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

Diabetes may be associated with systolic hypertension secondary to atherosclerosis, renal hypertension secondary to diabetic nephropathy, and essential hypertension. The latter is by far the most prevalent, and a wealth of epidemiologic data suggests that such an association is independent of age and obesity. Considerable evidence indicates that the link between diabetes and essential hypertension is hyperinsulinemia. Thus, when hypertensive subjects, whether obese or of normal body weight, are compared to age- and weight-matched normotensive controls, a heightened plasma insulin response to a glucose challenge is found consistently. A state of cellular resistance to insulin action subtends the observed hyperinsulinism. With the use of the glucose clamp technique coupled with tracer glucose infusion and indirect calorimetry, it can be shown that the insulin resistance of essential hypertension is located in peripheral tissues (muscle), is limited to nonoxidative pathways of glucose disposal, and is directly correlated with the severity of hypertension. The reasons for the association of insulin resistance and essential hypertension can be sought in at least four general types of mechanisms--sodium retention, sympathetic nervous system overactivity, disturbed membrane ion transport, and altered muscle fiber composition. Physiologic maneuvers such as caloric restriction in the overweight individual and regular physical exercise can improve tissue sensitivity to insulin; good preliminary evidence shows that these measures can also lower blood pressure in both normotensive and hypertensive individuals. A strong case can therefore be made for the use of physiologic intervention in the treatment of essential hypertension.
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PMID:The association of essential hypertension and diabetes. 268 84

Performing muscular exercise regularly is generally recommended to diabetics; indeed, exercise increases muscle insulin sensitivity, helps fighting overweight and, at least partly, tends to correct plasma lipids abnormalities, thus contributing to limit the development of atherosclerosis. Moreover, the practice of sport is beneficial from a psychological point of view, because, thanks to it, diabetic patients can match, even surpass, "the others" and overcome what they often consider as a disability. However, diabetes--especially type 1, insulin dependent, diabetes--deeply modifies the metabolic adaptations to muscular exercise; consequently, exercise must be performed only in good metabolic control conditions, for avoiding a worsening of ketonaemia. In adequately controlled diabetics, muscular exercise can be beneficial by reducing blood glucose levels; it can also lead to hypoglycaemia occurring during or after the exercise bout. In order to reduce the risk of exercise-induced hypoglycaemia, diabetics have to know how to modify three essential parameters of their treatment: (1) increase carbohydrate intake before, during or after exercise; (2) reduce the dose of the insulin acting during exercise, and this in relation to the usual doses and to exercise intensity; (3) under some circumstances, modify the site of insulin injection according to the type of exercise performed. Taking into account these parameters, some general rules can be assessed, which are to be adapted to every particular situation; the use of home blood glucose monitoring before and after exercise is not only useful but sometimes mandatory.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Adaptation to sports by insulin-treated diabetics]. 304 87

The insulinization of sulfonylurea secondary failures in the menopause without essential overweight (n = 25) on an average already in the first week of treatment led to an increase of the HDL-cholesterol and to clear reductions of the triglycerides and of the atherosclerosis risk index total cholesterol/HDL-cholesterol. When a higher dose of insulin was given and in a comparable condition of glycaemia these changes continued to increase up to the 6th week of treatment, total cholesterol and LDL-cholesterol decreased. Sulfonylurea secondary failures in the menopause which were euglycaemic after a 6-week insulin therapy (n = 20) revealed at this date a higher HDL-cholesterol, lower triglycerides and a more favourable quotient total cholesterol/HDL-cholesterol as well as a shorter duration of diabetes than the female patients with more unfavourable condition of glycaemia (n = 20). Already before the induction of the insulin therapy the later on euglycaemic female patients showed an on an average lower triglyceride level than the comparative group. The reductions of total cholesterol, LDL-cholesterol and triglycerides after insulinization did not significantly differ between the two groups. On the other hand, the decrease of the quotient total cholesterol/HDL-cholesterol was significantly more distinctly characterized in the female diabetics who had become euglycaemic after a 6-week insulin therapy on account of an increase of HDL-cholesterol which is to be registered only in these patients. In sulfonylurea secondary failures in the menopause without essential overweight insulinization leads to an improvement of the lipoprotein profile, particularly when a euglycaemic metabolic conduction is achieved.
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PMID:[Effect of insulin therapy on lipoprotein concentrations in secondary sulfonylurea treatment failures in menopause]. 314 25

