Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0004153 (atherosclerosis)
 77,401 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Persistent inappropriate blood pressure elevation leads to the development of left ventricular hypertrophy, progressive atherosclerosis, and structural changes in the arterial tree. These changes result in clinical manifestations such as ischemic cardiac and cerebral events, congestive heart failure, renal failure, and peripheral vascular insufficiency. This article reviews the 5-year course of 439 patients with primary hypertension who were seen at a time (1946-1953) when potent antihypertensive therapy was not widely used. At the end of 5 years, 55% of the men (78 of 143) and 28% of the women (83 of 296) were dead. The principal causes of death were coronary insufficiency, congestive heart failure, cerebral infarction and hemorrhage, accelerated hypertension, renal failure, and dissecting aneurysm of the aorta. Coronary insufficiency and accelerated hypertension predominated in men, whereas women died principally of cerebral events and congestive heart failure. The 439 patients were stratified according to the level of their office blood pressure on the first visit, the severity of the changes in the optic fundi, the degree of left ventricular hypertrophy determined by electrocardiogram, cardiac enlargement determined by roentgenogram and their renal function, as measures of end-organ damage. Patients who had higher initial blood pressures showed more evidence of end-organ damage than patients with lower initial pressures. The higher the initial blood pressure or the more advanced the evidence of end-organ damage, the greater was the 5-year mortality. The mortality was particularly high in patients who had already sustained a clinical cardiovascular event before entry into the study and in those with malignant hypertension or gross cardiomegaly.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Retrospective and prospective research on hypertension-related end-organ damage. 760 71

Endothelin is the most potent mammalian vasoconstrictor yet discovered. Its three isoforms play leading roles in regulating vascular tone and causing mitogenesis. The isoforms bind to two major receptor subtypes (ETA and ETB), which mediate a wide variety of physiologic actions in several organ systems. Endothelin may also be a disease marker or an etiologic factor in ischemic heart disease, atherosclerosis, congestive heart failure, renal failure, myocardial and vascular wall hypertrophy, systemic hypertension, pulmonary hypertension, and subarachnoid hemorrhage. Specific and nonspecific receptor antagonists and ECE inhibitors that have been developed interfere with endothelin's function. Many available cardiovascular therapeutic agents, such as angiotensin-converting-enzyme inhibitors, calcium-entry blocking drugs, and nitroglycerin, also may interfere with endothelin release or may modify its activity. The endothelin antagonists have great potential as agents for use in the treatment of a wide spectrum of disease entities and as biologic probes for understanding the actions of endothelin in human beings.
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PMID:Endothelin and endothelin antagonism: roles in cardiovascular health and disease. 766 Oct 79

The purpose of this study was to identify factors from simple past medical history which could alert surgeons to patients at increased risk of postoperative complications. Five hundred and fourteen patients undergoing elective surgery were studied prospectively. Factors evaluated included the patients' age, gender, race and the presence in the past medical history of coronary artery disease, congestive heart failure, cardiac dysrhythmias, respiratory disease, endocrine disease, peripheral atherosclerosis, renal disease, neuropsychiatric disease, hypertension, diabetes mellitus, prior major surgery and prior or active malignancy. All complications were recorded. The data were analysed by univariate and multivariate statistical methods. Gender, race and age were not associated with any complications. Coronary artery disease, respiratory disease, atherosclerotic peripheral vascular disease, neuropsychiatric disease, malignancy, the absence of prior major surgery, hypertension and diabetes mellitus were associated with specific postoperative complications by univariate analysis. Malignancy, diabetes mellitus, peripheral atherosclerosis, coronary artery disease, neuropsychiatric disease, renal disease and respiratory disease were independent predictors of complications as determined by multivariate analysis. Of interest is the phenomenon that the risk of postoperative complications when a combination of risk factors was present was greater than what would be predicted by the cumulative risk of these factors. This study helps identify those patients which by simple history may be at increased risk of postoperative complications and may require aggressive preoperative evaluation.
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PMID:The effects of age, gender, race and concomitant disease on postoperative complications. 769 33

