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

Vasorenal hypertension occurs approximately in 5% of patients, suffering arterial hypertension and in majority of them constitutes the consequence of the renal arteries stenosing atherosclerosis. Stenting constitutes the method of choice in the treatment of the renal artery stenosis. Endoprosthesis of renal artery was performed in 113 patients, in 10 of them--bilateral stenting. Angiographic effect was achieved in more than 98% of observations and the clinical one--in more than 85%. Severe intraoperative complications were absent, all the patients are alive. In 13 patients the restenosis in the stent had occurred in 6-18 months after the operation, presenting by the clinical signs recurrence. To these patients the balloon angioplasty in the stent was accomplished. The depiction of technical peculiarities of the diagnosis and the procedure of the renal arteries stenting was suggested. According to modern recommendations of ACC/AHA, the stenting is indicated in the patients, suffering renal artery stenosis, and cardiac weaknesparoxysms, progressing arterial hypertension, unstable stenocardia, bilateral arterial affection. In the absence of symptoms, the efficacy of revascularization is not proved.
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PMID:[Renal arteries stenting. Indications, procedure, results]. 1831 68

Resveratrol may protect against metabolic disease through activating SIRT1 deacetylase. Because we have recently defined AMPK activation as a key mechanism for the beneficial effects of polyphenols on hepatic lipid accumulation, hyperlipidemia, and atherosclerosis in type 1 diabetic mice, we hypothesize that polyphenol-activated SIRT1 acts upstream of AMPK signaling and hepatocellular lipid metabolism. Here we show that polyphenols, including resveratrol and the synthetic polyphenol S17834, increase SIRT1 deacetylase activity, LKB1 phosphorylation at Ser(428), and AMPK activity. Polyphenols substantially prevent the impairment in phosphorylation of AMPK and its downstream target, ACC (acetyl-CoA carboxylase), elevation in expression of FAS (fatty acid synthase), and lipid accumulation in human HepG2 hepatocytes exposed to high glucose. These effects of polyphenols are largely abolished by pharmacological and genetic inhibition of SIRT1, suggesting that the stimulation of AMPK and lipid-lowering effect of polyphenols depend on SIRT1 activity. Furthermore, adenoviral overexpression of SIRT1 stimulates the basal AMPK signaling in HepG2 cells and in the mouse liver. AMPK activation by SIRT1 also protects against FAS induction and lipid accumulation caused by high glucose. Moreover, LKB1, but not CaMKKbeta, is required for activation of AMPK by polyphenols and SIRT1. These findings suggest that SIRT1 functions as a novel upstream regulator for LKB1/AMPK signaling and plays an essential role in the regulation of hepatocyte lipid metabolism. Targeting SIRT1/LKB1/AMPK signaling by polyphenols may have potential therapeutic implications for dyslipidemia and accelerated atherosclerosis in diabetes and age-related diseases.
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PMID:SIRT1 regulates hepatocyte lipid metabolism through activating AMP-activated protein kinase. 1848 75

Aortic stenosis is the most frequent valvular heart disease. Aortic sclerosis is the first characteristic lesion of the cusps, which is considered today as the process similar to atherosclerosis. Progression of the disease is an active process leading to forming of bone matrix and heavily calcified stiff cusps by inflammatory cells and osteopontin. It is a chronic, progressive disease which can remain asymptomatic for a long time even in the presence of severe aortic stenosis. Proper physical examination remains an essential diagnostic tool in aortic stenosis. Recognition of characteristic systolic murmur draws attention and guides further diagnosis in the right direction. Doppler echocardiography is an ideal tool to confirm diagnosis. It is well known that exercise tests help in stratification risk of asymptomatic aortic stenosis. Serial measurements of brain natriuretic peptide during a follow-up period may help to identify the optimal time for surgery. Heart catheterization is mostly restricted to preoperative evaluation of coronary arteries rather than to evaluation of the valve lesion itself. Currently, there is no ideal medical treatment for slowing down the disease progression. The first results about the effect of ACE inhibitors and statins in aortic sclerosis and stenosis are encouraging, but there is still not enough evidence. Onset symptoms based on current ACC/AHA/ESC recommendations are I class indication for aortic valve replacement. Aortic valve can be replaced with a biological or prosthetic valve. There is a possibility of percutaneous aortic valve implantation and transapical operation for patients that are contraindicated for standard cardiac surgery.
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PMID:[Aortic stenosis: from diagnosis to optimal treatment]. 1872 Jul 55

