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Query: UMLS:C0004153 (atherosclerosis)
 77,401 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

This case report describes a progressive dementia in a 49-year-old black male on long-term hemodialysis. The initial presentation simulated depression. The dementia persisted after an unsuccessful cadaver homograft transplant. The character of the dementia was nonspecific but typical features of dialysis dementia were lacking. Autopsy revealed a ruptured cerebral aneurysm, polycystic kidneys, moderately severe atherosclerosis, miliary tuberculosis, and neurofibrillary degeneration of the hippocampus. The significance of a possible relationship between end-stage renal disease (ESRD), hemodialysis, and Alzheimer's disease in this case is discussed.
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PMID:Alzheimer's disease in a patient on long-term hemodialysis: a case report. 394 16

The ability to recognize diverse clinical forms of xanthomas, such as tuberous, planar, eruptive and tendinous, is important in the detection of underlying systemic disease. A variety of primary genetic disorders, as well as numerous secondary conditions such as diabetes, obstructive liver disease, thyroid disease, renal disease, and pancreatitis, can lead to hyperlipoproteinemia that results in the formation not only of xanthomas but also of life-threatening vascular atherosclerosis. An understanding of the pathogenesis of the underlying lipoprotein alterations provides a rational approach to therapy utilizing dietary manipulations and drugs. Such treatment is capable of correcting most disorders of lipid metabolism, and, if appropriate therapy is initiated at the first sign of xanthoma evolution, it may prevent progression of atherosclerosis, provide resolution of xanthomas, and in some instances prevent serious pancreatitis.
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PMID:Xanthomas and hyperlipidemias. 403 Nov 42

The causes of death and morbidity in a series of 104 patients with end-stage renal disease were analysed in an attempt to determine whether dialysis and renal transplantation accelerate atherogenesis. Only 4 of 37 deaths were due to myocardial infarction; a further 2 were due to other manifestations of occlusive arterial disease; and severe atheroma was an incidental finding at necropsy in only 3 other patients. Symptomatic arterial disease developed during treatment in only 3 of 61 patients at present alive; 2 other patients with myocardial infarctions before dialysis treatment have survived uneventfully for long periods. These data suggest that dialysis and transplantation may allow previously acquired atherosclerosis to manifest itself clinically; but the hypothesis that atheroma is accelerated is not yet proven.
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PMID:Accelerated atherosclerosis in long-term dialysis and renal-transplant patients: fact or fiction? 610 36

The Hypertension Detection and Follow-up Program (HDFP) first demonstrated that treatment of patients with mild hypertension (90 to 104 mm Hg diastolic) could reduce morbidity and mortality in coronary heart disease (CHD). Previous studies had already shown the beneficial effect of blood pressure reduction on renal disease, heart failure, and cerebrovascular disease. When uncontrolled, mild hypertension in the patient with renal disease will lead to further deterioration of renal function. To prevent this and other complications (such as atherosclerosis) of hypertension, whether primary or secondary, one should place these patients on antihypertensive therapy. However, standard stepped-care therapy with diuretic drugs and beta-blocking agents is now under reevaluation in view of the potential adverse effect of these agents on serum lipids and renal function. Beta-blocking drugs, furthermore, tend to increase peripheral resistance, a hemodynamic effect opposite to that desired in these patients. Other drugs, acting centrally or peripherally on the nervous system, also have some undesirable features in addition to troublesome side effects. Prazosin, a vasodilator and effective antihypertensive agent with a different mechanism of action, has no adverse action on lipids and renal function, lowers peripheral resistance, and does not cause many of the side effects that limit use of the other drugs. It therefore appears to be a good choice for initial therapy in mild to moderate hypertension with associated renal insufficiency.
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PMID:Treating the patient with mild hypertension and renal insufficiency. 613 5

The biracial population of New Orleans has a high overall mortality rate, high coronary heart disease (CHD) mortality rate, and high autopsy rate. In the New Orleans Community Pathology Study we investigated atherosclerosis and CHD in all deceased males aged 25 to 44 years, with major focus on the 52% of subjects from whom heart and arterial specimens were collected and evaluated according to standardized procedures. Morphologic correlates of CHD are the same in young black and white males. CHD mortality and mortality from cerebral hemorrhage, hypertensive heart disease, chronic renal disease, and diabetes are greater in young black males than young white males. Age, serum cholesterol, and hypertension were identified as important associated factors in the atherosclerotic process, as well as in CHD. The extent of coronary lesions seems to have decreased between 1960-1964 and 1969-1978 in young white males but not in blacks. Racial differences in coronary lesion involvement in non-CHD deaths are smaller than in our earlier studies.
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PMID:Coronary heart disease in young black and white males in New Orleans: Community Pathology Study. 647 44

