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

We describe four patients aged 14 to 21 years who developed acute aortic dissection. In three of the four patients, the course was fatal, despite aggressive medical and surgical intervention. All four patients had sustained systemic hypertension related to chronic renal insufficiency. The patients had no other identifiable risk factors for aortic dissection, including congenital cardiovascular disease, advanced atherosclerosis, vasculitis, trauma, pregnancy, or family history of aortic dissection. Although aortic dissection is rare in individuals younger than 40 years of age, young patients with sustained systemic hypertension are at increased risk for this serious and often fatal condition. Physicians must be aware of this rare complication of hypertension and consider aortic dissection in the differential diagnosis of unusual chest, abdominal, and back pain in hypertensive children, adolescents, and young adults.
 ...
PMID:Aortic dissection in young patients with chronic hypertension. 1002 53

Mediacalcinosis (MC) represents a disease of the muscular type arteries characterized by progredient calcification of the media. MC involves most frequently the arteries of the lower extremities. However, a more extensive disease involving the arteries of the pelvis and the abdominal aorta is common. A systemic extension of MC with the involvement of the coronary arteries has been reported, but is however, according to the present opinion, rather rare. MC occurs isolated (primary MC) as well as associated with other diseases (secondary MC). The secondary forms are most frequently due to diabetes mellitus type II and to chronic renal insufficiency and accompanying secondary hyperparathyroidism. The etiopathogenesis of MC has not yet been clarified. The recent evidence based on molecular-biologic investigations suggests an active pathomechanism of an ectopic arterial wall ossification. Genetic predisposition appears possible. The diagnosis of MC is traditionally established by conventional x-ray radiography of the pelvis-lower extremity-region. Among the newer imaging modalities, the computed tomography and the high resolution B-mode ultrasonography are of special importance. The diagnostics of coronary calcification are in descending order of importance relevant the intracoronary ultrasonography (IVUS), the electron beam computed tomography (EBT), the thorax-fluoroscopy and the thorax-radiography. For the diagnosis of coronary MC necessary arterial wall layer specific calcium detection is currently possible only with the IVUS methodology. The prognosis of the primary MC is quoad vitam good. However, the mechanic and biological effects of MC on cardiacal and vascular function have not yet been determined. The secondary MC in type II diabetics represents an independent cardiovascular risk factor. A causal therapy of MC is not known. For the clinical cardiologists, MC is of primary interest as a differential diagnosis to atherosclerosis. For the scientists, MC offers an excellent in vivo model to study processes associated with arterial wall ossifications and ageing.
 ...
PMID:[Media calcinosis from the viewpoint of the cardiologist]. 1002 65

Eighteen patients with severe renal artery atherosclerosis underwent conventional percutaneous transluminal renal angioplasty (PTRA) followed immediately by implantation of an endovascular stent. Hemodynamic measurements showed a baseline trans-stenotic pressure gradient of 78.3 mmHg that was reduced to 14.8 mmHg after PTRA. The post PTRA trans-stenotic pressure gradient was further reduced to 0.86 mmHg after stent placement. The average baseline diameter stenosis of 81.3% was reduced to 43.7% after PTRA and 6.1% after stent placement. Six month angiographic follow-up revealed restenosis in 6/16 patients. In patients treated for chronic renal insufficiency without restenosis the 6 month creatinine was 1.46 mg/dl compared to a pre-procedure creatinine of 2.4 mg/dl. Therefore those patients with renal insufficiency and renal artery stenosis who had long term patency after successful stent implantation showed significant improvement in renal function at six months. Stent implantation also significantly improved acute hemodynamic results and acute angiographic results compared to conventional renal artery angioplasty.
 ...
PMID:Improved hemodynamic, angiographic and functional results after renal artery stenting. 1014 66