In this study we have compared the lipoprotein patterns, in particular HDL subfractions, of 34 obese men to those of 34 normoponderal normolipemic men, matched for age and use of tobacco. Obesity was associated with increased VLDL concentrations in only half the subjects. HDL concentrations in all obese subjects were lower than in matched controls. The decrease was most marked in the HDL2 subfraction in which cholesterol and protein contents were decreased by 50%; it was independent of triglyceride levels and not related to the severity of overweight. Moreover, while HDL2 was negatively correlated with BMI (P less than 0.01) when both populations were considered together, the correlation disappeared when calculated separately within each population, suggesting a threshold effect. The low levels of HDL2 might result from discretely altered lipolysis, not sufficient to cause an elevation in fasting triglyceridemia. In this case, HDL2 should prove to be a sensitive index of lipolytic efficiency.
Atherosclerosis 1988 Sep
PMID:Low high density lipoprotein-2 concentrations in obese male subjects. 317 32

The authors compare the prevalence of risk factors of atherosclerosis and ischaemic heart disease (dyslipoproteinaemia, elevated arterial pressure, overweight, smoking, low physical activity) in representative samples of 11- and 14-year old school-children in Moscow, Novosibirsk and Tallin. The number of pupils subjected to medical examination totalled 3369; the respondence rate was 87-92%. There appeared a number of regional differences: the study in Moscow showed the highest prevalence of elevated arterial pressure and overweight, in Novosibirsk - hypertriglyceridaemia, in Tallin - hypercholesterolaemia. The most unfavourable situation was registered in school-children in Novosibirks. The authors conclude that when planning preventive measures among the population it is necessary to take into account regional specificities and differences in the intensity of risk factors in children populations.
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PMID:Epidemiological characteristics of dyslipoproteinaemia and certain other risk factors of atherosclerosis and ischaemic heart disease in 11- and 14-year children in different climatogeographic zones. Results of a cooperative study. 326 84

The control of coronary heart disease (CHD) depends primarily on its prevention at an early stage. It is generally agreed that this depends upon the elimination or treatment of the known risk factors for CHD. Among these, hyperlipidaemia occupies a central position. The diagnosis and treatment of this condition is the subject of this statement. Before initiating therapy for primary hyperlipidaemia the common causes of secondary hyperlipidaemia are sought and dealt with, including diabetes, hypothyroidism, over-use of alcohol, renal and liver diseases and certain drugs. Next, an assessment of all risk factors for CHD is carried out, i.e. family history of CHD, smoking, hypertension, high density lipoprotein (HDL) cholesterol measurement, diabetes mellitus and overweight. More intensive therapy is called for in patients with multiple risk factors than in those with lone hyperlipidaemia, and also after successful bypass operation or after coronary angioplasty. Evaluation of hyperlipidaemia in the patient's family is often appropriate. The diagnosis and follow-up of the hyperlipidaemic patient depend on reliable and well-controlled laboratory support. The primary hyperlipidaemias include several distinct diseases that are characterized by elevated serum levels of cholesterol and/or triglyceride with or without abnormally low levels of HDL cholesterol. From these measurements, low-density lipoprotein (LDL) cholesterol levels are calculated [except when triglyceride levels are greater than 500 mg dl-1 (5.6 mmol l-1)]. Elevated LDL levels are causally important in atherosclerosis, and occur in three disorders: familial hypercholesterolaemia, familial combined hyperlipidaemia and common hypercholesterolaemia. The finding of elevated serum triglyceride without marked hypercholesterolaemia may occur in familial hypertriglyceridaemia and sometimes in familial combined hyperlipidaemia. Elevation of serum cholesterol and triglyceride can have several genetic bases, including remnant (type III) hyperlipidaemia and familial combined hyperlipidaemia. The characteristic feature of remnant (type III) hyperlipidaemia (demonstrated by ultracentrifugation in a specialized laboratory) is the presence of cholesterol and triglyceride-rich very low density lipoproteins (VLDL), whereas combined (mixed) hyperlipidaemia is diagnosed when both VLDL (of normal composition) and LDL levels are elevated. Investigation of other family members is necessary to make the diagnosis of familial combined hyperlipidaemia. It depends on the identification of different lipoprotein profiles in affected members of the same family.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:The recognition and management of hyperlipidaemia in adults: A policy statement of the European Atherosclerosis Society. 340 74

