such, this review summarized some of the most poignant recent advances in the development of theranostic agents for the treatment of this class of diseases.
McCarthy, Jason R.
Cardiovascular disease (CVD), the leading cause of morbidity and mortality worldwide, is a complex multifactorial disease which is influenced by environmental and genetic factors. There is substantial evidence on the relationship between diet and CVD risk. An understanding of how genetic variation interacts with the diet to influence CVD risk is a rapidly evolving area of research. Since diet is the mainstay of risk factor modification, it is important to consider potential genetic influences on CVD risk. Nutrigenomics is the study of the interaction between diet and an individual's genetic makeup. Single nucleotide polymorphisms are the key factors in human genetic variation and provide a molecular basis for phenotypic differences between individuals. Whole genome and candidate gene association studies are two main approaches used in cardiovascular genetics to identify disease-causing genes. Recent nutrigenomics studies show the influence of genotype on the responsiveness to dietary factors or nutrients that may reduce CVD risk. Nutrigenomics research is expected to provide the scientific evidence for genotype-based personalized nutrition to promote health and prevent chronic disease, including CVD. It is imperative that healthcare providers, including cardiovascular nurses, are trained in genetics to foster delivery of competent genetic- and genomic-focused care and to facilitate incorporation of this new knowledge into current clinical practice, education, and research. PMID:20002344
Engler, Mary B
In the vasculature, reactive oxidant species including reactive oxygen, nitrogen, or halogenating species, and thiyl, tyrosyl, or protein radicals, may oxidatively modify lipids and proteins with deleterious consequences for vascular function. These biologically active free radical and non-radical species may be produced by increased activation of oxidant-generating sources and/or decreased cellular antioxidant capacity. Once formed, these species may engage in reactions to yield more potent oxidants that promote transition of the homeostatic vascular phenotype to a pathobiological state that is permissive for atherothrombogenesis. This dysfunctional vasculature is characterized by lipid peroxidation and aberrant lipid deposition, inflammation, immune cell activation, platelet activation, thrombus formation, and disturbed hemodynamic flow. Each of these pathobiological states is associated with an increase in the vascular burden of free radical species-derived oxidation products and, thereby, implicates increased oxidant stress in the pathogenesis of atherothrombotic vascular disease.
Leopold, Jane A.; Loscalzo, Joseph
The activity of several components of the vascular system appears to be diurnally regulated. Endothelial cell activation, leukocyte and platelet interactions and lipoprotein metabolism have all been shown to vary with time of day, but whether these variations are due to the endogenous circadian clock, exogenous factors, such as the light-dark cycle, or an interaction between the two remains to be determined. Endothelium-dependent vasodilation also varies diurnally. This rhythmicity is lost in individuals with established coronary disease has been shown to occur in the early stages of atherosclerosis. The incidence of coronary events appears to be higher in the early hours of the morning, this may be related to heightened activity of the autonomic nervous system at this time. Higher circulating levels of catecholamines in the morning are associated with increased vascular tone, affecting circulating blood volume and blood pressure. Time dependent variations may be of particular significance for individuals with disrupted circadian rhythms, including rotating shift workers, transmeridian travellers and blind individuals with no light perception. Variations in endothelial function are observed during the menstrual cycle, varying with circulating oestrogen levels. Oestrogen deficiency in postmenopausal women may contribute to endothelial dysfunction, together with other modifiable risk factors. The absolute risk of coronary disease is greater for men than for pre-menopausal women. Following the menopause gender differences in coronary risk are thought to diminish, although this remains controversial. This review focuses on the influence of both endogenous biological rhythms and environmental factors on the function and health of the human vascular system. PMID:12552252
Walters, Janie; Skene, Debra; Hampton, Shelagh M; Ferns, Gordon A
Based on Codeço's cholera model (2001), an epidemic cholera model that incorporates the pathogen diffusion and disease-related death is proposed. The formula for minimal wave speed c? is given. To prove the existence of traveling wave solutions, an invariant cone is constructed by upper and lower solutions and Schauder's fixed point theorem is applied. The nonexistence of traveling wave solutions is proved by two-sided Laplace transform. However, to apply two-sided Laplace transform, the prior estimate of exponential decrease of traveling wave solutions is needed. For this aim, a new method is proposed, which can be applied to reaction-diffusion systems consisting of more than three equations.
Zhang, Tianran; Gou, Qingming
Largely due to better control of infectious diseases and significant advances in biomedical research, life expectancy worldwide has increased dramatically in the last three decades. However, as the average age of the population has risen, the incidence of chronic age-related diseases such as arthritis, Alzheimer's, Parkinson's, cardiovascular disease, cancer, osteoporosis, benign prostatic hyperplasia, and late-onset diabetes have increased and have become serious public health problem, as well. The etiology of these disorders is still incompletely understood, therefore, neither preventive strategies nor long-term effective treatment modalities are available for these disorders. In keeping with the aforementioned, the ultimate goal in cardiovascular research is to prevent the onset of cardiovascular episodes and thereby allow successful ageing without morbidity and cognitive decline. Herein, I argue that cardiovascular episodes could be contained with relatively simple approaches. Cardiovascular disorder is characterized by cellular and molecular changes that are commonplace in age-related diseases in other organ system, such alterations include increased level of oxidative stress, perturbed energy metabolism, and “horror autotoxicus” largely brought about by the perturbation of ubiquitin -proteasome system, and excessive oxidative stress damage to the cardiac muscle cells and tissues, and cross-reactions of specific antibodies against human heat shock protein 60 with that of mycobacterial heat shock protein 65.” Horror autotoxicus”, a Latin expression, is a term coined by Paul Ehrlich at the turn of the last century to describe autoimmunity to self, or the attack of “self” by immune system, which ultimately results to autoimmune condition. Based on the currently available data, the risk of cardiovascular episodes and several other age-related disorders, including cancer, Alzheimer's disease and diabetes, is known to be influenced by the nature and level of food intake. Now, a wealth of scientific data from studies of rodents and monkeys has documented the significant beneficial effects of calorie restriction (CR) or dietary restriction (DR), and multiple antioxidant agents in extending life span and reducing the incidence of progeroid-related diseases. Reduced levels of cellular oxidative stress, protection of genome from deleterious damage, detoxification of toxic molecules, and enhancement of energy homeostasis, contribute to the beneficial effects of dietary restriction and multiple antioxidant agents. Recent findings suggest that employment of DR and multiple antioxidant agents (including, catalase, gluthatione peroxidase, CuZn superoxide dismutase, and Mn superoxide dismutase = enzymes forming the primary defense against oxygen toxicity), and ozone therapy may mount an effective resistance to pathogenic factors relevant to the pathogenesis of cardiovascular episodes. Hence, while further studies will be needed to establish the extent to which CR and multiple antioxidant agents will reduce incidence of cardiovascular episodes in humans, it would seem prudent to recommend CR and multiple antioxidant agents as widely applicable preventive approach for cardiovascular disorders and other progeroid-related disorders.
Ofodile, Okom Nkili F.C.
