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

Cardiovascular morbidity and mortality increase after menopause. There has been reluctance to use estrogen replacement therapy (ERT) for treating women with a high risk of cardiovascular disease because of adverse experience in two areas: (1) The Coronary Drug Project administered high doses of estrogen to male survivors of MI, which was associated with excess coronary and thromboembolic events. (2) Studies of OC use revealed an increased incidence of heart attacks among women over the age of 35 years who smoke. Eight case-control studies have examined the effect of estrogen replacement therapy on cardiovascular events; five have shown a protective effect. Eleven of 19 reports have found a protective effect. Ten of 11 cohort studies have found a protective effect. One randomized study (by Nachtigall et al) found a beneficial effect. Angiographic studies at the University of Tennessee/Baptist Memorial Hospital, Memphis have examined the relative risk for coronary artery disease for postmenopausal women relative to estrogen use. Cases with significant coronary angiograms. Logistic regression analysis showed that estrogen use had a statistically significant independent protective effect against coronary atherosclerosis. These observations have been confirmed by three subsequent studies. The same study group also examined the effect of estrogen replacement on survival of patients who underwent coronary arteriography at baseline. Of 23,190 patients undergoing arteriography, 2,268 women were eligible for long-term study. While patients who were initially free of coronary artery lesions did not have a significant reduction of mortality when given estrogen replacement, a significant reduction of all-cause mortality was observed in those groups with coronary artery disease who received estrogens.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Atherosclerosis and estrogen replacement therapy. 819 38

Cardiovascular morbidity and mortality are increased 4- to 6-fold in patients with type II diabetes. The high prevalence is multifactorial and reflects in part the adverse influence of covariate, cardiac risk factors such as hypertension and hyperlipidemia. Type II diabetes is characterized by insulin resistance, hyperinsulinemia, and altered carbohydrate and lipid metabolism resulting in hyperglycemia, increased concentrations in blood of very low-density and low-density lipoproteins, and decreased blood high-density lipoproteins. Abnormalities seen predispose to vasculopathy through lipid deposition into vessel walls associated with monocyte infiltration, vascular smooth muscle cell proliferation, arterial mural fibrosis, and thrombosis. Conventional therapy for cardiovascular disease such as angioplasty and bypass surgery are of only limited efficacy. Thus, retardation of progression of atherosclerosis is essential. In addition to focusing on co-existent cardiac risk factors such as hypertension, therapy for patients with type II diabetes should reduce or reverse insulin resistance, improve metabolic control, and, ideally, do so without exacerbating hyperinsulinemia. Diet and exercise are central, and novel orally active hyperglycemic agents such as the biguanides and the thiazolidinediones that sensitize diverse tissues to insulin offer particular promise.
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PMID:Determinants of coronary vascular disease in patients with type II diabetes mellitus and their therapeutic implications. 913 73

The epidemiology of a common measure of cardiovascular reactivity, the change in systolic blood pressure (DeltaSBP) from the supine to the standing position, is described in a cohort of 13 340 men and women aged 45 to 65 years enrolled in the Atherosclerosis Risk in Communities (ARIC) Study. The distribution of DeltaSBP was found to be symmetrical and unimodal, with a mean value near zero (-0.45 mm Hg). The range of DeltaSBP was from -63.2 to 54.3 mm Hg, and the standard deviation was 10.8. Stratification of DeltaSBP by race and gender shows a slight shift in distribution toward higher values for black men and women. DeltaSBP was categorized into deciles. Participants in the top 30% and bottom 30% of the distribution were compared with individuals in the middle 40% of the distribution, who had little or no change in SBP on standing. Participants in the bottom 30% (ie, SBP decreased on standing) were significantly older, had a greater prevalence of hypertension and peripheral vascular disease, had higher values of SBP, and had more cigarette-years of smoking. Among participants in the top 30% (ie, SBP increased on standing), a significantly larger proportion were black, mean seated SBP was higher, and the predicted risk of developing coronary heart disease after 8 years was greater. The response of SBP to change in posture showed considerable variability in a population sample of middle-aged adults. Cardiovascular morbidity, sociodemographic factors, and cigarette smoking were associated with the magnitude and direction of the postural change.
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PMID:Descriptive epidemiology of blood pressure response to change in body position. The ARIC study. 1033 98

Women with polycystic ovary syndrome (PCOS) carry a number of cardiovascular risk factors. Cardiovascular morbidity is elevated even in young women with PCOS. Low-grade chronic inflammation, reflected in elevated levels of serum C-reactive protein (CRP) and endothelial dysfunction have recently been linked to development of atherosclerosis. We compared high-sensitivity (hs)CRP concentrations and endothelium dysfunction in 37 women with PCOS and 25 control subjects matched as a group for age and body mass index (BMI). Arterial endothelium and smooth muscle function was measured by examining brachial artery responses to endothelium-dependent and endothelium-independent stimuli. Serum LH, testosterone, androstenedione, and fasting insulin levels were significantly higher in the PCOS group than the control group. The PCOS group was more insulin resistant than age- and BMI-matched control women. CRP concentrations were higher in PCOS women than the healthy control group (0.25 vs. 0.09 mg/dl). hsCRP concentrations were correlated with BMI, insulin sensitivity indices (homeostasis model assessment and quantitative insulin sensitivity check index), and endothelium-dependent vasodilation. The groups were well matched for baseline brachial artery diameter. There was a significant difference in endothelium-dependent (flow- mediated dilation) and endothelium-independent (sublingual nitroglycerin) vascular responses between the women with PCOS and the normal healthy control group (P = 0.002 and P = 0.01, respectively). Endothelium-dependent vasodilation was correlated with hsCRP concentrations and insulin resistance. In conclusion, this study is the first to demonstrate increased levels of hsCRP, endothelial dysfunction, and the relation with insulin resistance in young and normal-weight women with PCOS. Clinical strategies aimed at reducing insulin resistance may prevent early atherosclerosis in women with PCOS.
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PMID:Endothelial dysfunction in young women with polycystic ovary syndrome: relationship with insulin resistance and low-grade chronic inflammation. 1553 16