Antihypertensive therapy has been used for almost 40 years to reduce blood pressure and to prevent morbidity and mortality related to the hypertensive state. Cardiovascular events are related to the initial elevation of blood pressure; the benefits of treating malignant, severe or moderate hypertension are well established. Although large scale clinical trials have demonstrated a decrease in morbid events when mildly elevated blood pressures is treated, the benefits are neither universal or dramatic and treatment is certainly less cost effective than no treatment. Recently it has been emphasised that the absolute risk of cardiovascular events is determined only in part by blood pressure, and that it is also influenced by age, gender, race and the presence of other cardiovascular risk factors. For example, in older individuals where the absolute risk of vascular complications is greater than in younger individuals for any given level of blood pressure, the benefits of therapy will be greater. It has been suggested that in younger individuals with mild hypertension and a low absolute risk of developing cardiovascular morbid events it may be more appropriate to monitor the effects of drug therapy on measures of cardiac and vascular damage that are associated with the hypertensive state. Drug therapy has been shown to be extremely effective in reducing the incidence of stroke, congestive cardiac failure and renal failure associated with elevated blood pressure. Meta-analysis of randomised large scale clinical trials indicates that drug therapy may not reduce coronary events to the extent expected in patients with hypertension. One plausible explanation is that the trials have been of insufficient duration to detect the benefit of blood pressure lowering on coronary heart disease. It has also been suggested that certain adverse metabolic effects associated with the use of thiazide diuretics and beta-blockers employed in these trials may have partially offset the benefits of blood pressure reduction. However, the clinical significance of these drug-induced metabolic disturbances remains unclear. Experimental data suggesting differences in the ability of antihypertensive drugs to inhibit atherosclerosis in animal models are also of interest, but again the relation of the findings to the clinical situation is unknown. Thiazide diuretics, beta-blockers, calcium antagonists, angiotensin-converting enzyme (ACE) inhibitors and alpha-blockers can produce regression of left ventricular hypertrophy (LVH). While LVH is clearly a strong and independent predictor for coronary disease, it remains to be shown that a lower risk for coronary morbid events exists in patients whose LVH has undergone regression over and above that attributable to blood pressure reduction.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Goals of antihypertensive therapy. 772 25

The present investigation was designed to evaluate whether end-stage cardiac failure in patients affected by dilated cardiomyopathy (DC) was dependent upon extensive myocyte cell death with reduction in muscle mass or was the consequence of collagen accumulation in the myocardium independently from myocyte cell loss. In addition, the mechanisms of ventricular dilation were analysed in order to determine whether the changes in cardiac anatomy were important variables in the development of intractable congestive heart failure. DC is characterized by chamber dilation, myocardial scarring and myocyte hypertrophy in the absence of significant coronary atherosclerosis. However, the relative contribution of each of these factors to the remodeling of the ventricle is currently unknown. Moreover, no information is available concerning the potential etiology of collagen deposition in the myocardium and the changes in number and size of ventricular myocytes with this disease. Morphometric methodologies were applied to the analysis of 10 DC hearts obtained from patients undergoing cardiac transplantation. An identical number of control hearts was collected from individuals who died from causes other than cardiovascular diseases. DC produced a 2.2-fold and 4.2-fold increase in left ventricular weight and chamber volume resulting in a 48% reduction in mass-to-volume ratio. In the right ventricle, tissue weight and chamber size were both nearly doubled. Left ventricular dilation was the result of a 59% lengthening of myocytes and a 20% increase in the transverse circumference due to slippage of myocytes within the wall. Myocardial scarring represented by segmental, replacement and interstitial fibrosis occupied approximately 20% of each ventricle, and was indicative of extensive myocyte cell loss. However, myocyte number was not reduced and average cell volume increased 2-fold in both ventricles. In conclusion, reactive growth processes in myocytes and architectural rearrangement of the muscle compartment of the myocardium appear to be the major determinants of ventricular remodeling and the occurrence of cardiac failure in DC.
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PMID:The cellular basis of dilated cardiomyopathy in humans. 776 Mar 53

Calcium antagonists comprise a diverse group of chemically unrelated agents that interact with voltage-operated calcium channels (L-type) and thereby inhibit smooth muscle contractility. They are used to treat several major cardiovascular disorders, including hypertension and angina pectoris; they are also studied in congestive heart failure and in atherosclerosis. The current view is that their therapeutic action is related to vasodilatation. This view is an oversimplification, as will be shown in this review. It will also be illustrated that all calcium antagonists are not identical pharmacological agents.
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PMID:Calcium antagonists and vasodilatation. 784 16

NO has been shown to be a biologic substance important to normal physiologic functioning. It appears to be an endogenous vasodilator and is involved in hemostasis and inflammation. Endothelial cell dysfunction often leads to diminished NO production; this reduction in NO concentrations may be an etiologic factor in systemic hypertension, myocardial and splanchnic ischemia, atherosclerosis, CHF, and pulmonary vascular disease. A new class of drugs, NO donors, have potential utility in the treatment of coronary and pulmonary arterial diseases. Their major advantage over nitrates and nitroprusside is a lack of pharmacologic tolerance. Clinical trials with drugs of this class are now in progress.
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PMID:Nitric oxide donors in the treatment of cardiovascular and pulmonary diseases. 787 93