With the recent technological advances, it is possible to monitor vital signs using Bluetooth-enabled biometric mobile devices such as smartphones, tablets or electric wristbands. In this manuscript, we present a system to estimate the risk of cardiovascular diseases in Ambient Assisted Living environments. Cardiovascular disease risk is obtained from the monitoring of the blood pressure by means of mobile devices in combination with other clinical factors, and applying reasoning techniques based on the Systematic Coronary Risk Evaluation Project charts. We have developed an end-to-end software application for patients and physicians and a rule-based reasoning engine. We have also proposed a conceptual module to integrate recommendations to patients in their daily activities based on information proactively inferred through reasoning techniques and context-awareness. To evaluate the platform, we carried out usability experiments and performance benchmarks. PMID:23681093
Hervás, Ramón; Fontecha, Jesús; Ausín, David; Castanedo, Federico; Bravo, José; López-de-Ipiña, Diego
More than 2000 plants have been listed in the Traditional (Herbal/Alternative) systems of medicine and some of these are providing comprehensive relief to the people suffering from cardio-vascular diseases, specially "hyperlipidemia" and "ischemic heart disease". WHO reports indicate that around eighty percent of the global population still relies on botanical drugs and several herbal medicines have advanced to clinical use in modern times. Based on these findings, present review is written to identify the "Pharmacology and Cardio-vascular Application" of four commonly used plants in Pakistan. These include, Crataegus oxycantha, Inula racemosa, Terminalia arjuna and Commiphora mukul. The selection of the plants in the present study is primarily based on their chemistry and pharmacological properties including toxicology reported in various research articles and reviews. Some very interesting findings have been observed and thus recorded and reported in this review. PMID:20067878
Mahmood, Zafar Alam; Sualeh, Mohammad; Mahmood, Saad Bin Zafar; Karim, Mahwish Ahmed
Background Serum p-cresyl sulfate (PCS) associates with cardiovascular disease in patients with chronic kidney disease. PCS concentrations are determined by intestinal uptake of p-cresol, human metabolism to PCS and renal clearance. Whether intestinal uptake of p-cresol itself is directly associated with cardiovascular disease in patients with renal dysfunction has not been studied to date. Methods We performed a prospective study in patients with chronic kidney disease stage 1 – 5 (NCT00441623). Intestinal uptake of p-cresol, under steady state conditions, was estimated from 24 h urinary excretion of PCS. Primary endpoint was time to first cardiovascular event, i.e., cardiac death, myocardial infarction/ischemia, ventricular arrhythmia, cardiovascular surgery, ischemic stroke or symptomatic peripheral arterial disease. Statistical analysis was done using Kaplan-Meier estimates and Cox proportional hazard analyses. Results In a cohort of 200 patients, median 24 h urinary excretion of PCS amounted to 457.47 ?mol (IQR 252.68 – 697.17). After a median follow-up of 52 months, 25 patients reached the primary endpoint (tertile 1/2/3: 5/6/14 events, log rank P 0.037). Higher urinary excretion of PCS was directly associated with cardiovascular events (univariate hazard ratio per 100 ?mol increase: 1.112, P 0.002). In multivariate analysis, urinary excretion of PCS remained a predictor of cardiovascular events, independent of eGFR (hazard ratio 1.120, P 0.002). Conclusions In patients with chronic kidney disease, intestinal uptake of p-cresol associates with cardiovascular disease independent of renal function. The intestinal generation and absorption of p-cresol may be therapeutic targets to reduce cardiovascular disease risk in patients with renal dysfunction.
Untreated sleep disorders may contribute to secondary causes of uncontrolled hypertension, cardiovascular disease (CVD), and stroke. Restless legs syndrome, or Willis-Ekbom Disease (RLS/WED), is a common sensorimotor disorder with a circadian rhythmicity defined by an uncontrollable urge to move the legs that worsens during periods of inactivity or at rest in the evening, often resulting in sleep disruptions. Sleep disorders such as insomnia and obstructive sleep apnea (OSA) are established risk factors for increased risk of hypertension and vascular diseases. This literature review outlines the lessons learned from studies demonstrating insomnia and OSA as risk factors for hypertension and vascular diseases to support the epidemiologic and physiologic evidence suggesting a similar increase in hypertension and vascular disease risk due to RLS. Understanding the relationships between RLS and hypertension, CVD, and stroke has important implications for reducing the risks associated with these diseases. PMID:23963470
Ferini-Strambi, Luigi; Walters, Arthur S; Sica, Domenic
Carotid artery intima-media thickness (IMT) has been used as a surrogate marker of atherosclerosis and is related to cardiovascular risk. Indices of arterial stiffness are also associated with cardiovascular risk and atherosclerosis. The aim of this study was to assess the prognostic value of the combination of surrogate markers of cardiovascular disease measured non-invasively in subjects without cardiovascular disease. In
K S Stamatelopoulos; D Kalpakos; A D Protogerou; C M Papamichael; I Ikonomidis; M Tsitsirikos; I Revela; T G Papaioannou; J P Lekakis
Obstructive sleep apnea (OSA) has been recognized as a cause of sleep disruption and daytime somnolence. During the past two\\u000a decades, emerging evidence has implicated OSA as a comorbidity in a number of cardiovascular disease conditions (1). More recently, the effects of OSA have been linked to the activation of a number of mechanisms that may contribute to the\\u000a development
Virend K. Somers
Epidemiologic investigations support the hypothesis that regular consumption of flavonoid-containing foods can reduce the risk of cardiovascular diseases (CVD). While flavonoids are ubiquitous in plants, cocoa can be particularly rich in a sub-class of flavonoids known as flavanols. A number of human dietary intervention trials with flavanol-containing cocoa products have demonstrated improvements in endothelial and platelet function, as well as
John W Erdman Jr; LeaAnn Carson; Catherine Kwik-Uribe; Ellen M
Eating and physical activity (PA) patterns and obesity in childhood have many long-term effects on the risk of cardiovascular disease (CVD). Two-thirds of premature deaths in the US are due to poor nutrition, lack of PA and tobacco use. Obesity, a result of excess energy intake and inadequate PA, is an indicator of unhealthy lifestyles. Currently, over one-third of American
This article summarizes recent evidence on the role of physical activity in the prevention of overt and subclinical vascular\\u000a disease. Epidemiologic data suggest that as little as 30 minutes per day of moderate-intensity physical activity, including\\u000a brisk walking, reduces the incidence of clinical cardiovascular events in men and women. Regular exercise may also retard\\u000a the progression of asymptomatic coronary and
Shari S. Bassuk; JoAnn E. Manson
Pentraxin 3 (PTX3) is an essential component of the humoral arm of innate immunity and belongs, together with the C-reactive protein (CRP) and other acute phase proteins, to the pentraxins' superfamily: soluble, multifunctional, pattern recognition proteins. Pentraxins share a common C-terminal pentraxin domain, which in the case of PTX3 is coupled to an unrelated long N-terminal domain. PTX3 in humans, like CRP, correlates with surrogate markers of atherosclerosis and is independently associated with the risk of developing vascular events. Studies addressing the potential physiopathological role of CRP in the cardiovascular system were so far inconclusive and have been limited by the fact that the sequence and regulation have not been conserved during evolution between mouse and man. On the contrary, the conservation of sequence, gene organization, and regulation of PTX3 supports the translation of animal model findings in humans. While PTX3 deficiency is associated with increased inflammation, cardiac damage, and atherosclerosis, the overexpression limits carotid restenosis after angioplasty. These observations point to a cardiovascular protective effect of PTX3 potentially associated with the ability of tuning inflammation and favor the hypothesis that the increased levels of PTX3 in subjects with cardiovascular diseases may reflect a protective physiological mechanism, which correlates with the immunoinflammatory response observed in several cardiovascular disorders.
