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

Cardiovascular disease, in particular coronary artery disease (CAD), remains the most important cause of morbidity and mortality in developed countries and, in the near future, more so in the developing world. Atherosclerotic plaque formation is the underlying basis for CAD. Growth of the plaque leads to coronary stenosis, causing a progressive decrease in blood flow that results in angina pectoris. Acute myocardial infarction and unstable angina were recently recognised as related to plaque rupture, not progressive coronary stenosis. Acute thrombus formation causes an abrupt coronary occlusion. The characteristics of the fibrin cap, contents of the plaque, rheological factors and active inflammation within the plaque contribute to plaque rupture. Oxidative processes are important in plaque formation. Oxidized low density lipoproteins (LDL) but not unoxidized LDL is engulfed by resident intimal macrophages, transforming them into foam cells which develop into fatty streaks, the precursors of the atherosclerotic plaque. Inflammation is important both in plaque formation and rupture. Animal studies have shown that antioxidants reduce plaque formation and lead to plaque stabilisation. In humans, high intakes of antioxidants are associated with lower incidence of CAD, despite high serum cholesterol levels. This observation suggests a role for inflammation in CAD and that reducing inflammation using antioxidants may ameliorate these processes. Men and women with high intakes of vitamin E were found to have less CAD. Vitamin E supplementation was associated with a significant reduction in myocardial infarction and cardiovascular events in the incidence of recurrent myocardial infarction. In the hierarchy of evidence in evidence-based medicine, data from large placebo-controlled clinical trials is considered necessary. Results from various mega-trials have not shown benefits (nor adverse effects) conferred by vitamin E supplementation, suggesting that vitamin E has no role in the treatment of CAD. These results do not seem to confirm, at the clinical level, the effect of antioxidants against active inflammation during plaque rupture. However, a closer examination of these studies showed a number of limitations, rendering them inconclusive in addressing the role of vitamin E in CAD prevention and treatment. Further studies that specifically address the issue of vitamin E in the pathogenesis of atherosclerosis and in the treatment of CAD need be performed. These studies should use the more potent antioxidant property of alpha-tocotrienol vitamin E.
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PMID:Vitamin E in cardiovascular disease: has the die been cast? 1249 32

The process of accelerated atherosclerosis appears to share common pathophysiologic mechanisms, namely, endothelial injury with early platelet involvement and subsequent progressive smooth muscle cell proliferation and thrombosis leading to vascular occlusion. Understanding the mechanisms of this process has made it possible to include strategies to limit vascular injury and reduce subsequent thrombotic and proliferating cellular responses. In contrast to spontaneous atherosclerosis, a more significant denuding endothelial injury appears to be the critical initiating event, followed by intense platelet involvement and thrombus formation, leading to an initial predominant process of smooth muscle cell proliferation in accelerated atherosclerosis. Risk factors like cigarette smoking and hypertension play an important role in this process. This accelerated proliferative process appears to be the cause of premature coronary occlusion in patients undergoing heart and kidney transplantation, coronary vein graft bypass and percutaneous transluminal coronary angioplasty and diabetes. This accounts for significant morbidity and mortality in these patients. Prophylactic anticalcinotic vasoprotection by suitable calcium antagonists may offer a more appropriate way of anti-arteriosclerotic arterial protection than the other procedures hitherto used. Calcium channel blockers have positive effects on a number of processes that may be associated with restenosis, including reduction of platelet aggregation, minimisation of vasospasm and inhibition of mitogens. In this article the role of nifedipine in accelerated atherosclerosis has been reviewed.
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PMID:Accelerated atherosclerosis. 1267 86

The relationship of diet to serum lipids and to atherosclerosis is a controversial subject. The data presented indicate that diets containing very large amounts of vegetable fat are consistently associated with a sharp fall in serum cholesterol and phospholipid, whereas administration of equal amounts of fat of animal origin is associated with a rise of the serum lipids to levels noted on an average mixed diet. In critical evaluation of elderly hospitalized diabetic patients with advanced atherosclerosis it was observed that there was close mathematical correlation between serum content of cholesterol, "lipoproteins," and phospholipids. There was no obvious correlation between the degree or kind of atherosclerosis and any one of the lipid entities followed. Coronary occlusion occurred in a patient with one of the lowest levels of cholesterol and of lipoprotein.
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PMID:Serum lipids in normal and abnormal subjects; observations on controlled experiments. 1300 10