By lowering blood pressure, a number of hypertensive complications can be prevented, including congestive heart failure and such consequences of hypertensive arteriolar disease as nephropathy, intracerebral hemorrhage, and lacunar stroke. Whether atherosclerotic complications such as myocardial infarction can be prevented is more problematic and may depend on effects of the antihypertensive drugs other than the reduction of blood pressure, such as effects on plasma lipids and possibly hemodynamic effects. The following discussion summarizes a series of studies that suggest that the hemodynamic effects of antihypertensive drugs may be an important aspect of this problem. In studies in rhesus monkeys and hypertensive patients, antihypertensive drugs were shown to have differing effects on blood velocity and heart rate, important parameters in the genesis of arterial flow disturbances. In patients with carotid stenosis, hydralazine increased, whereas propranolol reduced, the occurrence of abnormal high-velocity flow patterns associated with turbulence and vortex formation. In a hypertensive (one kidney, one-clip) cholesterol-fed rabbit model, propranolol was significantly more effective than hydralazine in preventing the occurrence of aortic atherosclerosis. These observations suggest that the cardioprotective effect of beta blockers may extend to an antiatherosclerotic effect by hemodynamic mechanisms. This hypothesis is being further tested in patients with carotid stenosis.
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PMID:Hemodynamic effects of antihypertensive drugs. Possible implications for the prevention of atherosclerosis. 651 56

Hyperlipidemia is common in patients with renal disease. This fact may be of great clinical relevance in view of the overwhelming evidence associating disturbed lipid metabolism and atherogenesis. Thus, hyperlipidemia may predispose to vascular disease in patients with chronic renal disorders and premature atherosclerosis could be an important risk in renal disease and a major factor limiting survival of patients on long-term maintenance hemodialysis. The aim of the present review is to present a brief but clinically relevant description of lipoprotein physiology and then to survey the now considerable literature concerned with lipoprotein and thus lipid abnormalities in patients with renal disease. A particular emphasis is placed on the role of the plasma lipoproteins in forming an integrated and controlled pathway for lipid metabolism, and how altered regulatory control within the pathway may be associated with pathogenic mechanisms. Finally, the evidence for accelerated development of vascular disease associated with these lipid abnormalities is briefly considered.
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PMID:Plasma lipid alterations in patients with chronic renal disease. 674 32

Four patients with chronic systemic lupus erythematosus (SLE) in whom myocardial infarction occurred at an unusually early age are described. The evidence suggests that the coronary occlusion was due to atherosclerosis. There was no evidence that active arteritis played any role. The only risk factor for atherosclerotic disease was hypertension. All patients had had both central nervous system and renal disease and had been taking corticosteroids for a minimum of 9 years. It is suggested that hypertension aggravated by chronic corticosteroid administration may be an important risk factor for atherosclerosis in patients with SLE.
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PMID:Myocardial infarction in four young patients with SLE. 688 70

Serum and lipoprotein lipids were determined in 42 female transplant recipients and compared with age-matched and serum lipid-matched normal subjects. Eight patients had glomerulonephritis as the pre-transplant etiology of renal disease, 22 had analgesic nephropathy, 6 polycystic kidneys and 6 ureteric reflux. A number of abnormalities were observed: (i) Serum triglycerides and phospholipids were elevated in all patients. Serum cholesterol levels were increased in analgesic nephropathy, polycystic kidney and ureteric reflux, but not in glomerulonephritis patients. The serum esterified/free cholesterol ratio was reduced in all patients except those with polycystic kidneys as the pre-transplant diagnosis; (ii) All VLDL lipids were raised in transplant patients regardless of etiology of renal disease prior to transplantation; (iii) LDL lipids, cholesterol, triglyceride and phospholipid were elevated in analgesic nephropathy, polycystic kidney and ureteric reflux patients, but were normal in glomerulonephritis patients: (iv) HDL cholesterol and triglycerides were elevated in all patients regardless of etiology. HDL phospholipid levels also tended to be raised, but this was significant only in glomerulonephritis patients. Lipoprotein--lipid ratio data indicated that lipoprotein--lipid composition deviated less from normal in glomerulonephritis patients than in the other patient groups.
Atherosclerosis 1980 Sep
PMID:The influence of pre-transplant etiology of renal disease on lipoprotein lipids in female renal allograft receipients. 700 88

Serum and lipoprotein lipids have been compared in male and female transplant recipients with glomerulonephritis or analgesic nephropathy as etiology of pre-transplant renal disease, and a number of differences were observed. (1) Serum cholesterol and phospholipid levels were elevated in glomerulonephritis and female analgesic nephropathy, but not in male analgesic nephropathy patients. (2) Glomerulonephritis patients had normal low density lipoprotein (LDL) cholesterol levels whereas these were elevated in female and depressed in male analgesic nephropathy patients. (3) LDL phospholipid, on the other hand, was normal in male and elevated in female transplant recipients irrespective of etiology of pre-transplant renal disease, while high density lipoprotein (HDL) phospholipid levels were elevated in female glomerulonephritis patients only. Mild hypertriglyceridemia and a tendency to increased HDL cholesterol were observed in all patients. These results provide further evidence for the complexity of lipoprotein lipid abnormalities in renal disease.
Atherosclerosis 1981 May
PMID:Lipoprotein lipids in renal transplant recipients of different pre-transplant etiology of renal disease. A comparison of male and female patients. 701 3


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