Bonacina, Fabrizia; Baragetti, Andrea; Catapano, Alberico Luigi
Elevated lipoprotein(a) (Lp[a]) is a causal genetic risk factor for cardiovascular disease. To determine if current evidence supports both screening and treatment for elevated Lp(a) in high-risk patients, an English-language search of PubMed and MEDLINE was conducted. In population studies, there is a continuous association between Lp(a) concentrations and cardiovascular risk, with synergistic effects when low-density lipoprotein (LDL) is also elevated. Candidates for Lp(a) screening include patients with a personal or family history of premature cardiovascular disease, familial hypercholesterolemia, recurrent cardiovascular events, or inadequate LDL cholesterol (LDL-C) responses to statins. Given the comparative strength of clinical evidence, reducing LDL-C to the lowest attainable value with a high-potency statin should be the primary focus of lipid-modifying therapies. If the Lp(a) level is 30 mg/dL or higher in a patient who has the aforementioned characteristics plus residual LDL-C elevations (?70-100 mg/dL) despite maximum-potency statins or combination statin therapy, the clinician may consider adding niacin (up to 2 g/d). If, after these interventions, the patient has progressive coronary heart disease (CHD) or LDL-C levels of 160-200 mg/dL or higher, LDL apheresis should be contemplated. Although Lp(a) is a major causal risk factor for CHD, no currently available controlled studies have suggested that lowering it through either pharmacotherapy or LDL apheresis specifically and significantly reduces coronary risk. Further research is needed to (1) optimize management in order to reduce CHD risk associated with elevated Lp(a) and (2) determine what other intermediate- or high-risk groups might benefit from Lp(a) screening. PMID:24182706
Jacobson, Terry A
BACKGROUND: Cardiovascular disease (CVD) and its most common manifestations – including coronary heart disease (CHD), stroke, heart failure (HF), and atrial fibrillation (AF) – are major causes of morbidity and mortality. In many industrialized countries, cardiovascular disease (CVD) claims more lives each year than any other disease. Heart disease and stroke are the first and third leading causes of death
Martin G Larson; Larry D Atwood; Emelia J Benjamin; L Adrienne Cupples; Ralph B D'Agostino Sr; Caroline S Fox; Diddahally R Govindaraju; Chao-Yu Guo; Nancy L Heard-Costa; Shih-Jen Hwang; Joanne M Murabito; Christopher Newton-Cheh; Christopher J O'Donnell; Sudha Seshadri; Ramachandran S Vasan; Thomas J Wang; Philip A Wolf; Daniel Levy
Context: Low testosterone (T) is associated with prevalent cardiovascular disease (CVD) and mortality. DHT, a more potent androgen, may also be associated with CVD and mortality, but few studies have examined this. Objective: The study objective was to examine whether T and DHT are risk factors for incident CVD and mortality. Design: In a longitudinal cohort study, we evaluated whether total T, calculated free T (cFT), DHT, and calculated free DHT were associated with incident CVD and mortality in men in the Cardiovascular Health Study (mean age 76, range 66-97 years) who were free of CVD at the time of blood collection. Main Outcome: The main outcomes were incident CVD and all-cause mortality. Results: Among 1032 men followed for a median of 9 years, 436 incident CVD events and 777 deaths occurred. In models adjusted for cardiovascular risk factors, total T and cFT were not associated with incident CVD or all-cause mortality, whereas DHT and calculated free DHT had curvilinear associations with incident CVD (P < .002 and P = .04, respectively) and all-cause mortality (P < .001 for both). Conclusions: In a cohort of elderly men, DHT and calculated free DHT were associated with incident CVD and all-cause mortality. Further studies are needed to confirm these results and to clarify the underlying physiologic mechanisms. PMID:24628549
Shores, Molly M; Biggs, Mary L; Arnold, Alice M; Smith, Nicholas L; Longstreth, W T; Kizer, Jorge R; Hirsch, Calvin H; Cappola, Anne R; Matsumoto, Alvin M
This Task Force report encompasses three broad areas: basic research on cardiovascular development and the causes of cardiovascular disease, research to improve clinical outcomes, and population strategies to reduce cardiovascular disease in adults by alt...
Introduction Recent epidemiological data suggest increasing burden of NCDs in many African countries but these diseases have not been given adequate attention due to the overwhelming burden of infectious diseases. There are no recent reports or studies on NCDs or related issues in The Gambia, consequently, this report intends to stimulate further epidemiological studies and also policy initiatives to forestall an epidemic. Methods Routine data on morbidity (in and out-patients), hospitalisation and mortality due to NCDs from health facilities in The Gambia between 2008 and 2011 were used. Other relevant data from multiple sources were also used. Results There is an increasing trend in the morbidity, hospitalisation and mortality due to NCDs in the Gambia between 2008 and 2011; 19.8%, 9.9% and 23.4% increments respectively. There is evidence of gender differences in these variables; more males suffer higher mortality from NCDs than females (p < 0.001). Furthermore, there is dearth of highly skilled health workforce as well as poor health infrastructures in The Gambia. Conclusion NCDs are becoming a public health challenge and the capacity to respond to NCDs in most African countries, particularly, The Gambia is very weak. There is need for a population-based study to accurately quantify the burden and their risk factors as a first step towards policy formulation and effective implementation. Furthermore, there is dire need for increased investments on health workforce as well as medical products and technologies towards addressing the consequences of this emerging epidemic.
Omoleke, Semeeh A
The relationship between serum uric acid (SUA) and cardiovascular disease has been controversial. Here we review recent literature assessing whether hyperuricemia is an independent risk factor for adverse cardiovascular outcomes. Studies from the past 6 years evaluating the association of SUA with cardiovascular disease were identified through MEDLINE, EMBASE, and Cochrane library searches, bibliography cross-referencing, and review articles. Twenty-one cohort
Joshua F. Baker; Eswar Krishnan; Lan Chen; H. Ralph Schumacher
Resistin, originally described as an adipocyte-specific hormone, has been suggested to be an important link between obesity, insulin resistance and diabetes. Although its expression was initially defined in adipocytes, significant levels of resistin expression in humans are mainly found in mononuclear leukocytes, macrophages, spleen and bone marrow cells. Increasing evidence indicates that resistin plays important regulatory roles apart from its role in insulin resistance and diabetes in a variety of biological processes: atherosclerosis and cardiovascular disease (CVD), non-alcoholic fatty liver disease, autoimmune disease, malignancy, asthma, inflammatory bowel disease and chronic kidney disease. As CVD accounts for a significant amount of morbidity and mortality in patients with diabetes and without diabetes, it is important to understand the role that adipokines such as resistin play in the cardiovascular system. Evidence suggests that resistin is involved in pathological processes leading to CVD including inflammation, endothelial dysfunction, thrombosis, angiogenesis and smooth muscle cell dysfunction. The modes of action and signalling pathways whereby resistin interacts with its target cells are beginning to be understood. In this review, the current knowledge about the functions and pathophysiological implications of resistin in CVD development is summarized; clinical translations, therapeutic considerations and future directions in the field of resistin research are discussed. LINKED ARTICLES This article is part of a themed section on Fat and Vascular Responsiveness. To view the other articles in this section visit http://dx.doi.org/10.1111/bph.2012.165.issue-3
Jamaluddin, Md S; Weakley, Sarah M; Yao, Qizhi; Chen, Changyi
Disruptions in iron homeostasis are linked to a broad spectrum of chronic conditions including cardiovascular, malignant, metabolic, and neurodegenerative disease. Evidence supporting this contention derives from a variety of analytical approaches, ranging from molecular to population-based studies. This review focuses on key epidemiological studies that assess the relationship between body iron status and chronic diseases, with particular emphasis on atherosclerosis ,metabolic syndrome and diabetes. Multiple surrogates have been used to measure body iron status, including serum ferritin, transferrin saturation, serum iron, and dietary iron intake. The lack of a uniform and standardized means of assessing body iron status has limited the precision of epidemiological associations. Intervention studies using depletion of iron to alter risk have been conducted. Genetic and molecular techniques have helped to explicate the biochemistry of iron metabolism at the molecular level. Plausible explanations for how iron contributes to the pathogenesis of these chronic diseases are beginning to be elucidated. Most evidence supports the hypothesis that excess iron contributes to chronic disease by fostering excess production of free radicals. Overall, epidemiological studies, reinforced by basic science experiments, provide a strong line of evidence supporting the association between iron and elevated risk of cardiovascular disease and diabetes. In this narrative review we attempt to condense the information from existing literature on this topic.
Basuli, Debargha; Stevens, Richard G.; Torti, Frank M.; Torti, Suzy V.
Background Numerous clinical and experimental studies support the hypothesis that the intrauterine environment is an important determinant of cardiovascular disease and hypertension. Objective This review examines the mechanisms linking an adverse fetal environment and increased risk for chronic adult disease, with an emphasis on gender differences and the role of sex hormones in mediating sexual dimorphism in response to a sub-optimal fetal environment. Methods This is a selective review that focuses on current findings regarding sex differences in fetal programming and the mechanisms involved in the fetal programming of cardiovascular disease and hypertension. Results The mechanisms involved in the fetal programming of adult disease are multifactorial and involve alterations in the regulatory systems involved in the long-term control of arterial pressure. Sex differences are observed in animal models of fetal programming and recent studies suggests sex hormones modulate activity of regulatory systems leading to a lower incidence of hypertension and vascular dysfunction in females compared to males. Conclusions Animal models of fetal programming demonstrate that female offspring are protected from the adverse effects of fetal insult, and are providing insight into the mechanisms by which sex hormones contribute to sexual dimorphism in adult disease.
Grigore, Daniela; Ojeda, Norma B.; Alexander, Barbara T.