Marked obesity was induced in rats by feeding a high fat, egg yolk-rich diet. The obese rats were hyperlipemic and showed an increased incidence of lipomatous coronary lesions, but did not develop severe atheromatous lesions. Spontaneous vascular lesions of several kinds have been observed in aging rats. Among them, plaques containing a fibrin-like material seem to be conspicuous. However, these lesions differ from the experimentally induced changes, which were more fatty. Atherosclerosis, as it is defined in human pathology, has not been observed to develop spontaneously in rats. Experimental induction of marked hyperlipemia and hypercholesterolemia by feeding a high fat egg yolk-rich diet (supplemented with cholesterol, choleate, and thiouracil), and use of viosterol to cause vascular injury, led to severe atherosclerosis, coronary occlusion, and myocardial infarction. A consideration of all the findings reported here leads to renewed support of the concept that atherosclerosis has a combination of causes (Aschoff, Anitschkow, Page). Of all the etiological factors considered here, elevation of blood lipides and vascular injury are thought to be the most important ones.
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PMID:Experimental atherosclerosis and cardiac infarcts in rats. 1362 Aug 55

Evidence continue to accumulate indicating that patients with rheumatoid arthritis (RA) present an increased risk of cardiovascular disease (and death). The risk factors for coronary artery disease (CAD) in RA are not fully understood. However, a number of possible factors have been described, but more than one may be efficient, such as homocysteine, presence of antiphospholipid antibodies, altered serum levels of selected lipoproteins, and all together may have implications for the atherogenesis observed in these patients. Other factors that may facilitate this process, include corticosteroid use, methotrexate therapy and hormonal factors. However, the relative importance of these specific risk factors for the atherogenesis in this disease is poorly known. Recent findings indicate that cardiac death is increased in RA patients when compared with subjects without arthritis and that generally, the inflammatory process may contribute to atherosclerosis. In addition, other studies indicate that serum concentration of pro-inflammatory cytokines are found elevated at baseline, among patients at risk for future coronary occlusion.
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PMID:[Rheumatoid arthritis and atherosclerosis]. 1451 12

Regulation of coronary vascular tone is critical for proper perfusion and function of the myocardium. Many disease processes result in compromised regulation of coronary vascular tone and impaired myocardial perfusion. A common result of coronary vascular dysfunction is the development of areas of replacement fibrosis within the myocardium and surrounding the vasculature. Both intravascular processes, such as coronary atherosclerosis and endothelial dysfunction, and extravascular processes, including compromised myocardial metabolism, hormone excesses, and altered local signaling, may result in coronary vascular dysregulation. Coronary occlusion events, in turn, lead to myocardial damage and the activation of inflammatory cells and fibroblasts. The role of fibroblasts in regulating myocardial fibrosis and the contribution of myofibroblasts, cells that have limited contractile potential while retaining many of the extracellular matrix regulating processes of the fibroblast, may also contribute to the development of myocardial disease. In this review we examine the recent literature on myocardial fibrosis and myofibroblast activity, highlighting the effects of several classes of cardiovascular agents on the remodeling process.
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PMID:The interaction of coronary tone and cardiac fibrosis. 1581 Dec 57

Ischemic heart disease is one of the leading causes of death in Japan. Acute coronary syndrome (ACS) most commonly begins with atherosclerotic plaque rupture and intracoronary thrombus formation. Therefore, the primary goal of treatment of acute coronary occlusion is the achievement of early and complete reperfusion. To achieve this goal, detection of atherosclerosis and/or myocardial necrosis by imaging and serologic tests is important. Original diagnosis of acute myocardial infarction (AMI) was made from typical symptoms, characteristic rises in serum enzyme levels, and an atypical electrocardiographic pattern. Increasingly sensitive and specific tests have been developed in recent years and have been rapidly adopted into clinical practice. Rapid developments in technology in the field of serum biomarkers have redefined the diagnosis of AMI. The new ESC/ACC criteria place increased emphasis on cardiac biomarkers, especially troponins. However, the electrocardiogram still remains significant in the diagnosis of AMI and the ability to identify high risk subgroups by admission electrocardiogram is necessary to estimate the severity of AMI. Current practice guidelines recognize the importance of promptly restoring normal epicardial blood flow, but blood flow to the ischemic tissue may still be impeded after relief of the occlusion; a phenomenon known as no reflow. Myocardial scintigraphy is one of the methods for defining coronary microvascular injury in the acute phase of AMI. Prompt assessment of coronary perfusion and detection of coronary microvascular injury may aid in making decisions concerning the use of drugs to improve microvascular function and left ventricular function after primary coronary angioplasty.
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PMID:[Ischemic heart disease]. 1596 7