Atherosclerosis is a very common complication and frequently recordable cause of death in patients with chronic renal insufficiency (ChRI). The authors focus on current notions about causes of rapidly advancing atherosclerosis in patients presenting with manifest and terminal ChRI, who were exposed to a conservative treatment, programme hemodialysis or prolonged peritoneal dialysis. Treated in the article at length are proatherogenic (generally known, common in ChRI only) and antiatherogenic mechanisms. A worthwhile line of investigations is suggested to be designed to study ChRI pathogenesis and devise relevant preventive and curative measures.
 ...
PMID:[Pro- and antiatherogenic mechanisms in chronic kidney failure]. 1020 39

Plasma levels of alpha-tocopherol (vitamin E) in chronic renal insufficiency (CRI) patients may be decreased, normal or elevated. However, an abnormal distribution of vitamin E in each lipoprotein has been reported. In comparison to control subject low-density lipoprotein (LDL), patient LDL contained less vitamin E. On the contrary, malondialdehyde (MDA) in patient LDL was enhanced. According to the evaluation of the susceptibility of LDL to in vitro oxidation and the rate of lipid peroxidation by fluorescence development during copper exposure, the susceptibility of patient LDL was enhanced, suggesting a possible relationship between excessive LDL peroxidation and accelerated atherosclerosis. In a clinical small uncontrolled trial, the increments of an aortic calcification index estimated by CT scan in patients treated with vitamin E were suppressed compared to those treated without vitamin E, suggesting that vitamin E might prevent the progress of atherosclerosis in CRI patients.
 ...
PMID:[Vitamin E disturbances in chronic renal failure]. 1054 Aug 88

Both markedly and mildly elevated circulating homocysteine concentrations are associated with increased risk of vascular occlusion. Here we review possible mechanisms that mediate these effects. Inborn errors of homocysteine metabolism result in markedly elevated plasma homocysteine (200-300 micromol/L) and thromboembolic (mainly venous) disease: treatment to lower but not to normalize these concentrations prevents vascular events. Mild homocysteine elevation (>15 micromol/L) occurs in approximately 20-30% of patients with atherosclerotic disease. Usually, this is easily normalized with oral folate and ongoing trials are assessing the effect of folate treatment on outcomes. Although there is evidence of endothelial dysfunction with both markedly and mildly elevated homocysteine concentrations, the elevated homocysteine concentration in atherosclerotic patients is also associated with most standard vascular risk factors, and importantly, with early decline in renal function, which is common in atherosclerosis. Decline in renal function alone causes elevated plasma homocysteine (and cysteine). These observations suggest that mild hyperhomocysteinemia could often be an effect rather than a cause of atherosclerotic disease. Data on the common C677T methylenetetrahydrofolate reductase polymorphism supports this, in that, although homozygosity is a frequent cause of mild hyperhomocysteinemia when plasma folate is below median population concentrations, it appears not to increase cardiovascular risk. Indeed, there is recent evidence suggesting an acute antioxidant effect of folic acid independent of its effect on homocysteine concentrations. This antioxidant mechanism may oppose an oxidant effect of homocysteine and be relevant to treatment of patients with vascular disease, especially those with chronic renal insufficiency. Such patients have moderately elevated plasma homocysteine and greatly increased cardiovascular risk that is largely unexplained.
 ...
PMID:Homocysteine and cardiovascular disease: cause or effect? 1147 Jul 33

Hypertension remains the most common reason for patients to visit physicians in the United States. Although awareness of hypertension among patients continues to increase, adequate control of hypertension remains poor. In addition, as the population of patients with hypertension ages, atherosclerosis becomes increasingly prevalent. Atherosclerotic renal artery stenosis is the most common secondary cause of hypertension and can cause hypertension to be difficult to control. Atherosclerotic renal artery stenosis may also result in chronic renal insufficiency. The physician must be aware of the clinical scenarios in which renal artery stenosis may occur, methods of diagnosis, and indications for intervention.
 ...
PMID:Hypertension and renal artery stenosis: a complex clinical scenario. 1110 61