BackgroundThe relationship between ambient air pollution exposure and mortality of cardiovascular and cerebrovascular diseases in human is controversial, and there is little information about how exposures to ambient air pollution contribution to the mortality of cardiovascular and cerebrovascular diseases among Chinese. The aim of the present study was to examine whether exposure to ambient-air pollution increases the risk for cardiovascular
Pengfei Zhang; Guanghui Dong; Baijun Sun; Liwen Zhang; Xi Chen; Nannan Ma; Fei Yu; Huimin Guo; Hui Huang; Yungling Leo Lee; Naijun Tang; Jie Chen
Background: The Schizophrenia patients are at higher risk for cardiovascular morbidity and mortality. The aim of this case-control study is to measure Cardiovascular Disease (CVD) risk parameters in patient group and compare it with normal population. Methodology: We recruited 45 cases of Schizophrenia diagnosed by diagnostic and statistical manual of mental disorders (DSM-IV) criteria and 41 healthy controls from general population. The body mass index, metabolic syndrome parameters, lipid parameters and high sensitive C-reactive protein were measured in both groups. Metabolic syndrome and dyslipidemia prevalence were assessed based on National Cholesterol Education Programme (NCEP) Adult Treatment Panel III (ATP III) guidelines. Results: The Schizophrenia subjects showed statistically significant high waist circumference, increased triglycerides and decreased HDL cholesterol values. The subjects also showed statistically significant increased hs-CRP values. The prevalence of metabolic syndrome and laboratory dyslipidemia were 28.8% and 51.1% respectively, which were higher compared to control group. Conclusion: The Schizophrenia subjects are at higher risk for cardiovascular disease events due to high prevalence of metabolic syndrome and dyslipidemia. These patients should be regularly monitored for CVD risk factors and timely referred to physician for further management.
Joshi, Kedar B.; Nillawar, Anup; Thorat, A.P.
Resveratrol is a naturally occurring polyphenol found in the skin of red grapes, peanuts, and red wine that has been shown to modify many cardiovascular risk factors. Small animal models have been extensively used to investigate cardiovascular disease, but the results often fail to translate in clinical trials. Disease-specific pig models are emerging as clinically useful tools that may offer insight into cardiovascular disease and the effect of drugs such as resveratrol on cardiovascular health. In this paper, we discuss the advantage of using clinically relevant pig models of diabetes, hypercholesterolemia, and myocardial ischemia to investigate the role of resveratrol in cardiovascular disease prevention. PMID:23855475
Elmadhun, Nassrene Y; Sabe, Ashraf A; Robich, Michael P; Chu, Louis M; Lassaletta, Antonio D; Sellke, Frank W
Cardiovascular diseases are the major cause of morbidity and mortality worldwide, and there is considerable interest in the role of dietary constituents and supplements in the prevention and treatment of these disorders. We reviewed the major publications related to potential effects on cardiovascular risk factors and outcomes of some common dietary constituents: carotenoids, flavonoid-rich cocoa, tea, red wine and grapes, coffee, omega-3 fatty acids, and garlic. Increased intake of some of these has been associated with reduced all-cause mortality or reduced incidence of myocardial infraction, stroke, and hypertension. However, although the evidence from observational studies is supportive of beneficial effects for most of these foodstuffs taken as part of the diet, potential benefits from the use of supplements derived from these natural products remain largely inconclusive.
Yang, Yaling; Chan, Sze Wa; Hu, Miao; Walden, Richard; Tomlinson, Brian
This article reviews literature pertinent to cardiovascular disparities in women, focusing primarily on heart failure (HF). It provides an in-depth look at causes, biological influences, self-management and lack of adherence to HF-treatment guidelines in women. Disparities in treatment of causative factors of HF, such as myocardial infarction and hypertension, contribute to women having poorer HF outcomes than men. This article discusses major contributing reasons for nonadherence to medication regimes for HF in women, including advanced age at time of diagnosis, likelihood of multiple comorbidities, lack of social support and low socioeconomic status. Limited inclusion of women in clinical trials and the scarcity of gender analyses for HF and other cardiovascular diseases continues to limit the applicability of research findings to women.
McSweeney, Jean; Pettey, Christina; Lefler, Leanne L; Heo, Seongkum
The past decade has seen substantial advances in cardiovascular pharmacogenomics. Genetic determinants of response to clopidogrel and warfarin have been defined, resulting in changes to the product labels for these drugs that suggest the use of genetic information as a guide for therapy. Genetic tests are available, as are guidelines for incorporation of genetic information into patient-care decisions. These guidelines and the literature supporting them are reviewed herein. Significant advances have also been made in the pharmacogenomics of statin-induced myopathy and the response to ?-blockers in heart failure, although the clinical applications of these findings are less clear. Other areas hold promise, including the pharmacogenomics of antihypertensive drugs, aspirin, and drug-induced long-QT syndrome (diLQTS). The potential value of pharmacogenomics in the discovery and development of new drugs is also described. In summary, pharmacogenomics has current applications in the management of cardiovascular disease, with clinically relevant data continuing to mount.
Johnson, JA; Cavallari, LH; Beitelshees, AL; Lewis, JP; Shuldiner, AR; Roden, DM
Patients with rheumatic diseases have an increased risk of mortality by cardiovascular events. In fact, several rheumatic diseases such as rheumatoid arthritis, osteoarthritis, systemic lupus erythematosus, and ankylosing spondylitis are associated with a higher prevalence of cardiovascular diseases (CVDs). Although traditional cardiovascular risk factors have been involved in the pathogenesis of cardiovascular diseases in rheumatic patients, these alterations do not completely explain the enhanced cardiovascular risk in this population. Obesity and its pathologic alteration of fat mass and dysfunction, due to an altered pattern of secretion of proinflammatory adipokines, could be one of the links between cardiovascular and rheumatic diseases. Indeed, the incidence of CVDs is augmented in obese individuals with rheumatic disorders. Thus, in this paper we explore in detail the relationships among adipokines, rheumatic diseases, and cardiovascular complications by giving to the reader a holistic vision and several suggestions for future perspectives and potential clinical implications.
Scotece, Morena; Conde, Javier; Gomez, Rodolfo; Lopez, Veronica; Pino, Jesus; Gonzalez, Antonio; Lago, Francisca; Gomez-Reino, Juan J.; Gualillo, Oreste
The basic reproduction number, R?, is probably the most important quantity in epidemiology. It is used to measure the transmission potential during the initial phase of an epidemic. In this paper, we are specifically concerned with the quantification of the spread of a disease modeled by a Markov chain. Due to the occurrence of repeated contacts taking place between a typical infective individual and other individuals already infected before, R? overestimates the average number of secondary infections. We present two alternative measures, namely, the exact reproduction number, Re0, and the population transmission number, Rp, that overcome this difficulty and provide valuable insight. The applicability of Re0 and Rp to control of disease spread is also examined. PMID:23620082
Artalejo, J R; Lopez-Herrero, M J
The objective of this study was to investigate cardiovascular autonomic function in patients with parkin disease. Ten patients with a genetically confirmed diagnosis were compared to 11 healthy controls. Symptoms related to autonomic dysfunction were collected by structured interviews. Cardiovascular autonomic reflex function was evaluated using a standard battery of eight tests. Autonomic tests included the study of sympathetic function through the analysis of blood pressure responses to head-up tilt, standing, isometric hand grip, cold pressor, mental arithmetic, Valsalva maneuver (Valsalva overshoot), and the study of parasympathetic function through the analysis of heart rate responses to deep breathing, hyperventilation, and Valsalva ratio. Seven out of 10 patients reported symptoms involving different aspects of autonomic function, while 5 out of 11 controls reported symptoms related exclusively to orthostatic dizziness and constipation. Symptoms related to bladder dysfunction were the most frequent autonomic abnormality occurring in six patients, followed by orthostatic dizziness and dry mouth (in four patients each). Constipation occurred in three patients, sialorrhea in two, and erectile dysfunction, dry eye, and warm intolerance in one each. Cardiovascular reflex testing revealed no difference between patients and controls in quantitative assessment of both sympathetic and parasympathetic functions, except for diastolic blood pressure after isometric hand grip that did not increase normally in parkin patients compared to controls (P = 0.007). These data show that cardiovascular dysautonomia is not associated to the parkin phenotype, whereas urinary complaints are more frequently reported by parkin patients than by controls. Urinary dysautonomia warrants further investigation in patients with parkin disease. PMID:17230469
Del Sorbo, Francesca; Elia, Antonio E; De Joanna, Gabriella; Romito, Luigi M; Garavaglia, Barbara; Albanese, Alberto
Ectopic fat accumulation in the liver causes nonalcoholic fatty liver disease (NAFLD), which is the most common cause of chronic liver disease in Western countries. Ectopic liver lipid, particularly diacylglycerol, exacerbates hepatic insulin resistance, promotes systemic inflammation, and increases risk of developing both type 2 diabetes mellitus and cardiovascular disease. Increasing evidence suggests that NAFLD is an emerging risk factor for cardiovascular disease, and although there are currently no licensed treatments for NAFLD per se, current evidence suggests that statin treatment is safe in NAFLD. Presently, there is insufficient evidence to indicate that statins or other cardioprotective agents, such as angiotensin receptor blockers, are effective in treating NAFLD. In this brief narrative review, we discuss the diagnosis of NAFLD and the role of ectopic liver fat to cause insulin resistance and to increase risk of both type 2 diabetes mellitus and cardiovascular disease. For this review, PubMed was searched for articles using the key words non-alcoholic fatty liver disease or fatty liver combined with diabetes risk, cardiovascular risk, and cardiovascular mortality between 1990 and 2014. Articles published in languages other than English were excluded. PMID:24743428
Byrne, Christopher D; Targher, Giovanni
Osteoporosis is the most common and serious age-related skeletal disorder, characterized by a low bone mass and bone microarchitectural deterioration, with a consequent increase in bone fragility and susceptibility to spontaneous fractures, and it represents a major worldwide health care problem with important implications for health care costs, morbidity and mortality. Today is well accepted that osteoporosis is a multifactorial disorder caused by the interaction between environment and genes that singularly exert modest effects on bone mass and other aspects of bone strength and fracture risk. The individuation of genetic factors responsible for osteoporosis predisposition and development is fundamental for the disease prevention and for the setting of novel therapies, before fracture occurrence. In the last decades the interest of the Scientific Community has been concentrated in the understanding the genetic bases of this disease but with controversial and/or inconclusive results. This review tries to summarize data on the most representative osteoporosis candidate genes. Moreover, since recently osteoporosis and cardiovascular diseases have shown to share common physiopathological mechanisms, this review also provides information on the current understanding of osteoporosis and cardiovascular diseases common genetic bases.