Cardiovascular morbidity and mortality are highly prevalent among patients with chronic renal failure (CRF). Endothelial dysfunction is regarded as the initial reversible step in the development of atherosclerosis and has been demonstrated in all stages of renal failure. Non-invasive techniques to assess endothelial function have been recently developed and have been proven to predict future mortality in adults. We aimed to assess endothelial function in children with stage 4 chronic kidney disease (CKD 4) on conservative treatment, using a-non invasive, high-resolution, ultrasound Doppler study of the brachial artery flow, correlating it with other clinical and laboratory parameters. This study included 34 children with CKD 4 on conservative treatment who were compared with 30 healthy controls. Flow-mediated dilatation (FMD), nitroglycerin-mediated dilatation (NTG-MD) and FMD/NTG-MD ratio were estimated. FMD was abnormal (< 5%) in 24 patients (71%). FMD and FMD/NTG-MD ratio were significantly lower in patients than in controls (P = 0.001 and P = 0.01, respectively). FMD correlated positively with serum calcium and negatively with alkaline phosphatase. We concluded that endothelial dysfunction is present in children with CKD 4 on conservative treatment and may reflect increased atherogenic and thrombogenic properties of the endothelium, contributing to subsequent adverse cardiovascular outcome.
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PMID:Doppler assessment of brachial artery flow as a measure of endothelial dysfunction in pediatric chronic renal failure. 1854 3

Renal artery stenosis (RAS) is a common manifestation of atherosclerosis and is associated with many other atherosclerotic conditions. Cardiovascular morbidity and mortality is increased among patients with RAS. This increase is likely due in part to the associated disease states; however, RAS itself may also contribute. Current strategies to limit cardiovascular morbidity and mortality in RAS include various pharmacologic interventions targeting both RAS atherosclerosis in general. Additionally, revascularization has been advocated; however, clear data are lacking. Ongoing clinical trials such as the Cardiovascular Outcomes in Renal Atherosclerotic Lesions (CORAL) trial will ultimately help to determine the best strategies to limit the morbidity and mortality associated with RAS.
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PMID:Cardiovascular morbidity and mortality and renal artery stenosis. 1991 35

Cardiovascular morbidity and mortality are common in end stage renal disease (ESRD) patients. There is scarce data on carotid and bulb intima-media thickness (IMT-C and IMT-B) as an early marker of atherosclerosis and related factors in children on hemodialysis (HD) and peritoneal dialysis (PD). Since we did not have enough information about our patients, this study was carried on all ESRD children (hemodialysis and peritoneal dialysis) in a referral center. Data was collected from 16 ESRD children under 18 years with seven patients on PD and nine on HD. Lab tests and biochemical parameters including serum von Willebrand factor (vWF), homocystein, apo lipoprotein A, apo lipoprotein B and quantitative CRP were measured in fasting patients just before initiating dialysis. IMT-C and IMT-B were measured by gray scale ultrasound using 7.5 MHZ probe. The mean of age was 12.76+/-4.5 years. The mean duration of dialysis in HD and PD patients were not significantly different; 11.88+/-3.25 months and 10.14+/-2.4 months respectively. Mean of systolic blood pressure in HD group was significantly higher than PD group, 135.55+/-25.54 mmHg versus 121.42+/-12.14 mmHg, P<0.05. Significant differences among all following parameters in ESRD patients, with normal laboratory values, were clarified: cholesterol, triglycerides, apo A, apo B, quantitative CRP, VWF, homocystein and IMT-C. However, we could not demonstrate any difference between IMT-B in case and control group. After adjusting for age, partial correlation showed significant correlation between IMT-C and following factors: N-PTH and serum alkaline phosphatase. Longitudinal studies with large size samples are needed to clarify the contributing factors with intima-media thickness in ESRD children.
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PMID:Carotid intima-media thickness in children with end-stage renal disease on dialysis. 2053 68

Cardiovascular morbidity and mortality are becoming major health concerns for adults with inflammatory rheumatic diseases. The enhanced atherogenesis in this patient population is promoted by the exposure to traditional risk factors as well as nontraditional cardiovascular insults, such as corticosteroid therapy, chronic inflammation and autoantibodies. Despite definite differences between many adult-onset and pediatric-onset rheumatologic diseases, it is extremely likely that atherosclerosis will become the leading cause of morbidity and mortality in this pediatric patient population. Because cardiovascular events are rare at this young age, surrogate measures of atherosclerosis must be used. The three major noninvasive vascular measures of early atherosclerosis--namely, flow-mediated dilatation, carotid intima-media thickness and pulse wave velocity--can be performed easily on children. Few studies have explored the prevalence of cardiovascular risk factors and even fewer have used the surrogate vascular measures to document signs of early atherosclerosis in children with pediatric-onset rheumatic diseases. The objective of this review is to provide an overview on cardiovascular risk and early atherosclerosis in pediatric-onset systemic lupus erythematosus, juvenile idiopathic arthritis and juvenile dermatomyositis patients, and to review cardiovascular preventive strategies that should be considered in this population.
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PMID:Cardiovascular risk in pediatric-onset rheumatological diseases. 2373 70