HRT is likely to benefit menopausal women with concurrent conditions. In particular, women with atherosclerosis and its sequelae who use HRT may live longer. Our knowledge concerning the differential pharmacologic, biologic, and clinical effects of various estrogen preparations and routes is rudimentary, particularly in the sick climacteric woman. What data do exist, however, suggest that estrogen use is likely to improve the morbidity or mortality of women with coronary heart disease, myocardial infarction, congestive heart failure, hypertension, peripheral vascular disease, diabetes mellitus, stroke, and thromboembolic disorders. Whether there are any advantages to oral versus nonoral administration in these clinical circumstances has not been concretely determined. In order to minimize hepatic impact, it may be prudent to administer by a nonoral route estrogens that naturally occur in women to those with dyslipidemias, coagulopathies, liver disease, and cholelithiasis. Women who smoke are unlikely to accrue the full benefits of HRT. Although prospective, randomized clinical trials are expensive and tedious to execute, they are needed to determine the impact in sick menopausal women of estrogens and progestins in general and the different preparations, routes, and regimens in particular.
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PMID:Hormonal management of the sick menopausal woman. 793 43

To characterize acute myocardial infarction (AMI) in young adults and octogenarians, 475 AMI patients, in age subsets, were examined. The clinical features, risk factors and in-hospital mortality were compared among 17 young patients (< 40 years), 426 patients of common age (40-79 years), and 32 very elderly patients (> or = 80 years). The octogenarian patients were mainly female (male/female ratio, 0.9 vs. 4.7 in other subgroups, P < 0.005), and had more frequent atypical presentation and postinfarctional congestive heart failure; whereas infarct size, location and development of Q-wave, major arrhythmias and cardiac wall rupture were not different among these age subsets. The most common risk factors in the young group were dyslipidemia (67%) and cigarette smoking (65%), and in the octogenarian group were dyslipidemia (52%) and hypertension (50%). Among age subsets, however, the prevalence of risk factors was not significantly different except for a relatively lower smoking rate in the octogenarians. Compared with 40- to 79-year-old patients who had predominantly multi-vessel diseases, the young patients had milder coronary atherosclerosis and were more likely to have normal coronaries (27% vs. 5%, P < 0.01). Significantly more octogenarians than young patients succumbed to AMI in the hospital (44% vs. 18%, P < 0.005), usually because of a cardiogenic complication (93%). Also, the octogenarians were less likely than the younger patients to have received thrombolytic therapy, mostly because of delayed diagnosis and arrival at the hospital, or because of old age itself.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Acute myocardial infarction in young and very old Chinese adults: clinical characteristics and therapeutic implications. 802 Oct 47

Although long-term use of cyclosporine has been implicated in the pathogenesis of arteriolar hyalinosis, interstitial fibrosis, and glomerulosclerosis observed in the native kidneys of heart transplant recipients, it is not clear that these histologic abnormalities are entirely specific for a drug-induced toxic nephropathy. The purpose of this study was to determine whether long-standing congestive heart failure, particularly when complicated by disease processes such as atherosclerosis and hypertension, may independently predispose to the development of similar renal histopathology. Records and specimens were selected from autopsy files for evaluation of clinical profiles and kidney histology in 16 patients who died of end-stage cardiomyopathy of varying causes without having recourse to heart transplantation. The study cohort consisted of 12 men and four women. Cardiomyopathies were the result of coronary artery disease in six patients and nonischemic causes in the other 10 patients. The mean age at the time of death was 53 +/- 3 years (range 28 to 74 years). Thirteen (81%) of 16 patients had a history of hypertension. Nadir serum creatinine concentrations during the month before death were 1.7 +/- 0.2 mg/dl (range 1.2 to 3.5 mg/dl). Interstitial fibrosis, tubular atrophy, and glomerulosclerosis were present in 15 (94%) of 16 patients. Arteriosclerosis and arteriolosclerosis were found in 13 (81%) of 16 and 14 (88%) of 16 patients, respectively. A nodular pattern of arteriolar hyalinosis was observed in two patients with ischemic disease.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Evaluation of chronic renal disease in heart transplant recipients: importance of pretransplantation native kidney histologic evaluation. 806 Oct 12


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