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)

To elucidate the potential association of diabetic autonomic neuropathy with increased prevalence of silent coronary artery disease (CAD), 138 asymptomatic diabetic subjects were screened using exercise ECG. 24-h ambulatory ECG and dynamic thallium scintigraphy. Fourteen patients with exercise-induced myocardial ischaemia and angiographically confirmed CAD (greater than or equal to 50% coronary artery narrowing) were found using this protocol. Their autonomic nervous function was assessed using standard cardiovascular tests and compared with that of 23 consecutive diabetic patients catheterised because of symptomatic CAD (mean New York Heart Association class 3.0). The diabetic patients with symptomatic CAD had more severe coronary atherosclerosis than the diabetic patients with asymptomatic CAD assessed by jeopardy score (P less than 0.01). The groups did not, however, differ with respect to autonomic function tests. Five patients (22%) with symptomatic CAD and 3 patients (21%) with asymptomatic CAD had definite autonomic dysfunction, i.e. two or more abnormal tests. Thus, our results suggest that the frequency of autonomic neuropathy is not increased in diabetic patients with asymptomatic CAD. The contribution of diabetic autonomic neuropathy to the absence of cardiac pain needs further clinical and pathological studies.
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PMID:Asymptomatic coronary artery disease in diabetes: associated with autonomic neuropathy? 157 55

Multiple risk factors interplay in the formation of foot ulceration and/or limb amputation in the diabetic patient. This study defines the prevalence of foot pathology, lower extremity complications, and known risk factors for ulceration in a cross-sectional analysis of 92 diabetic patients in a Veterans Affairs Metabolic Clinic. Sixteen percent of patients had a history of lower extremity complications including pedal ulceration and/or amputation, previously requiring 1480 hospital days of care. Sixty-eight percent of patients had structural pathology in the foot, including: 51 percent callus, 32 percent hammertoes, 8 percent bunions, and 1 percent Charcot foot. Thirty-four percent of patients were insensate, while 25 percent had autonomic neuropathy. Twenty-two percent of patients had atherosclerosis obliterans as defined by an ankle brachial index less than 0.9; 13 percent suffered from intermittent claudication. The following pathologies were significantly more prevalent in diabetic patients with a history of ulceration and/or amputation compared to those patients without ulceration or amputation: hammertoe deformity (p less than .0001), abnormal cutaneous pressure sensation (p less than .05), abnormal R-R interval (p less than .05), intermittent claudication (p less than .05), and abnormal ankle brachial index (p less than .05). An important finding was that 41 percent of insensate patients were not aware of their sensory deficit. In addition, two-thirds of the patients with vascular disease had palpable pulses. All patients with diabetes should be entered into a basic foot education program. The high prevalence of lower extremity pathology coupled with the inadequacy of history and physical examination in detecting neuropathy and vascular disease emphasize the need for vigorous screening to determine whether patients are at high risk of ulceration/amputation. These patients should be entered into aggressive prophylactic treatment programs.
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PMID:Prevalence of foot pathology and lower extremity complications in a diabetic outpatient clinic. 266 42

This article reviews the clinical features of heart disease in the diabetic in three categories: (1) coronary atherosclerosis (CAD), (2) autonomic neuropathy, and (3) cardiomyopathy. Particular attention is given to current methods of noninvasive assessment of cardiac function in juvenile diabetics.
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PMID:Juvenile diabetes and the heart. 637 92

This review examines the pathology, clinical effects and physiological disturbances produced by vascular disease and autonomic neuropathy in the lower limb in diabetic subjects. Atherosclerosis is a major factor in causing foot lesions in diabetics. The distribution of the disease frequently makes vascular reconstructive surgery difficult or impossible but an aggressive approach to reconstruction is justified because the results of major amputations are bad. Arterial calcification probably has no significant effect on the blood supply to the foot. There is some evidence that disease of arteries in the foot may be associated with the development of ulcers or gangrene. Disease of the arterioles and capillaries is frequent, but there is little evidence that this microangiopathy causes lesions. Autonomic neuropathy affecting the limb is also common, and although there are several mechanisms by which this might predispose to ulcers or gangrene, there is little evidence of such a direct relationship. In a patient presenting with ulceration or gangrene of the foot it is often impossible to determine the relative roles of vascular disease, affecting large or small vessels, and neuropathy, either somatic or autonomic, in the development of the lesion. Further progress depends on the development of more direct methods for assessing microvascular and autonomic nervous function.
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PMID:Vascular disease and vascular function in the lower limb in diabetes. 652 89

This article reviews the clinical features of heart disease in the diabetic in three categories: (1) coronary atherosclerosis (CAD), (2) autonomic neuropathy, and (3) cardiomyopathy. Particular attention is given to current methods of noninvasive assessment of cardiac function in juvenile diabetics.
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PMID:Exercise and the patient with Type I diabetes mellitus. 672 29

