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

The purpose of this study was to evaluate which factors might influence health care attitudes such as anxiety about dental care by older adults in Israel. The study population consisted of 103 non-institutionalized patients (46 men and 57 women) over the age of 65 who attended a dental clinic that provided services for older adults during a one-year period. Socio-demographic information and information about the subjects' general health and their level of concern about health problems were obtained from self-reported questionnaires, while the dental anxiety level was found by means of a dental anxiety scale (DAS). Ninety-nine percent of the patients suffered from a major systemic disease such as diabetes, hypertension, atherosclerosis, respiratory disease, and rheumatic disease. Both unmarried and first-time patients expressed high anxiety scores. Patients with 12 or fewer years of formal schooling demonstrated significantly higher dental anxiety. Among patients who regularly attended a synagogue or a social club, concern about oral health was significantly higher than for the rest (p < 0.02). No association was found between having dentures and gender, or between having dentures and level of education. The reason for visiting the clinic (inability to eat, pain, or esthetics) was not associated with any other health concern or with dental anxiety levels. This study determined that patients who were unmarried, less educated, or attending the facility for the first time were more likely to experience dental anxiety. These patients merit special consideration.
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PMID:Non-institutionalized elderly dental patients in Israel: socio-demographics, health concerns, and dental anxiety. 1120 80

The theoretical link between foods choice and masticatory efficiency has long been established. Recent evidence has confirmed this association, demonstrating a progressive alteration in food choice with decreasing numbers of teeth, with the greatest effect being among those who are edentulous. This altered food selection results in significant differences in the hematological status for some key nutrients in the one study in which this association was investigated. This paper summarizes some of the literature relevant to diet as a risk factor for systemic disease and identifies areas where altered food choice as a consequence of reduced masticatory efficiency might be placing individuals at increased risk of life-threatening conditions, such as atherosclerosis and cancer.
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PMID:Oral health and nutrition in older people. 1124 51

Atherosclerosis, a chronic systemic disease of the vasculature with an inflammatory component, is the primary cause of cardiovascular morbidity and mortality in industrialized countries. Impairment of vascular endothelial cell function in atherosclerosis and in conditions associated with increased cardiovascular risk are important determinants of disease progression. Reduced endothelium-dependent relaxation in the coronary and systemic circulation due to decreased bioavailability of nitric oxide (NO) and increased release of oxygen-derived free radicals promotes the adhesion of leukocytes, thrombosis, inflammation, cell proliferation, and increases in vascular tone. In addition to decreases in bioactive NO, enhanced production of the 21-amino acid peptide endothelin-1 contributes to the progression of atherosclerosis. This paper discusses mechanisms and therapeutic approaches to improving endothelial pathways in atherosclerosis. Restoration of endothelium-derived NO bioactivity through inhibition of the renin-angiotensin system, the endothelin system, or statin therapy improves vascular function in experimental hypercholesterolemia, hypertension and heart failure. These treatments may also have therapeutic benefit for patients at risk or with overt atherosclerosis, and are likely to reduce vascular and myocardial complications of this disease.
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PMID:Endothelium and atherogenesis: endothelial therapy revisited. 1181 71

Atherosclerosis manifests as a systemic disease with near global involvement of the named segments of the arterial tree. Acute thrombotic arterial occlusion, however, is not equally distributed. To evaluate intra-individual regional differences in arterial thrombogenicity, we compared (111)In-platelet deposition in porcine carotid and femoral arteries after a standardized crush injury. Within the unidirectional flow conditions of elastic carotid arteries, platelet deposition was more than 3-fold higher compared with predominantly muscular femoral arteries with triphasic arterial flow. To determine the influence of rheology on platelet deposition after crush injury, carotid arteries were transplanted into the femoral position and compared with the paired native carotid and femoral arteries. Similarly, femoral arteries transposed to the carotid position were compared with the paired native carotid artery. In each of these experiments, arterial transposition to a new anatomic location imparts a predilection for platelet deposition indigenous to the new location. In the controlled environment of two high-shear thrombin-independent and -dependent flow chambers, porcine carotid and femoral arterial substrates were indistinguishable from one another with respect to platelet deposition. Regional differences in arterial hemodynamics may account for substantial differences in thrombosis arising from deep arterial injury.
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PMID:Influence of anatomical location on arterial thrombosis. 1183 39

Atherosclerosis represents a frequent health problem in developed countries. Although a systemic disease, the diagnostic approach to atherosclerosis has remained segmental. Largely, this approach has been a reflection of limitations inherent to the imaging techniques used. Recently, whole-body MR angiography has become possible allowing the display of the arterial vasculature from the supraaortic arteries to the distal run-off vessels in merely 72 seconds. The technique provides images quality comparable to catheter angiography. The advantage of this approach relates to its potential in detecting vascular pathologies in regions which would have remained unexamined with conventional diagnostic management. Thus, the outlined strategy of whole-body MR angiography mirrors the systemic nature of atherosclerosis and can be used as a noninvasive comprehensive screen for arterial disease screening.
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PMID:[Arterial vascular screening with whole body MR angiography]. 1207 89

