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

Normalization of serum lipid levels should be initiated as soon as possible in patients with myocardial, cerebrovascular, or peripheral vascular disease. Clinical trials indicate that coronary artery disease and overall mortality rates can be reduced and atherosclerosis stabilized or reversed by lipid-lowering therapy. Treatment should lower low-density lipoprotein cholesterol levels to 130 mg/dL or less and total triglyceride levels to 150 mg/dL or less and increase high-density lipoprotein cholesterol levels to at least 52 mg/dL in men and 66 mg/dL in women. Nonlipid coronary risk factors should be eliminated when possible. Lipid-lowering therapy may consist of dietary modification and drug treatment with colestipol hydrochloride (Colestid), cholestyramine (Cholybar, Questran), lovastatin (Mevacor), gemfibrozil (Lopid), and nicotinic acid (Nicolar).
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PMID:Treating serum lipid abnormalities in high-priority patients. 198 20

Electrical impedance plethysmography has been evaluated for early detection of peripheral atherosclerosis. A pressure cuff was wrapped around the lower leg and the cuff pressure increased. Two circumferential electrodes glued in the middle of the cuff recorded the impedance pulse, from which the arterial pulse volume was calculated. The ratio of maximal arterial volume change to the pulse pressure was determined as a measure of maximal compliance Cp. Based on the data from 118 human subjects, Cp was found to correlate well with known cardiovascular risk factors. For example, Cp decreased on the average from 3.08 to 1.92 microL.mm Hg-1.cm-1 (1 microL.mm Hg-1.cm-1 = 7.5 x 10(-10) m4.N-1) in groups of subjects of increasing age from 22 to 70 years. Subjects on a regular exercise program had an average value of 3.86, while those with proven peripheral vascular disease had a value of 0.70. In a related pathologic validation study on 15 monkeys fed a cholesterol-control diet a good correlation was found between the limb peak compliance and morphometric data obtained from iliac and carotid arteries.
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PMID:Noninvasive measurement of compliance of human leg arteries. 202 33

The objective of this study is the identification of the most important risk factors of atherosclerosis and the determination of its multicentricity, the goal being an efficient primary and secondary prevention of this disease. Over the course of eight years, at the Department of Diagnosis and Surgical Physiopathology of Peripheral Vascular Diseases, 829 subjects with atherosclerosis were examined, of whom 513 males and 316 females between 18 and 85 years old, as well as to 200 healthy control subjects. The risk factors in consideration were: age, sex, hypertension, diabetes, lipoidoproteinosis, smoking, alcohol and coffee intake. From the data obtained it was revealed that smoking represents the most important risk factor for atherosclerosis (65% of the cases, 40% of the controls), followed in decreasing order by hypertension (31% of the cases, 6% of the controls), diabetes (26% of the cases, 2% of the controls), lipoidoproteinosis (15% of the cases, 6% of the controls). Furthermore 21% of the subjects drank coffee and 28% ingested alcoholic beverages, compared with, respectively 19% and 24% of the controls. In 70% of the cases the presence of atherosclerotic lesions were found in more than one vascular region. Atherosclerosis has a multifactorial etiology as there exists a correlation between the predisposition of the patient to acquire the disease and environmental factors. It is difficult to distinguish the determining effects of a single risk factor, because often many risk factors are tightly interrelated in the same individual; a nearly direct relationship clearly exists between the number and entity of the risk factors and the clinical picture of the patient examined.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Risk factors and multicentricity of vascular atherosclerotic disease. Our experience]. 208 79