The functional and morphological changes in myocardium of diabetic patients is caused by diabetic macroangiopathy, diabetic microangiopathy, autonomic neuropathy and metabolic disorders. Mechanism of these changes in the course of diabetes is not fully known. To determine whether there are myocardial ultrastructure differences between patients with diabetic cardiomyopathy (normal coronary angiograms) and diabetic patients with coronary artery disease, electron microscopy examination were performed of 70 sections received from seven biopsied patients (1F, 6M), average age 53 years (range: 42-60) with diabetes type II WHO (group A) without clinical evidence of prior coronary artery disease and hypertension, and 100 sections from 10 patients (2F, 8M), average age 54 years (range: 42-65) with diabetes and coronary atherosclerosis. These patients had clinical evidence of heart failure and were submitted to bypass-graft operations (group B). Endomyocardial biopsy tissues were obtained from the right ventricle without complications either during or after the procedure. Obtained biopsy specimens were fixed in 3% glutaraldehyde stabilized with 1M cacodylate buffer at pH 7.4, postfixed in 1% OsO4 on cacodylate buffer. The materials were then dehydrated and embedded in epon. The Irvin-Fischer test for statistical analysis was used. A p value < 0.05 was considered significant. The presence of focal mild loss of myofibrils (+) was statistically more frequent in the patients in A group (p < 0.05). It was found in 86% (6/7) of cases in A group, while in the B group was observed in 20% of (2/10) cases.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Cardiomyopathy in diabetes. Ultrastructural examinations]. 828 30

Epidemiologic studies have identified lipoprotein(a) (Lp(a)) as an independent risk factor for atherosclerosis, mainly for coronary heart disease. Atherosclerosis is the most common cause of death in diabetic patients, but there is little information available concerning the importance of Lp(a) in these patients. We compared the presence or absence of late diabetic complications with Lp(a) serum concentrations in 224 patients (82 IDDM, 142 NIDDM). Lp(a) distribution was skewed as described for non-diabetic patients. Despite highly significant differences for total cholesterol, total triglycerides, HDL-cholesterol, VLDL-cholesterol and VLDL-triglycerides (P < 0.001) and for LDL-cholesterol (P < 0.01) Lp(a) concentrations were similar in NIDDM and IDDM (mean: 27 vs. 30, median: 12 vs. 21 mg/dl, P = 0.10). Diabetic polyneuropathy, autonomic neuropathy, nephropathy, peripheral occlusive disease, diabetic gangrene and coronary heart disease were not associated with raised Lp(a) values. Non-insulin-dependent patients with retinopathy exhibited higher Lp(a) concentrations in serum than those without this complication. This significant association was lost when duration of diabetes was taken into account by logistic regression. We conclude, that other risk factors surpass the significance of Lp(a) in diabetic patients.
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PMID:Lipoprotein(a) in diabetes mellitus. 845 77

Cardiovascular diseases are the major cause of morbidity and mortality in the diabetic patient. Acute myocardial infarction carries twice the mortality of that in the general population. Although in the thrombolytic era, in-hospital survival for both diabetic and non-diabetic patients have improved considerably, the overall case fatality rate due to out-of-hospital death is still more than 50%. Screening relates particularly to the systematic search for cardiovascular risk factors and asymptomatic atherosclerosis. The individual risk cannot exactly be described by the level of risk factors alone. Today, diagnosis of preclinical cardiovascular disease can identify the high risk patient for severe cardiovascular events. The presence of asymptomatic or 'preclinical' cardiovascular disease such as left ventricular hypertrophy, peripheral arterial vessel disease, carotid atherosclerosis, autonomic neuropathy, and renal dysfunction carries a markedly increased risk for symptomatic morbidity as well as cardiovascular mortality. The unfavorable connection between autonomic neuropathy and coronary heart disease risk has just recently been reported. Therefore, diabetic patients with existing cardiovascular disease should be investigated and managed as vigorously as is warranted by existing evidence.
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PMID:Increased cardiovascular morbidity and mortality in diabetes mellitus: identification of the high risk patient. 896 98