Marini, Francesca; Brandi, Maria Luisa
Progress in cardiovascular disease understanding and management continues at an exponential pace. Our understanding of the molecular basis of disease is enhanced by newer molecular measurement techniques, sophisticated models of physiological protein functions, understanding of the genetic foundation for diseases, and the incorporation of population genetic tools in our clinical analysis. In this review, I discuss prevention and therapy of coronary stenosis impeding coronary flows, prevention of acute and chronic manifestation of coronary flow impairment, and interfering with myocardial manifestation of acute or chronic deprivation of coronary flow. Mechanical heart failure and arrhythmias are common causes of myocardial dysfunction that originate, in part, from the loss of myocardial tissue and function. Techniques for interfering with cardiac function, in order to address the molecular mechanisms associated with restenosis, range from pharmacologic to mechanical procedures including mechanical dilation and scaffolding of coronary stenosis. The use of stents with and without drug coating is leading the clinical world of revascularization side-by-side with cardiac bypass surgery. Other topics that are discussed here include managing myocardial damage and acute and chronic pump failure. Finally, population genetics of cardiac health and the potential for genetic therapeutic guidance in managing ischemic cardiovascular diseases are discussed. PMID:18375595
DNA sequence variants (DSVs) are major components of the “causal field” for virtually all-medical phenotypes, whether single-gene familial disorders or complex traits without a clear familial aggregation. The causal variants in single gene disorders are necessary and sufficient to impart large effects. In contrast, complex traits are due to a much more complicated network of contributory components that in aggregate increase the probability of disease. The conventional approach to identification of the causal variants for single gene disorders is genetic linkage. However, it does not offer sufficient resolution to map the causal genes in small size families or sporadic cases. The approach to genetic studies of complex traits entails candidate gene or Genome Wide Association Studies (GWAS). GWAS provides an unbiased survey of the effects of common genetic variants (common disease - common variant hypothesis). GWAS have led to identification of a large number of alleles for various cardiovascular diseases. However, common alleles account for a relatively small fraction of the total heritability of the traits. Accordingly, the focus has shifted toward identification of rare variants that might impart larger effect sizes (rare variant-common disease hypothesis). This shift is made feasible by recent advances in massively parallel DNA sequencing platforms, which afford the opportunity to identify virtually all common as well as rare alleles in individuals. In this review, we discuss various strategies that are used to delineate the genetic contribution to medically important cardiovascular phenotypes, emphasizing the utility of the new deep sequencing approaches.
Marian, A.J.; Belmont, John
Cognitive function decline secondary to cardiovascular disease has been reported. However, little is known about the impact of coronary artery disease (CAD) on the aging brain macrostructure or whether exercise training, in the context of cardiovascular rehabilitation, can affect brain structure following a coronary event. This study employed voxel-based morphometry of high resolution structural MRI images to investigate; 1) changes in regional gray matter volume (GMV) in CAD patients compared to age-matched controls, and 2) the effects of a six-month exercise-based cardiovascular rehabilitation program on CAD-related GMV decline. Compared to controls, significant decreases in regional GMV were found in the superior, medial and inferior frontal gyrus; superior and inferior parietal gyrus; middle and superior temporal gyrus and in the posterior cerebellum of CAD patients. Cardiovascular rehabilitation was associated with the recovery of regional GMV in the superior frontal gyrus, superior temporal gyrus and posterior cerebellum of the CAD patients as well as the increase in GMV in the supplementary motor area. Total and regional GMV correlated with fitness level, defined by the maximal oxygen consumption (VO2max), at baseline but not after cardiovascular rehabilitation. This study demonstrates that cardiovascular disease can adversely affect age-related decline in GMV; and that these disease-related effects could be mitigated by moderate levels of exercise training as part of cardiovascular rehabilitation.
Anazodo, U.C.; Shoemaker, J.K.; Suskin, N.; St. Lawrence, K.S.
\\u000a Coronary artery disease is common in chronic kidney disease (CKD) and dialysis patients. There is strong evidence that kidney\\u000a disease is an independent risk factor for atherosclerosis. In addition, traditional risk factors such as obesity, hypertension\\u000a and diabetes, as well as nontraditional factors such as inflammation and oxidative stress, likely contribute to the excess\\u000a risk of atherosclerosis in CKD. It
Hematopoietic cell transplantation (HCT) recipients may be at an increased risk of developing hypertension, diabetes, and dyslipidemia (referred to as cardiovascular risk factors [CVRFs]); and these factors can potentially increase the risk of cardiovascular disease (CVD). We examined the incidence and predictors of CVRFs and subsequent CVD in 1885 consecutive 1+year survivors of HCT performed at City of Hope between 1995 and 2004. Ten-year cumulative incidence of hypertension, diabetes, dyslipidemia, and multiple (? 2) CVRFs was 37.7%, 18.1%, 46.7%, and 31.4%, respectively. The prevalence of CVRFs was significantly higher among HCT recipients compared with the general population; contributed to largely by allogeneic HCT recipients. Older age and obesity at HCT were associated with increased risk of CVRFs. History of grade II-IV acute graft versus host disease was associated with an increased risk for hypertension (relative risk [RR] = 9.1, P < .01), diabetes (RR = 5.8, P < .01), and dyslipidemia (RR = 3.2, P < .01); conditioning with total body irradiation was associated with an increased risk of diabetes (RR = 1.5, P = .01) and dyslipidemia (RR = 1.4, P < .01). There was an incremental increase in 10-year incidence of CVD by number of CVRFs (4.7% [none], 7.0% [1 CVRF], 11.2% [? 2 CVRFs], P < .01); the risk was especially high (15.0%) in patients with multiple CVRFs and pre-HCT exposure to anthracyclines or chest radiation. PMID:23034279
Armenian, Saro H; Sun, Can-Lan; Vase, Tabitha; Ness, Kirsten K; Blum, Emily; Francisco, Liton; Venkataraman, Kalyanasundaram; Samoa, Raynald; Wong, F Lennie; Forman, Stephen J; Bhatia, Smita
Detection of Chronic Kidney Disease in Patients With or at Increased Risk of Cardiovascular Disease: A Science Advisory From the American Heart Association Kidney and Cardiovascular Disease Council; the Councils on High Blood Pressure Research, Cardiovascular Disease in the Young, and Epidemiology and Prevention; and the Quality of Care and Outcomes Research Interdisciplinary Working Group: Developed in Collaboration With the National Kidney Foundation
Chronic kidney disease (CKD) occurs commonly in patients with cardiovascular disease. In addition, CKD is a risk factor for the development and progression of cardiovascular disease. In this advisory, we present recommen- dations for the detection of CKD in patients with cardiovascular disease. CKD can be reliably detected with the combined use of the Modification of Diet in Renal Disease
Frank C. Brosius III; Thomas H. Hostetter; Ellie Kelepouris; Mark M. Mitsnefes; Sharon M. Moe; Michael A. Moore; Subramaniam Pennathur; Grace L. Smith; Peter W. F. Wilson