The recanalization of a chronic total coronary occlusion (CTO) is hampered by a high rate of lesion recurrence. The goal of the present study is to assess the effect of paclitaxel-eluting stents in CTOs in a strategy of extensive stent coverage and the optional use of additional bare metal stents (BMSs). In 82 consecutive patients, a CTO (duration > 2 weeks) was successfully recanalized with implantation of one or more Taxus stents. These patients underwent a repeat angiography after 5.0 +/- 1.5 months and were assessed by quantitative angiography. The patients were compared with 82 clinically and lesion-matched patients from a consecutive series of 148 patients with CTOs treated by BMS in the preceding time period. In 21 of the 82 patients, additional lesions in the target artery not directly related to the original occlusion site were treated with BMSs (hybrid approach). The history of diabetes, extent of coronary artery disease, clinical symptoms, and angiographic features were similar in the Taxus and BMS group. Periprocedural adverse events were 3.3% with Taxus and 3.3% with BMS, but 12 months MACE was significantly lower in the group with exclusive use of Taxus (13.3% vs. 56.7%; P < 0.001), mainly due to a lower target lesion revascularization of 10.0% as compared to 53.4% (P < 0.001). There was only one late reocclusion with Taxus (1.7%) as compared to 21.7% with BMS (P < 0.05). However, in the hybrid group, the MACE rate was considerably higher, with 33.3%. Our data of a 80% reduction of target vessel failure as compared to BMS, with a lower risk of late reocclusions without increased acute adverse events, demonstrate the benefit of paclitaxel-eluting stents in CTOs. However, diffuse atherosclerosis in CTOs should be covered completely by the drug-eluting stents.
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PMID:Paclitaxel-eluting stents for the treatment of chronic total coronary occlusions: a strategy of extensive lesion coverage with drug-eluting stents. 1634 51

This century brings a pandemic of diabetes mellitus, with marked increases in early-accelerated atherosclerosis. When asymptomatic patients with diabetes present for evaluation, they have more extensive coronary atherosclerosis, lower ejection fractions, higher rates of previous cardiac events, and more silent ischemia than the normal population. The challenge faced by clinicians is to accurately identify asymptomatic patients with diabetes who have significant coronary ischemia that would benefit from revascularization. Diabetic endovascular disease has all the high-risk features to promote atherosclerosis and coronary occlusion: hyperglycemia-induced endothelial dysfunction, impaired fibrinolysis, increased platelet aggregation, plaque instability, dysfunctional arterial remodeling, and fibrotic and calcified coronary arteries. The optimal revascularization strategy for patients with diabetes is an ongoing debate. The advent of drug-eluting stents has changed the landscape, and some have suggested that the current role of coronary artery bypass grafting may be reduced by as much as 46%. Unfortunately, there is limited evidence from randomized, controlled trials that reflects current practice and could guide clinicians in making the best choices for patients with diabetes and coronary disease. It is hoped that ongoing trials--including Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D), Future Revascularization Evaluation in Patients with Diabetes Mellitus: Optimal Management of Multivessel Disease (FREEDOM), and Coronary Artery Revascularisation in Diabetes (CARDia)--will answer many of the remaining questions. Still, the best treatment includes lifestyle modification and early prevention strategies with global risk reduction.
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PMID:Diabetic endovascular disease: role of coronary artery revascularization. 1730 63

The mechanisms that regulate the stability of the atheroma plaque are a new focus of interest to understand the pathophysiology of acute coronary syndromes (ACS) and its therapy. Up to 75% of ACS are clinical expression of an unstable plaque rupture. The identification of unstable or so called vulnerable plaque (VP) became an interesting target, since they are the substrate of eventual future events. The VP determinant factors are: the size and consistence of lipid core, thickness of fibrous cap around this core, and the balance inflammation- reparation inside this cap. Inflammation plays a starring role in every single atherosclerosis stage. High sensitivity C - reactive protein (hs-CRP) is one of the most used markers of inflammation. We determined hs-CRP in 104 patients. The elevation of this marker was 5.85 mg/L in stable angina, 19.92 in non ST elevation ACS, and 50.41 mg/L in whom that presented ACS with ST elevation. (p < 0.01). The majority of coronary occlusion occurs in previously non-significant (< 70%) angiographic stenosis. Therefore, the current challenge is to identify and treat VP using whether invasive or non-invasive methods. This lead to a new concept: the "vulnerable patient". Using these new diagnostic techniques, along with the information obtained from clinical trials in course, we should be able to prevent future coronary events.
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PMID:[Inflammation and plaque instability]. 1893 92


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