In patients with coronary artery disease, angina pectoris provides an unreliable underestimation of disease activity and risk. Unheralded myocardial infarction and sudden death are common clinical presentations. Furthermore, objective testing, in hospital and more recently during the patient's normal daily activities, has demonstrated frequent and asymptomatic episodes of ischemia, as indicated by transient ST-segment depression. Since the underlying pathophysiologic disturbances of myocardial perfusion appear to be similar in painful and painless episodes, it seems appropriate to consider them together as the "total ischemic burden" on the myocardium. Research into this functional expression of coronary disease has indicated that active ischemia is associated with an increased risk of morbid events in all clinical subgroups of patients, including those with stable angina, unstable angina, peripheral vascular disease and following myocardial infarction. If this is confirmed in prospective trials, the assessment of total ischemic burden is likely to become part of the clinical investigation of patients with coronary disease. Clinical trials testing the efficacy of interventions will need to examine the effect on ischemic activity during normal daily life, in addition to symptoms and exercise tolerance. Evidence is still required to demonstrate whether therapy aimed at reducing the total ischemic burden will prolong life. The total ischemic burden provides a marker to follow the dynamic changes of the atherosclerotic lesion. Future research may have to concentrate on treatment aimed at altering the natural history of obstructive coronary atherosclerosis in order to affect the long-term outlook for patients with coronary artery disease.
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PMID:Total ischemic burden in patients with coronary artery disease. 209 78

In a double-blind study, a single dose of 1600 mg cyclandelate or placebo was administered to 10 patients with cerebrovascular and/or peripheral vascular disease, and fibrinolytic activity was evaluated before and 1, 2, 4 and 6 h after treatment. Cyclandelate induced a reduction in euglobulin lysis time, an increase in tissue plasminogen activator concentration and a reduction in plasminogen activator inhibitor, alpha 2-antiplasmin and immunological fibrinogen concentrations, but no changes in antithrombin III and plasminogen concentrations were observed. After placebo administration no significant changes were observed. After treating two patients with 800 mg cyclandelate twice daily for 14 days, 1600 mg cyclandelate stimulated fibrinolysis for 8 h. It is concluded that the fibrinolytic activity of cyclandelate has implications for the treatment of cardiovascular complications of atherosclerosis.
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PMID:Fibrinolytic activity of oral cyclandelate in patients with generalized atherosclerotic vasculopathy: a double-blind study. 212 64

Laser energy transmitted through fiberoptic systems can recanalize totally occluded peripheral arteries and improve extremity perfusion in selected patients with peripheral vascular disease. Such a technique is obviously appealing in that it (1) reduces the morbidity currently associated with the surgical treatment of symptomatic peripheral atherosclerosis, and (2) allows treatment of patients currently excluded from therapy by the presence of other severe medical problems or relatively mild symptoms. Unfortunately, current delivery systems allow recanalization of only a small channel by laser energy alone, and channel enlargement using balloon dilation is usually required. Clinical trials of laser angioplasty (laser-assisted balloon angioplasty) have shown acceptable results in the treatment of stenosis or short occlusions in the iliac and superficial femoral arteries, but results in patients with long occlusions or disease below the knee remain well below the results achieved by standard surgical therapy. Thus the impact of laser angioplasty on the treatment of peripheral vascular disease is limited at present and much work remains to be done to further develop this exciting new therapy for the treatment of peripheral vascular disease.
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PMID:Current status of laser angioplasty. 213 41

In 12 patients (8 males, 4 females; 59.4 +/- 6.2 years) with clinically manifest atherosclerosis (peripheral vascular disease stage II according to Fontaine and coronary heart disease) without any risk factor and 6 controls (4 males, 2 females; 58.5 +/- 7.06 years) autologous platelets were labelled using 100 microCi 111-In-oxine. In parallel, serum- and plasma-thromboxane (TX) B2 and conversion of exogenous radiolabelled arachidonic acid towards TXB2 were determined. No difference in labelling efficiency and recovery was noted. Platelet half-life was significantly (p less than 0.01) shortened in the atherosclerotics. Gamma-camera images were obtained during the first 64 minutes after reinjection as well as 2, 6, 18, 24 and daily up to 1 week after reinjection of autologous radiolabelled platelets. No difference between the patients suffering from atherosclerosis--having either visible atherosclerotic lesions or not--could be discovered. Serum-TXB2 was comparable, whereas plasma-TXB2 showed a trend towards an increase and the conversion from exogenous 14C-AA to 14C-TXB2 was increased in atherosclerosis.
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PMID:Platelet kinetics in patients with atherosclerosis. 213 47