Many studies have demonstrated that women are substantially underrepresented in cardiovascular trials, but few have considered that women develop cardiovascular disease at older ages than men. The extent to which observed gender enrollment inequalities persist after accounting for age-gender differences in disease prevalence is unknown. The purpose of the study was to compare observed rates of women participating in cardiovascular clinical trials with expected rates of female participation based on age- and gender-specific population disease prevalence. Publications between 1997 and 2009 in the three leading medical journals were included to calculate observed women's enrollment rates. Population-based data in Canada were used to determine the expected enrollment rates of women. Multicenter, randomized cardiovascular clinical trials that enrolled both men and women were analyzed. Two reviewers independently extracted data on women's enrollment and important clinical trial characteristics. The female enrollment rate was 30% in the included 325 trials, which ranged from 27% in trials of coronary artery disease, 27% in heart failure, 31% in arrhythmia, to 45% in primary prevention. Increased female enrollment correlated strongly with increasing age at recruitment in cardiovascular clinical trials (P?0.001). After accounting for age- and gender-specific differences in disease prevalence, gaps in female enrollment were much lower than the expected enrollment rates estimated by 5% in coronary artery disease, 13% in heart failure, 9% in arrhythmia, and 3% in primary prevention. Only cardiovascular trials were evaluated in our study. Female underrepresentation in cardiovascular clinical trials is smaller than conventionally believed after accounting for age- and gender-specific population disease prevalence. Our findings suggest that greater representation of women in cardiovascular clinical trials can be achieved through the recruitment of older populations. PMID:21713543
Tsang, Wendy; Alter, David A; Wijeysundera, Harindra C; Zhang, Tony; Ko, Dennis T
Accelerated atherosclerosis and arterial stiffness are the two leading causes of increased cardiovascular disease in patients with chronic kidney disease. Dysfunctional thyroid hormone metabolism has been suggested to play a role in atherosclerosis and arterial stiffness. Changes in cardiac contractility and output, myocardial oxygen demand, systemic and peripheral vascular resistance, blood pressure and lipid profile, increased inflammatory burden and endothelial dysfunction may be responsible for thyroid hormone-related cardiovascular disease. This article focuses on the mechanistic insights of this association and provides a concise review of the current literature. PMID:23206977
Tatar, Erhan; Kircelli, Fatih; Ok, Ercan
Peripheral arterial disease (PAD) in the legs, measured noninvasively by the ankle-arm index (AAI) is associated with clinically manifest cardiovascular disease (CVD) and its risk factors. To determine risk of total mortality, coronary heart disease, or stroke mortality and incident versus recurrent CVD associated with a low AAI, we examined the relationship of the AAI to subsequent CVD events in
Anne B. Newman; Lynn Shemanski; Teri A. Manolio; Mary Cushman; Maurice Mittelmark; Joseph F. Polak; Neil R. Powe; David Siscovick
Background Because of its polygenic nature, Alzheimer's disease is believed to be caused not by defects in single genes, but rather by variations in a large number of genes and their complex interactions. A systems biology approach, such as the generation of a network of co-expressed genes and the identification of functional modules and cis-regulatory elements, to extract insights and knowledge from microarray data will lead to a better understanding of complex diseases such as Alzheimer's disease. In this study, we perform a series of analyses using co-expression networks, cis-regulatory elements, and functions of co-expressed gene modules to analyze single-cell gene expression data from normal and Alzheimer's disease-affected subjects. Results We identified six co-expressed gene modules, each of which represented a biological process perturbed in Alzheimer's disease. Alzheimer's disease-related genes, such as APOE, A2M, PON2 and MAP4, and cardiovascular disease-associated genes, including COMT, CBS and WNK1, all congregated in a single module. Some of the disease-related genes were hub genes while many of them were directly connected to one or more hub genes. Further investigation of this disease-associated module revealed cis-regulatory elements that match to the binding sites of transcription factors involved in Alzheimer's disease and cardiovascular disease. Conclusion Our results show the extensive links between Alzheimer's disease and cardiovascular disease at the co-expression and co-regulation levels, providing further evidence for the hypothesis that cardiovascular disease and Alzheimer's disease are linked. Our results support the notion that diseases in which the same set of biochemical pathways are affected may tend to co-occur with each other.
Ray, Monika; Ruan, Jianhua; Zhang, Weixiong
Objectives Pre?existing conditions have been postulated as possible causes of the J?shaped relationship between alcohol intake and cardiovascular disease. Two research questions have been addressed in this paper. First, whether never drinkers and former drinkers differ from moderate drinkers in terms of health, and if so, which health problems contribute to this difference. Second, whether the U?shaped relationship between current alcohol intake and cardiovascular disease or all?cause mortality could in part be explained by difference in pre?existing disease burden. Design, setting and participants A prospective case?cohort, the Lifestyle and Health Study, consisting of 16?210 men and women aged between 45 and 70?years. Alcohol intake and risk factors were assessed at baseline with a self?administered questionnaire. Medical information was obtained from general practitioners. Cardiovascular events and mortality were followed for a period of 5?years (1996–2001). Main results Never drinkers and former drinkers were less healthy than moderate drinkers. They rated their health more often as poor, and often had more diseases, such as cardiovascular disease, diabetes, and also alcohol?related diseases. The difference in disease burden did not change the observed relationship between alcohol intake and cardiovascular events, and only partially changed the U?shaped relationship between alcohol intake and all?cause mortality. Conclusions The found difference in health between never drinkers and former drinkers compared with moderate drinkers appeared to be only a partial explanation of the observed relationships between alcohol intake and cardiovascular disease, and between alcohol intake and all?cause mortality.
Friesema, I H M; Zwietering, P J; Veenstra, M Y; Knottnerus, J A; Garretsen, H F L; Lemmens, P H H M
The past decade has seen tremendous advances in our understanding of the genetic factors influencing response to a variety of drugs, including those targeted at treatment of cardiovascular diseases. In the case of clopidogrel, warfarin, and statins, the literature has become sufficiently strong that guidelines are now available describing the use of genetic information to guide treatment with these therapies, and some health centers are using this information in the care of their patients. There are many challenges in moving from research data to translation to practice; we discuss some of these barriers and the approaches some health systems are taking to overcome them. The body of literature that has led to the clinical implementation of CYP2C19 genotyping for clopidogrel, VKORC1, CYP2C9; and CYP4F2 for warfarin; and SLCO1B1 for statins is comprehensively described. We also provide clarity for other genes that have been extensively studied relative to these drugs, but for which the data are conflicting. Finally, we comment briefly on pharmacogenetics of other cardiovascular drugs and highlight ?-blockers as the drug class with strong data that has not yet seen clinical implementation. It is anticipated that genetic information will increasingly be available on patients, and it is important to identify those examples where the evidence is sufficiently robust and predictive to use genetic information to guide clinical decisions. The review herein provides several examples of the accumulation of evidence and eventual clinical translation in cardiovascular pharmacogenetics.
Cavallari, Larisa H.