Hyperlipidaemia appears to be a major factor in the development of graft atherosclerosis in the five- to 10-year period after coronary artery bypass graft surgery. A preliminary survey of coronary risk factors was conducted in 103 consecutive patients, who lived in the Sydney metropolitan area and who had undergone coronary artery bypass graft surgery six to 12 months previously in a single hospital unit. The information was collected by reply-paid questionnaire (response rate, 93%) and by clinical assessment (measurement rate, 85%). The group was predominantly (86%) male and elderly (mean age, 62 years; 60% of men and 85% of women were aged over 59 years). Seven per cent of the group had undergone a second operation. Approximately two of every three subjects manifested hypercholesterolaemia, one in four subjects manifested hypertension and one in three subjects was overweight, but only one in 20 subjects currently smoked cigarettes. The findings were compared with those in a general population sample; the assumption was made that coronary risk factors would be overrepresented in a sample of patients in whom coronary artery bypass graft surgery had been required. The data suggested that cigarette smoking was receiving appropriate intervention (before or after surgery), that hypertension was receiving some intervention, and that hyperlipidaemia was receiving insufficient intervention. On a purely empirical basis, the appropriate use of a cardiac rehabilitation service is suggested as one possible way of preventing the return of a large number of patients with graft atherosclerosis in later years.
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PMID:Coronary risk factors six to 12 months after coronary artery bypass graft surgery. 349 29

It has been postulated that platelet function plays an important role in the initiation of atherosclerosis. Currently there are no definitive data on the longer-term effects of regular physical exercise on platelet function in humans. We assessed the influence of regular moderate-intensity physical exercise (brisk walking to slow jogging) on platelet aggregation in a population-based sample of middle-aged, overweight, mildly hypertensive men in eastern Finland. In this controlled study, we evaluated the net effect of exercise on platelet aggregation by studying changes in optical density and ATP release in platelet-rich plasma. A significant inhibition of secondary platelet aggregation from 27% to 36% was observed in the men taking regular exercise. These findings give new insight into the possible protective effects of exercise against the risk of ischemic heart disease.
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PMID:Inhibition of platelet aggregability by moderate-intensity physical exercise: a randomized clinical trial in overweight men. 353 15

In a group of grossly obese patients serum lipoproteins and the intravenous fat tolerance test were analysed before a weight reduction program (n = 98), after 6 weeks (n = 58) and 1 year (n = 15). At one year follow-up the mean weight had fallen from 120 to 105 to 100 kg, respectively. In spite of severe overweight, only a moderate hypertriglyceridaemia (males mean fasting concentration of plasma triglycerides (TG) 2.50 +/- 1.36, females 2.03 +/- 1.94 mmol/l) was found before treatment. After 6 weeks significant reductions were found in VLDL-TG, -cholesterol, LDL-cholesterol and HDL-cholesterol (P less than 0.05 at least). After one year VLDL-TG was still below pretreatment level, LDL-cholesterol had increased above pretreatment level, whereas HDL-cholesterol was significantly higher compared to pretreatment (P less than 0.05). Some previous studies suggest that weight loss may lead to HDL-cholesterol reductions, which would be undesirable. The present study indicates that after sustained weight loss and at a stable lower body weight, HDL-cholesterol levels may increase above pretreatment levels after an initial drop during the catabolic weight reduction phase.
Atherosclerosis 1987 Apr
PMID:Early and late effects of weight loss on lipoprotein metabolism in severe obesity. 360 9

Although several risk factors for heart disease including high blood pressure, diabetes mellitus, and lipid and lipoprotein abnormalities are associated with overweight, overweight is not consistently associated with coronary heart disease risk. Some prospective studies of white men (life insurance cohorts, airline pilots, cancer study volunteers, and the Framingham population) have shown a positive linear relationship of weight to coronary heart disease. Other epidemiologic studies show a negative association, no association, a U-shaped relationship, or a threshold effect. The inconsistencies do not appear to be explained by differences in the definition or distribution of obesity, duration of follow-up, or risk factor distribution. Neither misclassification bias nor confounding by cigarette smoking or chronic disease appears to explain the inconsistencies. No known protective effect of obesity could explain these divergent findings. Inconsistent results with regard to the nature, strength, and linearity of the association between obesity and atherosclerosis do not support the hypothesis that obesity causes atherosclerosis, despite its biological plausibility.
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PMID:Obesity, atherosclerosis, and coronary artery disease. 390 65


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