Current methodology for the in vitro determination of aortic and large artery stiffness is reviewed and involves three approaches: (1) the estimation of distensibility by pulse wave velocity measurement; (2) the estimation of distensibility from the fractional diameter change of a given arterial segment by imaging techniques (e.g., angiography, Doppler ultrasound) against pressure change; (3) the estimation of compliance by determining volume change against pressure change in the arterial system during diastolic runoff from the Windkessel model of the circulation. Clinical correlations may be summarized as follows: (1) age: a progressive stiffening on aging due to structural changes up to the seventh decade; (2) sex: a lower degree of stiffness in women until menopause, after which they show an accelerated stiffening, catching up with men by the seventh decade; (3) atherosclerosis: a dissociation between degree of stiffness and extent of atherosclerosis, with a suggestion that in advanced atherosclerosis the extensive calcification may lead to increased stiffness; (4) coronary disease: an inconsistent correlation by pulse wave velocity studies, but a strongly positive correlation by angiographic study of the aortic root; (5) diabetes mellitus: a significant correlation by pulse wave velocity study, particularly in the presence of advanced peripheral vascular disease; (6) hypertension (both essential and elderly patients with systolic): positive correlation but only referable to the stiffening effect of a higher mean arterial pressure (i.e., unrelated to structural changes), although an experimental study did show a loss of compliance unrelated to the mean arterial pressure level in baboons with chronic renovascular hypertension.
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PMID:Aortic and large artery stiffness: current methodology and clinical correlations. 218 12

The ability of glycosaminoglycans to bind to a wide number of biologically active macromolecules has already been investigated. Recent clinical trials on the possible therapeutic benefits of glycosaminoglycans must be placed in perspective, even if they appear to be particularly encouraging, especially as regards the glycosaminoglycan effects on certain coagulation factors. A multicenter, medium-term, double-blind, crossover trial was performed by several Italian Lipid Clinics to determine whether administration of a medium molecular weight glycosaminoglycan (Sulodexide) has a significant clinical effect. Patients affected by peripheral vascular disease and/or hyperlipidemia (type IIa, IIb and IV) were submitted to a 4-week wash-out period, followed by parenteral Sulodexide (S) or placebo (P) administration for 2 weeks, another 2 week wash-out period, parenteral crossover drug or P administration for 2 weeks and, finally, oral S administration for 6 months. Sulodexide lowered plasma viscosity and plasma fibrinogen in all patients. There was also a drop in triglycerides together with a rise in apo A-I and HDL-C in type IV hyperlipoproteinemics, whereas there was no significant effect on total or LDL-plasma cholesterol in type IIa and IIb patients. Moreover, there was a percent increase in peak flow and rest flow in the lower limbs of peripheral vascular disease patients. No side effects or intolerance phenomena were detected. The results indicate that Sulodexide administration may be useful in long-term treatment of patients with peripheral vascular disease and a concomitant increase in plasma triglycerides and/or fibrinogen and/or viscosity.
Atherosclerosis 1990 Apr
PMID:Double-blind multicenter trial on a new medium molecular weight glycosaminoglycan. Current therapeutic effects and perspectives for clinical use. 219 May 65

Regular, wave-like constriction in medium-sized arteries, arterial segmental vasoconstriction (ASV), has been observed at arteriography and described by many authors. We found ASV in arteriograms of the superficial femoral artery in 13 of 107 hypercholesterolaemic patients, enrolled in the Probucol Quantitative Regression Swedish Trial (PQRST). The arteriograms were digitized and studied with a quantitative computer-assisted technique. The frequency of ASV was higher than has been reported earlier in clinical materials, possibly because of an increased vasoreactivity in hypercholesterolaemia, as recently observed experimentally. The ASV patients were, on average, younger, had lower blood pressure and less atherosclerosis, than the non-ASV patients. ASV was not found in any of the 19 patients in the material who either had symptoms of peripheral vascular disease or arteriographically verified arterial occlusions. No significant correlations with smoking habits or serum cholesterol levels were found. A computer-based index of ASV and measurement of ASV wavelength are discussed.
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PMID:Arterial segmental vasoconstriction in hypercholesterolaemic patients. 220 87


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