Renal transplant recipients (RTR) are considered representative of patients with chronic renal insufficiency (CRI) in general with respect to both reduced, progressively declining renal function, and increased risk for cardiovascular disease (CVD). In accord with this argument, we hypothesized that total (t) plasma concentrations of the putatively atherothrombotic amino acid homocysteine (Hcy) would be equivalent in RTR and CRI patients with comparable renal function. We determined plasma tHcy, folate, pyridoxal 5'-phosphate, and B12 concentrations, in addition to serum creatinine and albumin concentrations, in 86 chronic, stable RTR, and 238 patients with CRI. Within comparable ranges of serum creatinine (i.e. RTR=0.6-4.2 mg/dl; CRI=0.7-4.1 mg/dl), tHcy concentrations did not differ between the two groups (RTR=15.0 micromol/l; CRI=14.9 micromol/l, P=0.899). ANCOVA revealed that renal function, gauged as a simple creatinine measurement, was the major independent determinant of plasma tHcy concentrations, accounting for approximately 80-90% of the total variability in tHcy predicted by the full model (i.e. full model R(2)) containing, in addition to creatinine, the seven other potential explanatory variables. If controlled trials confirm that tHcy-lowering treatment reduces CVD events rates in RTR, these results should be applicable to CRI patients in general.
Atherosclerosis 2001 May
PMID:Chronic renal transplantation: a model for the hyperhomocysteinemia of renal insufficiency. 1136 18

Homocysteine (tHcy) is a risk factor for atherosclerosis in patients with end-stage renal disease and chronic renal insufficiency (CRI). Vitamin B6 deficiency may result in high tHcy levels, especially after a methionine load (PML). Therefore, we evaluated vitamin B6 metabolism and tHcy (fasting and PML) levels in patients with CRI and those on hemodialysis (HD) therapy before and during high-dose sequential vitamin B6 and folic acid supplementation in male patients (27 patients, HD, 17 patients, CRI) and 19 age-matched healthy controls. Vitamin B6 doses were 100 mg/d in patients with CRI and 200 mg/d in HD patients, plus folic acid (5 mg/d), for more than 3 months in each period. We analyzed vitamin B6 metabolites by high-performance liquid chromatography in plasma and red blood cells (RBCs) and fasting tHcy in all cases and PML in subgroups of 11 HD patients and 14 patients with CRI. We found vitamin B6 deficiency and high tHcy (fasting and PML) levels in all patients. Plasma and RBC levels of pyridoxal and pyridoxal phosphate were abnormally low, whereas levels of pyridoxic acid (PA), an end product of vitamin B6 metabolism, were extremely high in both groups. Fasting and PML tHcy levels were partially resistant to vitamin B6 supplements, with different response patterns in HD patients and those with CRI. Thus, the PML defect was more responsive to folic acid in HD patients, whereas vitamin B6 partially reduced PML tHcy levels in patients with CRI. Resistance of tHcy to vitamin B6 treatment in patients with CRI and HD patients is not caused by poor absorption or low tissue stores. Rather, nonvitamin factors or potentially toxic PA levels may be implicated in abnormal vitamin B6 and/or tHcy metabolism during renal insufficiency.
 ...
PMID:Vitamin B6 metabolism and homocysteine in end-stage renal disease and chronic renal insufficiency. 1177 12

Cardiovascular disease (CVD) is the leading cause of death in the general population and a major cause of morbidity and mortality chronic kidney disease (CKD) and end-stage renal disease (ESRD) patients. The high prevalence of CVD in incident dialysis populations suggests that CVD begins during or before the stage of chronic renal insufficiency. While traditional risk factors observed in the general population may play a role in the progression of CVD in CKD and ESRD patients, the presence of several nontraditional factors related to the extent of uremia seems to be the more significant feature of CVD in this patient population. Recently, there have been significant advances in our understanding of how inflammation contributes to the pathogenesis of atherosclerosis and myocardial infarction. The fact that chronic inflammation and CVD are highly prevalent in ESRD patients, it is probable that chronic inflammation may be a causative factor for accelerated atherosclerosis observed in CKD and ESRD patients. Given the extent of the problem, efforts to lower the mortality rate among ESRD patients will require new approaches to reduce and/or prevent cardiovascular morbidity and mortality.
 ...
PMID:Epidemiology of vascular disease in renal failure. 1180 53


<< Previous 1 2 3 4 5 Next >>