Acute coronary syndromes (ACSs) are the most common cause of hospital admission in patients with coronary artery disease (CAD). The term ACS refers to a spectrum of acute life-threatening disorders that includes: unstable angina (UA), non ST elevation myocardial infarction (NSTEMI) and ST elevation myocardial infarction (STEMI). The pathophysiology is similar: coronary atherosclerosis plaque rupture and subsequent thrombus formation. Such plaques usually are lesions with <50% stenosis severity prior to ACS, but are lipid-rich soft plaques (vulnerable plaques). The clinical presentation depends on the degree of partial (UA/NSTEMI) or complete lumen obstruction of the culprit coronary artery (STEMI). This article reviews the UA/NSTEMI ACS, since these two entities are closely related and usually, it is not possible to distinguish them upon presentation at the emergency department (ED). It presents the latest advancement on the pathophysiology, clinical presentations, diagnosis, risk stratification and management. It emphasizes on the selection of the optimal management approach which includes early invasive versus initial conservative strategies. Besides, it discusses the different approaches being used in the light of the information provided by the latest clinical trials. Although, at the present time, the optimal management approach remains unsettled, ACSs are usually managed using an early invasive strategy in tertiary care hospitals in the USA. The application of clinical practice guidelines developed by the American College of Cardiology and the American Heart Association (ACC/AHA) has confirmed definite improvement of patient care. Part of the information presented in this article, particularly in its management, is based on these guidelines (3). Evidence base scientific data insists upon using aggressive medical therapy (statins, anti-platelets, beta blockers [BBs], angiotensin converting enzyme inhibitors [ACE-Is], and control of coronary risk factors) as well as mechanical reperfusion, whether by percutaneous coronary intervention (PCI) or by coronary artery bypass graft (CABG). These approaches are considered complementary rather than as opposing strategies.
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PMID:Unstable angina and non ST elevation acute coronary syndromes. 1906 75

Renal artery stenosis (RAS) is common among patients with atherosclerosis, and is found in 20-30% of individuals who undergo diagnostic cardiac catheterization. Renal artery duplex ultrasonography is the diagnostic procedure of choice for screening outpatients for RAS. Percutaneous renal artery stent placement is the preferred method of revascularization for hemodynamically significant RAS, and is favored over balloon angioplasty alone. Stent placement carries a class I recommendation for atherosclerotic RAS according to ACC and AHA guidelines. Discordance exists between the very high (>95%) procedural success rate and the moderate (60-70%) clinical response rate after renal stent placement, which is likely to be a result of poor selection of patients, inadequate angiographic assessment of lesion severity, and the presence of renal parencyhmal disease. Physiologic lesion assessment using translesional pressure gradients, and measurements of biomarkers (e.g. brain natriuretic peptide), or both, could enhance the selection of patients and improve clinical response rates. Long-term patency rates for renal stenting are excellent, with 5-year secondary patency rates greater than 90%. This Review will outline the clinical problem of atherosclerotic RAS and its diagnosis, and will critically assess treatment options and strategies to improve patients' outcomes.
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PMID:Diagnosis and management of atherosclerotic renal artery stenosis: improving patient selection and outcomes. 1923 98