Disturbances of coronary circulation have been reported in diabetic patients with microvascular complications but without obstructive coronary atherosclerosis. The aim of the present study was to investigate coronary flow reserve in young adult patients with IDDM but without microalbuminuria and diabetic autonomic neuropathy. Coronary flow reserve was determined in 12 nonsmoking male patients with IDDM (age 30.0 +/- 6.6 years) and 12 healthy matched volunteers. Groups were similar with respect to blood pressure and serum lipid concentrations, and no subject had a positive family history of coronary heart disease. The patients with IDDM had normal exercise echocardiography and autonomic nervous function tests. Five patients had minimal background retinopathy, and none had microalbuminuria. Positron emission tomography and [15O]H2O were used to measure myocardial blood flow at rest and after dipyridamole administration. The studies were performed during euglycemic hyperinsulinemia (serum insulin approximately 70 mU/l). The baseline myocardial blood flow was similar in patients with IDDM and in control subjects (0.84 +/- 0.18 vs. 0.88 +/- 0.25 ml x g(-1) x min(-1), NS). The myocardial blood flow during hyperemia was 29% lower in patients with IDDM (3.17 +/- 1.57) compared with the control subjects (4.45 +/- 1.37 ml x g(-1) x min(-1), P < 0.05). Consequently, coronary flow reserve (the ratio of flow during hyperemia and at rest) was lower in diabetic patients than in control subjects (3.76 +/- 1.69 vs. 5.31 +/- 1.86, P < 0.05) and the total coronary resistance during hyperemia was higher in diabetic patients (53.7 +/- 31.5) compared with the control subjects (31.4 +/- 11.6 mmHg x min x g x ml(-1), P < 0.05). The coronary flow reserve was similar in diabetic patients with and without mild background retinopathy. No association was found between the coronary flow reserve and serum lipid or HbA1c values in either group. Coronary flow reserve is impaired in young adult males with IDDM and no or minimal microvascular complications and without any evidence of coronary heart disease. This abnormality cannot be explained by standard coronary heart disease risk factors. The results imply early impairment of coronary vascular reactivity in IDDM patients, which may represent an early precursor of future coronary heart disease or may contribute to the pathogenesis of diabetic cardiomyopathy.
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PMID:Coronary flow reserve is reduced in young men with IDDM. 951 21

Coronary artery disease (CAD), arterial hypertension, chronic bronchitis and diabetes mellitus are the most frequently encountered diseases complicating the clinical course of the vascular patient. Clinical signs of cardiac or pulmonary disease are often absent in patients with decreased functional capacity due to claudication. For instance, clinical evidence of coronary artery disease was found in 36% of patients scheduled for different vascular surgical procedures, whereas coronary angiography revealed significant stenoses in as many as 53-68%. Patients with chronic hypertensive disease, coronary artery disease and increased impedance to left ventricular ejection due to atherosclerosis frequently develop impairment of left ventricular (LV) function. Even without clinical or radiological evidence, approximately 20-35% of vascular patients have a LV ejection fraction below 50% indicating impaired systolic LV function. The incidence of diabetes mellitus in vascular surgical patients is around 18%. When requiring insulin treatment, diabetes is an independent risk factor for postoperative ischemic events and congestive heart failure. Those with autonomic neuropathy are often asymptomatic as regards coronary artery disease. Coronary artery disease is responsible for over 50% of the immediate, medium- and long-term mortality and morbidity. Unstable myocardial ischemia, acute myocardial infarction which is detected by troponin I and ischemic pulmonary edema are the most common immediate postoperative cardiac complications. A large number of recent studies, using long-term ECG recording techniques, have allowed more accurate estimation of the incidence and time course of perioperative myocardial ischemia in vascular surgical patients. The highest incidence of ischemia when compared to daily life activities has been noted during the first two days after surgery but has been reported to remain elevated even 3-5 days after surgery. Interestingly, the incidence of intraoperative ischemia is lower than that observed during daily life. Knowledge of the etiology of perioperative myocardial infarction is essential if one is to improve cardiac outcome after vascular surgery. Many studies have addressed this important field in patients undergoing vascular surgery. They have documented a relationship between perioperative myocardial ischemia and postoperative myocardial infarction. Although postoperative myocardial infarctions are in most cases limited to endocardium (non Q wave infarction) they significantly reduce life expectancy of the vascular surgical patients. The reduction of cardiac risk following general surgery should focus on methods by which the incidence of myocardial ischemia, particularly during the postoperative period, could be reduced. These methods include intensive intraoperative analgesia or preventive administration of cardiovascular treatment which limit postoperative stress: alpha-2 agonists or betablocking agents. There are, at present, no studies which convincingly confirm an overall decreased mortality if coronary bypass surgery is performed prior to peripheral vascular surgery. Although it has been demonstrated that the mortality of the peripheral procedure is reduced to approximately one half, the mortality of a coronary bypass procedure in vascular surgical patients is five to eight times that recorded in a coronary artery bypass population without peripheral vascular disease. It remains to be shown if the use of coronary angioplasty prior to peripheral vascular surgery can provide a more satisfactory overall outcome. Several non-invasive techniques have been suggested to improve the identification of high-risk patients undergoing vascular surgery. These tests include exercise ECG, ambulatory ECG, dipyridamolethallium scintigraphy and determination of left ventricular ejection fraction by gated radionuclide imaging. (ABSTRACT TRUNCATED)
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PMID:[Physiopathologic introduction to anesthesia and resuscitation of the vascular patient]. 955 51


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