The cardiovascular continuum describes the progression of pathophysiologic events from cardiovascular risk factors to symptomatic cardiovascular disease (CVD) and life-threatening events. Pharmacologic intervention early in the continuum may prevent or slow CVD development and improve quality of life. The renin-angiotensin-aldosterone system (RAAS) is central to the pathophysiology of CVD at many stages of the continuum. Numerous clinical trials of angiotensin converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) have shown that RAAS blockade provides benefits to patients across the continuum. ARBs are as effective as ACE inhibitors in the treatment of hypertension; however tolerability and adherence to therapy appear to be improved with ARBs. Large clinical trials have shown that ARBs may provide therapeutic benefits beyond blood pressure control in patients with diabetes, heart failure or at risk of heart failure following a myocardial infarction. In addition, ARBs have been shown to provide protective effects in patients with impaired renal function or left ventricular hypertrophy. Additional clinical trials are ongoing to further characterize the role of ARBs in CVD management. PMID:16915347
Maggioni, Aldo P
The past decade has seen tremendous advances in our understanding of the genetic factors influencing response to a variety of drugs, including those targeted at treatment of cardiovascular diseases. In the case of clopidogrel, warfarin, and statins, the literature has become sufficiently strong that guidelines are now available describing the use of genetic information to guide treatment with these therapies, and some health centers are using this information in the care of their patients. There are many challenges in moving from research data to translation to practice; we discuss some of these barriers and the approaches some health systems are taking to overcome them. The body of literature that has led to the clinical implementation of CYP2C19 genotyping for clopidogrel, VKORC1, CYP2C9; and CYP4F2 for warfarin; and SLCO1B1 for statins is comprehensively described. We also provide clarity for other genes that have been extensively studied relative to these drugs, but for which the data are conflicting. Finally, we comment briefly on pharmacogenetics of other cardiovascular drugs and highlight ?-blockers as the drug class with strong data that has not yet seen clinical implementation. It is anticipated that genetic information will increasingly be available on patients, and it is important to identify those examples where the evidence is sufficiently robust and predictive to use genetic information to guide clinical decisions. The review herein provides several examples of the accumulation of evidence and eventual clinical translation in cardiovascular pharmacogenetics. PMID:23686351
Johnson, Julie A; Cavallari, Larisa H
OBJECTIVE: Survey of physician attitudes toward practising cardiovascular disease prevention. DESIGN: Questionnaire administered via telecommunication from 1992 through 1994. SETTING: The FAMUS (Family Medicine, University of Sherbrooke) project, between 1992 and 1996, used weekly telecommunication to collect data from 200 general practitioners throughout the province of Quebec on cardiovascular disease risk factors and their treatment. PARTICIPANTS: Of 200 physicians contributing to the FAMUS project, 156 completed questionnaires (response rate 78%). MAIN OUTCOME MEASURES: Variations in attitudes to prevention policy and risk factor interventions. RESULTS: Survey results revealed physicians knew important risk factors for cardiovascular disease but differed in attitudes toward efficacy of treatment. Intervention to control cholesterol was thought to be very effective by 21.2% (95% confidence interval [CI] 21.2 +/- 6.4) and without effect by 10.3% (95% CI 10.3 +/- 4.8). Intervention to improve dietary habits was considered ineffective by 48.1% (95% CI 48.1 +/- 7.8). Confidence in managing risk factors varied; most respondents described themselves as only moderately skilled. A few practitioners (30.1%; 95% CI 30.1 +/- 7.2) acknowledged practice guidelines as an important source of information on which to base preventive interventions. Only 14.7% (95% CI 14.7 +/- 5.6) of those surveyed included remuneration as contributing to their implementation of prevention activities in practice. CONCLUSIONS: Variations in physician attitudes could influence risk factor intervention. Interventions to change lifestyle are associated with uncertainty about patient compliance, efficacy of treatment, and ability to effect lifestyle changes.
Grant, A. M.; Niyonsenga, T.; Dion, I.; Delisle, E.; Xhignesse, M.; Bernier, R.
Alcohol is a commonly used drug worldwide. Epidemiological studies have identified alcohol consumption as a factor that may either positively or negatively influence many diseases including cardiovascular disease, certain cancers and dementia. Often there seems to be a differential effect of various drinking patterns, with frequent moderate consumption of alcohol being salutary and binge drinking or chronic abuse being deleterious to one’s health. A better understanding of the cellular and molecular mechanisms mediating the many effects of alcohol consumption is beginning to emerge, as well as a clearer picture as to whether these effects are due to the direct actions of alcohol itself, or caused in part by its metabolites, e.g., acetaldehyde, or by incidental components present in the alcoholic beverage (e.g., polyphenols in red wine). This review will discuss evidence to date as to how alcohol (ethanol) might affect atherosclerosis that underlies cardiovascular and cerebrovascular disease, and the putative mechanisms involved, focusing on vascular endothelial and smooth muscle cell effects.
Cahill, Paul A.; Redmond, Eileen M.
Hutchinson-Gilford Progeria Syndrome (HGPS), a rare human disease characterized by premature aging, is mainly caused by the abnormal accumulation of progerin, a mutant form of the mammalian nuclear envelope component lamin A. HGPS patients exhibit vascular alterations and die at an average age of 13 years, predominantly from myocardial infarction or stroke. Animal models of HGPS have been a valuable tool in the study of the pathological processes implicated in the origin of this disease and its associated cardiovascular alterations. Some of the molecular mechanisms of HGPS might be relevant to the process of normal aging, since progerin is detected in cells from normal elderly humans. Conversely, processes linked to normal aging, such as the increase in oxidative stress, might be relevant to the pathogenic mechanisms of HGPS. In this review, we discuss recent advances in the understanding of the molecular mechanisms underlying the cardiovascular alterations associated with HGPS, the potential role of oxidative stress, and therapeutic approaches for the treatment of this devastating disease. PMID:21622271
Trigueros-Motos, Laia; Gonzalez, Jose M; Rivera, Jose; Andres, Vicente
The docking proteins of the Grb2-associated binder (Gab) family have emerged as crucial signaling compartments in metazoans. In mammals, the Gab proteins, consisting of Gab1, Gab2, and Gab3, are involved in the amplification and integration of signal transduction evoked by a variety of extracellular stimuli, including growth factors, cytokines, antigens, and other molecules. Gab proteins lack the enzymatic activity themselves; however, when phosphorylated on tyrosine residues, they provide binding sites for multiple Src homology-2 (SH2) domain-containing proteins, such as SH2-containing protein tyrosine phosphatase 2 (SHP2), phosphatidylinositol 3-kinase regulatory subunit p85, phospholipase C?, Crk, and GC-GAP. Through these interactions, the Gab proteins transduce signals from activated receptors into pathways with distinct biological functions, thereby contributing to signal diversification. They are known to play crucial roles in numerous physiological processes through their associations with SHP2 and p85. In addition, abnormal Gab protein signaling has been linked to human diseases including cancer, cardiovascular disease, and inflammatory disorders. In this paper, we provide an overview of the structure, effector functions, and regulation of the Gab docking proteins, with a special focus on their associations with cardiovascular disease, cancer, and inflammation.
Nakaoka, Yoshikazu; Komuro, Issei
The associations linking endothelial inflammation, endothelial oxidative stress, and atherogenesis and the potential for dietary phytonutrients to decrease the impact of these associations were assessed. A detailed literature review was conducted and summarized. A large body of scientific evidence describes the interactions among endothelial inflammation, endothelial oxidative stress, and atherogenesis. A growing body of research indicates that several dietary phytonutrients (astaxanthin, lycopene, lutein, and glabridin) can decrease the risk for atherosclerosis by decreasing endothelial inflammation and oxidative stress. The consumption of foods or dietary supplements that provide astaxanthin, lycopene, lutein, and glabridin can ameliorate endothelial inflammation and oxidative stress, retard atherogenesis, and decrease the risk for atherogenic cardiovascular disease. PMID:22480801
Riccioni, Graziano; Speranza, Lorenza; Pesce, Mirko; Cusenza, Salvatore; D'Orazio, Nicolantonio; Glade, Michael J
The endothelium, which forms the inner cellular lining of blood vessels and lymphatics, is a highly metabolically active organ that is involved in many physiopathological processes, including the control of vasomotor tone, barrier function, leukocyte adhesion, and trafficking and inflammation. In this review, we summarized and described the following: (i) endothelial cell function in physiological conditions and (ii) endothelial cell activation and dysfunction in the main cardiovascular diseases (such as atherosclerosis, and hypertension) and to diabetes, cigarette smoking, and aging physiological process. Finally, we presented the currently available evidence that supports the beneficial effects of physical activity and various dietary compounds on endothelial functions. PMID:24719887
Favero, Gaia; Paganelli, Corrado; Buffoli, Barbara; Rodella, Luigi Fabrizio; Rezzani, Rita
Diuretics are used extensively in hospitals and in community medical practice for the management of cardiovascular diseases. They are used frequently as the first line treatment for mild to moderate hypertension and are an integral part of the management of symptomatic heart failure. Although diuretics have been used for several decades, there is still some ambiguity and confusion regarding the optimal way of using these common drugs. In this paper, the classes and action of diuretics are reviewed, and the various indications, optimal doses, and recommendations on the effective use of these agents are discussed.