The rationale behind combined statin-acetylsalicylic acid therapy is based on the beneficial effects ofacetylsalicylic acid on thrombosis, the leading immediate cause of the majority of occlusive cardiovascular events, and those of statins on atherosclerosis, which is the main underlying cause. The clinical benefits of combined pravastatin-acetylsalicylic acid in the management of coronary patients have been demonstrated by a meta-analysis of five randomized clinical trials for secondary prevention; compared with pravastatin alone, the pravastatin-acetylsalicylic acid combination reduced the risk of fatal or non fatal myocardial infarction by 26%, the risk of ischemic stroke by 31%, and the risk of cardiovascular events at 5 years by 13%. Combined pravastatin-acetylsalicylic acid therefore appears to significantly reduce the cardiovascular risk in coronary patients. Following the AHA/ACC and National Cholesterol Education Program (NCEP) I and II guidelines, the proportion of patients treated by acetylsalicylic acid, beta-blockers and statins increased significantly: 94%, 57% and 91% respectively at one year versus 68%, 18% and 10% before the guidelines were applied. The impact of these treatments on clinical outcomes is statistically significant in terms of recurrent myocardial infarction, the need for re-hospitalization, sudden death or all-cause mortality. Patients treated with combined statin-acetylsalicylic acid therapy have significantly improved clinical outcome and a significantly lower rate of coronary events at 1 year of follow-up. These data therefore confirm the importance of optimizing therapeutic management of coronary patients, and in particular with combined acetylsalicylic acid-statin therapy.
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PMID:[Pravastatin and acetylsalycilic acid fixed-combination: a strategy to improve cardiovascular outcomes]. 1983 82

Hypertension is associated with an increased risk of cognitive decline, which is generally regarded as a consequence of advanced cerebral atherosclerosis. Many hypertensive patients, however, suffer from cognitive decline long before they have any signs of cerebrovascular disease. Therefore, this study examines direct effects of blood pressure on neurotransmitter status in the hippocampus, a vulnerable cerebral structure relevant for memory consolidation. Absolute glutamate concentration and N-acetylaspartate (NAA) concentration as an alternative marker of neuronal integrity were determined in the hippocampus and the cerebral cortex (anterior cingulate cortex; ACC) by 3-T proton magnetic resonance spectroscopy in 16 probands without any history of cerebrovascular disease. Memory function was tested by the auditory verbal learning test (AVLT) and the rivermead behavioural memory test (RBMT). Arterial stiffness was assessed by augmentation index (AI). Mean arterial pressure showed a significant negative age-adjusted correlation to absolute glutamate concentrations in the hippocampus (R=-0.655, P=0.011), but not in the ACC. There was no significant correlation of mean arterial pressure and NAA in either hippocampus or ACC. AI did not affect hippocampal glutamate. Moreover, there was a significant negative correlation between mean arterial pressure and AVLT (r=-0.558, P=0.025) and RBMT score (r=-0.555, P=0.026). There is an inverse relation between blood pressure and the concentration of hippocampal glutamate. Glutamate is essential for long-term potentiation, the neurobiological correlate for memory formation in the hippocampus. Thus, hypertension-associated cognitive decline may not only be mediated by structural atherosclerotic wall changes, but also by functional changes in neurotransmission.
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PMID:The impact of blood pressure on hippocampal glutamate and mnestic function. 2046 49

A renal artery stenosis (RAS) is common among patients with atherosclerosis, up to a third of patients undergoing cardiac catheterization. Fibromuscular dysplasia is the next cause of RAS, commonly found in young women. Atherosclerosis RAS generally progresses overtime and is often associated with loss of renal mass and worsening renal function (RF). Percutaneous renal artery stent placement is the preferred method of revascularization for hemodynamically significant RAS according to ACC and AHA guidelines. Several randomized trials have shown the superiority of endovascular procedures to medical therapy alone. However, two studies ASTRAL and STAR studies were recently published and did not find any difference between renal stenting and medical therapy. But these studies have a lot of limitations and flaws as we will discuss (poor indications, poor results, numerous complications, failures, poor technique, inexperienced operators, ecc.). Despite these questionable studies, renal stenting keeps indications in patients with: uncontrolled hypertension; ischemic nephropathy; cardiac disturbance syndrome (e.g. "flash" pulmonary edema, uncontrolled heart failure or uncontrolled angina pectoris); solitary kidney. To improve the clinical response rates, a better selection of the patients and lesions is mandatory with: good non-invasive or invasive imaging; physiologic lesion assessment using transluminal pressure gradients; measurements of biomarkers (e.g., BNP); fractional flow reserve study. A problem remains after renal angioplasty stenting, the deterioration of the RF in 20-30% of the patients. Atheroembolism seems to play an important role and is probably the main cause of this R.F deterioration. The use of protection devices alone or in combination with IIb IIa inhibitors has been proposed and seems promising as shown in different recent reports. Renal angioplasty and stenting is still indicated but we need: a better patient and lesion selection; improvements in techniques and maybe the use of protection devices to reduce the risk of RF deterioration after renal stenting.
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PMID:Renal angioplasty and stenting: is it still indicated after ASTRAL and STAR studies? 2092 31