Cardiovascular disease (CVD) is the leading cause of mortality and a major cause of disability in advanced age. The relationship between coronary heart disease (CHD) and dyslipoproteinaemia is well known. The fact, however, that atherosclerosis is a systemic disease leads also to the consideration that patients suffering from cerebrovascular and peripheral arterial disease should benefit similarly from lipid lowering therapy as do patients with CHD. There is already growing evidence that the incidence of stroke may be markedly decreased by statin therapy. Though overall, the clinical significance of hypercholesterolaemia seems to decrease with increasing age, patients at age 65 to 75 tend to benefit even more than younger patients when elevated LDL-cholesterol is treated effectively. It should be noticed that prevention or postponement of cardiovascular events may also prevent premature functional limitations and disability in old age. Hence, it is suggested to screen elderly people with CVD for dyslipoproteinaemia and to treat elevated cholesterol levels by means of life style changes, nutritional therapy, and drug therapy. Treatment regimes should be considered depending upon complete risk stratification and geriatric assessment. Chronological age alone cannot be an argument to withhold a proven effective therapy from a growing segment of the population at risk.
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PMID:[Primary and secondary prevention in dyslipidemia in the elderly]. 1218 49

Although vascular disease may present with symptoms that are representative of a focal exacerbation of atherosclerosis, it is inherently a systemic disease. Consequently, vascular surgeons must be capable of recommending to their patients pharmacologic approaches that will decrease future risk of cardiovascular-related morbidity and death. Antiplatelet treatments, in particular, have been shown to reduce future cerebrovascular and coronary events. Moreover, these medications have utility in maintaining peripheral vessel and graft patency after surgical bypass, endarterectomy, or percutaneous translumenal angioplasty. The future of optimal antiplatelet therapy will consist of strategies that block multiple platelet activation pathways simultaneously. Moreover, the use of directed antiplatelet medications promises more effective control of platelet physiology with a concomitant increase in safety. The authors review herein current recommendations for the use of aspirin, thienopyridines, and GP IIb/IIIa inhibitors in patients with peripheral vascular disease.
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PMID:Platelets: is aspirin sufficient or must we know how to pronounce abciximab? 1247 99

A mathematical model of the intramyocardial coronary microcirculation is used to explore the validity of a fast CT imaging method for characterizing the myocardial microcirculatory functional status. The fast CT method depends on the demonstrated CT-based estimation of myocardial perfusion (F) and the intramyocardial blood volume (B(v)). The observed curvilinear myocardial blood volume-to-flow relationship, empirically fitted to B(v) = a.F + b.F(0.5), is a signature of the underlying early pathophysiologic processes thought to be involved in systemic disease processes, such as atherosclerosis, hypertension, and diabetes mellitus. The sensitivity and specificity of the CT-based estimate of this characteristic relationship is explored by altering the characteristics of the vascular diameter-to-flow relationship and the variation in the fraction of capillaries perfused at different coronary flows. The simulation results also indicate that if the vascular diameters change so that the vascular resistance corresponds to the change in flow, then the empirically observed myocardial B(v)-to-F relationship holds well.
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PMID:Quantification of myocardial microcirculatory function with X-ray CT. 1249 34

Although an early invasive strategy (angiography and percutaneous coronary intervention) is the convention in acute coronary syndrome (ACS)/non-ST-segment elevation myocardial infarction (MI) in the U.S., a conservative pharmacologic approach is common in other countries. Trial evidence has demonstrated a modest benefit with an angiographically guided approach; but patients having negative troponin values or who were receiving aspirin showed little or no benefit, and those without ST-segment changes had slightly worse outcomes. Limitations of angiography are clinically important. Identification of hemodynamically significant stenoses may be confounded by coronary remodeling. Also, most plaques, particularly those responsible for acute events, are extraluminal. Assessment of the luminal diameter of a lesion, which requires comparison with a normal reference segment, may be impossible because of the diffuse nature of the disease. Percutaneous coronary intervention after plaque rupture may itself cause embolization and no-reflow phenomena, leading to severe complications. In addition, most ruptures may be clinically silent. Evidence of a systemic inflammatory component suggests that ACS patients are at risk for plaque rupture at multiple sites. The inability of angiography to depict the true extent of atherosclerosis is supported by necropsy and transplant donor studies. A metabolic approach to this systemic disease is the only strategy designed to influence the behavior of both the small number of angiographically visible lesions and the large number of occult plaques. Statins and other agents decrease the incidence of death and MI by stabilizing atherosclerotic plaques throughout the coronary bed, reducing inflammation, collagen degradation, tissue factor expression, and vasomotor tone.
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PMID:Pathobiology, not angiography, should guide management in acute coronary syndrome/non-ST-segment elevation myocardial infarction: the non-interventionist's perspective. 1264 48

Observational studies indicate periodontal infections as a risk factor for systemic conditions like cardiovascular disease and preterm low birth weight. This paper reviews and argues the biological plausibility for a periodontal infection-systemic disease link and reviews the available experimental data from animal models and human intervention trials. Five principal lines of evidence can be used to explain the biological plausibility of a link. First, infection in general has been implicated in the pathogenesis of both atherosclerosis and preterm delivery. Periodontal infection secondly causes transient and low-grade bacteraemias and endotoxaemias in patients. Thirdly, periodontal infection promotes systemic inflammatory and immune responses that may play roles in disease. Periodontal pathogens express specific virulence factors that can affect atherogenic or parturition events. Lastly, periodontal pathogens have also been isolated from non-oral tissues like atheromatous plaques. Experimental data derived from rodent and pig models indicate that infection or bacteraemias with the periodontal pathogen, Porphyromonas gingivalis, can increase atheroma size or reduce litter weights as compared to controls. While human intervention data are lacking for patients at risk for cardiovascular disease, early data indicate that periodontal therapy administered to pregnant mothers with periodontitis can reduce the incidence of preterm low birth weight deliveries. Nevertheless, more and larger intervention trials are needed before we can fully accept periodontal infection as a true risk factor in the causal pathways of cardiovascular disease and preterm low birth weight.
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PMID:The periodontal infection-systemic disease link: a review of the truth or myth. 1267 89


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