Shah, S; Anjum, S; Littler, W
The endothelium, which forms the inner cellular lining of blood vessels and lymphatics, is a highly metabolically active organ that is involved in many physiopathological processes, including the control of vasomotor tone, barrier function, leukocyte adhesion, and trafficking and inflammation. In this review, we summarized and described the following: (i) endothelial cell function in physiological conditions and (ii) endothelial cell activation and dysfunction in the main cardiovascular diseases (such as atherosclerosis, and hypertension) and to diabetes, cigarette smoking, and aging physiological process. Finally, we presented the currently available evidence that supports the beneficial effects of physical activity and various dietary compounds on endothelial functions.
Paganelli, Corrado; Buffoli, Barbara; Rodella, Luigi Fabrizio; Rezzani, Rita
Epidemic typhus is transmitted to human beings by the body louse Pediculus humanus corporis. The disease is still considered a major threat by public-health authorities, despite the efficacy of antibiotics, because poor sanitary conditions are conducive to louse proliferation. Until recently, Rickettsia prowazekii, the causal agent, was thought to be confined to human beings and their body lice. Since 1975, R prowazekii infection in human beings has been related to contact with the flying squirrel Glaucomys volans in the USA. Moreover, Brill-Zinsser disease, a relapsed form of epidemic typhus that appears as sporadic cases many years after the initial infection, is unrelated to louse infestation. Stress or a waning immune system are likely to reactivate this earlier persistent infection, which could be the source of new epidemics when conditions facilitate louse infestation. Finally, R prowazekii is a potential category B bioterrorism agent, because it is stable in dried louse faeces and can be transmitted through aerosols. An increased understanding of the pathogenesis of epidemic typhus may be useful for protection against this bacterial threat. PMID:18582834
Bechah, Yassina; Capo, Christian; Mege, Jean-Louis; Raoult, Didier
Cardiovascular disease (CVD) remains the most common cause of premature death in the chronic kidney disease (CKD) population. Individuals with CKD are at 10-20 times greater risk of cardiac death than controls without CKD, despite stratification for age, race, sex and diabetes. Heightened CVD mortality begins with mild kidney disease and rises further with more advanced kidney disease. Traditional risk factors account for up to 50% of cardiovascular disease in CKD, whilst renal specific markers, including anemia, disordered bone mineral metabolism and oxidative stress, also likely contribute to the total cardiovascular burden in CKD. Despite the increased mortality, there has been a dearth of interventional cardiovascular randomized controlled trials (RCTs) in the CKD population. Furthermore, many patients with kidney disease have been excluded from the majority of mainstream cardiovascular interventional trials. While recently published RCTs on traditional and non-traditional risk factors including dyslipidemia (PPP, 4D and ALERT, VA-HIT), cardiomyopathy (FOSIDIAL, telmisartan, carvedilol), anemia (US Normal Hematocrit, CHOIR and CREATE trials), hyperhomocystenemia (ASFAST, US folic acid trial, HOST), disordered bone mineral metabolism (Cunningham meta-analysis, DCOR), oxidative stress therapy (SPACE, HOPE and ATIC, N-acetylcysteine) and multidisciplinary multiple cardiovascular risk factor intervention clinics (LANDMARK) have added to the available pool of clinical data, level 1 clinical evidence remains significantly lacking. The negative findings in many of these trials highlight the potential dangers of extrapolating findings from non kidney disease patients to those with CKD. Further large, well-designed trials are urgently required to address this issue. PMID:17912225
Kaisar, M; Isbel, N; Johnson, D W
Most mathematical models of plant disease epidemics ignore the growth and phenology of the host crop. Unfortunately, reports of disease development are often not accompanied by a simultaneous and commensurate evaluation of crop development. However, the time scale for increases in the leaf area of field crops is comparable to the time scale of epidemics. This simultaneous development of host and pathogen has many ramifications on the resulting plant disease epidemic. First, there is a simple dilution effect resulting from the introduction of new healthy leaf area with time. Often, measurements of disease levels are made pro rata (per unit of host leaf area or total root length or mass). Thus, host growth will reduce the apparent infection rate. A second, related effect, has to do with the so-called "correction factor," which accounts for inoculum falling on already infected tissue. This factor accounts for multiple infection and is given by the fraction of the host tissue that is susceptible to disease. As an epidemic develops, less and less tissue is open to infection and the initial exponential growth slows. Crop growth delays the impact of this limiting effect and, therefore, tends to increase the rate of disease progress. A third and often neglected effect arises when an increase in the density of susceptible host tissue results in a corresponding increase in the basic reproduction ratio, R(0), defined as the ratio of the total number of daughter lesions produced to the number of original mother lesions. This occurs when the transport efficiency of inoculum from infected to susceptible host is strongly dependent on the spatial density of plant tissue. Thus, crop growth may have a major impact on the development of plant disease epidemics occurring during the vegetative phase of crop growth. The effects that these crop growth-related factors have on plant disease epidemics spread by airborne spores are evaluated using mathematical models and their importance is discussed. In particular, plant disease epidemics initiated by the introduction of inoculum during this stage of development are shown to be relatively insensitive to the time at which inoculum is introduced. PMID:18943216
Ferrandino, F J
We consider an SIR epidemic model with discontinuous treatment strategies. Under some reasonable assumptions on the discontinuous treatment function, we are able to determine the basic reproduction number R?, confirm the well-posedness of the model, describe the structure of possible equilibria as well as establish the stability/instability of the equilibria. Most interestingly, we find that in the case that an equilibrium is asymptotically stable, the convergence to the equilibrium can actually be achieved in finite time, and we can estimate this time in terms of the model parameters, initial sub-populations and the initial treatment strength. This suggests that from the view point of eliminating the disease from the host population, discontinuous treatment strategies would be superior to continuous ones. The methods we use to obtain the mathematical results are the generalized Lyapunov theory for discontinuous differential equations and some results on non-smooth analysis. PMID:22229398
Guo, Zhenyuan; Huang, Lihong; Zou, Xingfu
Background: There is conflicting evidence regarding the relationship between iron stores and cardiovascular disease (CVD). The present study aimed to investigate the association between body iron indices and some cardiovascular risk factors. Methods: In a case–control study conducted in the south of Shiraz, Iran, we determined ferritin, iron, total iron binding capacity (TIBC), metabolic risk factors, C-reactive protein (CRP), and anthropometric measurements in 100 men aged 45 years and higher with newly diagnosed CVD and 100 adjusted controls without evidence for CVD. Results: The mean of low density lipoprotein (LDL-c), CRP, and ferritin concentrations were significantly higher in cases than controls, and high density lipoprotein (HDL-c) was significantly lower in cases than controls. Pearson correlation coefficient between CRP and the other risk factors in case group showed that only ferritin, serum iron, waist circumference, and LDL-c significantly correlated with CRP (r = 0.32 with P < 0.001, r = 0.29 with P < 0.05, r = 0.41 with P < 0.01, and r = 0.36 with P < 0.001, respectively). Conclusions: This study indicated an association between a positive balance of body iron and CVD. Hence, caution should be exercised in administration of iron supplements to patients with CVD and in consumption of food rich in iron by them.
Eftekhari, Mohammad Hassan; Mozaffari-Khosravi, Hassan; Shidfar, Farzad; Zamani, Atefeh
Objectives To assess the effects of suffering in a spouse on prevalent and incident psychiatric (depression) and physical morbidity (cardiovascular disease, CVD) in their partner, controlling for known risk factors for depression and CVD. Design Descriptive longitudinal study. Participants 1330 older married couples enrolled in the Cardiovascular Health Study (CHS), a large epidemiologic study of the elderly. Measurements Predictor variables were physical, psychological, and existential/spiritual indicators of suffering. Primary outcomes were prevalent and incident depression and CVD. Results Controlling for known risk factors for depression, we found a dose-response relationship between suffering in a spouse and concurrent depression in their partner as well as a relationship between suffering and the partner’s future risk for depression. With respect to CVD, and controlling for sub-clinical CVD at baseline, husbands whose wives reported high levels of suffering also had higher rates of prevalent CVD, b