New recommendations put forth in the American College of Cardiology Foundation/American Heart Association (ACC/AHA) Guidelines for Assessment of Cardiovascular Risk in Asymptomatic Adults and the updated 2010 Appropriate Use Criteria for Cardiac Computed Tomography both reflect the unparalleled prognostic power of CAC scoring and it's unique ability to further refine current risk prediction models. The ACCF/AHA guidelines maintain the measurement of CAC is reasonable for cardiovascular risk assessment in asymptomatic adults at intermediate risk (10%-20% 10-year-risk) (IIa, Level of Evidence: B), low-to-intermediate risk (6%-10% 10-year-risk) (IIb, Level of Evidence: B), and in diabetics over age 40 (IIa, Level of Evidence: B). There now exists a large body of published evidence depicting the independent and incremental prognostic value of CAC scoring over Framingham risk score-based strategy alone, a feature unmatched by any other biomarker under investigation. Early detection of subclinical atherosclerosis through noninvasive assessment of CAC leads to more accurate risk stratification and a substantially higher net reclassification improvement (NRI) among intermediate-risk groups, deeming many patients newly eligible for lipid-lowering therapy and other preventative measures.
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PMID:Is coronary artery calcium the key to assessment of cardiovascular risk in asymptomatic adults? 2116 7

Inflammation plays an important role in the pathogenesis of atherosclerosis and acute coronary syndromes (ACS). Interleukin-10 (IL-10) is a potent anti-inflammatory cytokine that mediates the inflammatory process. The objective of the present study was to evaluate the role of IL-10 gene polymorphisms as susceptibility markers for ACS in Mexican patients. IL-10 promoter polymorphisms (positions -1082, -819, and -592) were analyzed by 5' exonuclease TaqMan genotyping assays in 389 ACS patients and 302 healthy controls. ACS patients showed increased frequencies of IL-10-592 C allele and CC genotype when compared to healthy controls (pC=0.0006, OR=1.48 and pC=0.022, OR=1.56, respectively), whereas the frequencies of the A allele and AA genotype were decreased in patients (pC=0.0006, OR=0.68 and pC=0.006, OR=0.57, respectively). When the distribution of IL-10-592 genotypes was analyzed separately in women and men (patients and healthy controls), a different distribution of alleles and genotypes was observed only in the group of men. In this case, increased frequency of C allele (pC=0.004, OR=1.46) and decreased frequencies of A allele (pC=0.004, OR=0.68) and AA genotype (pC=0.023, OR=0.56) were observed in the group of patients when compared to healthy controls. Multiple logistic analyses by gender showed that male individuals with IL-10-592CC+AC genotypes had 3.54-fold increased risk of developing ACS than individuals with AA genotype (p<0.001). The analysis of linkage disequilibrium showed one (ACC) increased haplotype in patients as compared to healthy controls. The results suggest that IL-10 gene polymorphisms could be involved in the risk of developing ACS in the Mexican population.
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PMID:Alleles and haplotypes of the interleukin 10 gene polymorphisms are associated with risk of developing acute coronary syndrome in Mexican patients. 2148 2


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