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Query: UMLS:C0018799 (heart disease)
 34,133 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Abnormalities of glucose, insulin, and lipoprotein metabolism are common in patients with hypertension. This constellation of risk factors may be recognized at a young ages and is, at least in part, inheritable. Insulin resistance and compensatory hyperinsulinemia may be primary events, and enhanced sympathetic activity and diminished adrenal medullary activity could be important links between the defect in insulin action and the development of hypertension and the associated metabolic abnormalities. But not all hypertensive patients have insulin resistance. It is possible that insulin resistance, and compensatory hyperinsulinemia have major roles in the regulation of blood pressure in susceptible subjects predisposed to hypertension by hereditary or environmental factors. Considerable evidence, both in experimental animal models and in humans, points to hypertension as being of critical importance in the pathogenesis of severe diabetic heart disease. In diabetic hypertensive cardiomyopathy, coronary artery disease as well as structural and functional abnormalities are more pronounced than would be expected from either process alone. The hypertension increases the risk of diabetic nephropathy in non-insulin-dependent diabetic patients. Microalbuminuria is a powerful predictor of mortality in these patients. It seems that angiotensin-converting-inhibitors have efficacy in postponing nephropathy in hypertensive non-insulin-dependent diabetic patients. In patients with hypertension and diabetes, additional clinical trials are required to identify the interventions that will most effectively reduce not only overall risk but also improve cardiovascular disease prognosis.
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PMID:[Arterial hypertension and disorders of hydrocarbon metabolism]. 988 63

The target organ failures associated with uremia are most often considered to be caused by processes other than uremia per se. Heart disease, for example, is considered the product of hypertension, lipid abnormalities, and so forth, rather then the uremic state. Erythropoietin deficiency, blood loss, and iron deficiency are believed to cause anemia, rather than the uremic state. Malnutrition is believed to be the product of poor nutrient intake and perhaps nutrient losses, rather than uremia per se. This article reviews evidence suggesting that anemia and malnutrition share a common cause; the acute-phase inflammatory process that is a normal host-defense mechanism. Given the high prevalence of heart disease among patients with end-stage renal disease (ESRD), data indicating activation of the acute-phase process in patients with kidney failure, and emerging evidence that the process has a significant role in the risk for cardiovascular disease among patients without kidney failure, there is a strong likelihood that heart disease will share with anemia and malnutrition the acute-phase state as a contributing cause. Thus, instead of disconnected target organ failures, each with different antecedent causes, we see emerging the likelihood of a unifying pathobiology for uremia. The antecedents of morbidity and mortality appear as a web of organ failures connected by a common pathobiology. Whereas each failure likely has contributing causes other than the acute-phase state, they probably share the state as a causative, contributing, or exacerbating factor.
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PMID:Acute-phase inflammatory process contributes to malnutrition, anemia, and possibly other abnormalities in dialysis patients. 989 76

Although recombinant erythropoietin (rHuEPO) has been available for use in dialysis patients since 1989, there is little information available on the optimal hematocrit to target in this patient population. The optimal hematocrit is the value that supplies the amount of oxygen to specific tissues and organs that maximizes the efficiency and effectiveness of organ function. Very few prospective studies have been published on this issue, and the retrospective review of clinical practice data is inadequate because of the small number of patients maintained with a hematocrit greater than 36%. Several recent abstracts shed light on this issue, however, and additional publications are likely soon. The available data indicate that brain and cognitive function are better at a normal hematocrit compared with the currently achieved values (31% to 32%). In addition, quality of life and exercise capacity improve as hematocrit is normalized. The AMGEN Normal Hematocrit Cardiac Trial (NHCT), studying the effects of normalizing the hematocrit in dialysis patients with heart disease, does not clearly show the benefit or harm of a normal hematocrit in this patient setting, although within both study groups (hematocrit of 30% v 42%), survival was better in patients with higher hematocrits. The challenge for clinicians is to determine the optimal hematocrit for a specific patient that maximizes organ function but does not cause adverse effects. Over the next few years, several studies should be published based on current abstracts, and if the results remain as reported, the evidence will be accumulating that normal hematocrits are beneficial in end-stage renal disease (ESRD) patients.
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PMID:Optimal hematocrit in patients on dialysis therapy. 989 81

> Objective: To investigate the perinatal management and outcome of fetuses diagnosed prenatally with single umbilical artery. Methods: Sixty-one consecutive fetuses with single umbilical artery diagnosed prenatally by ultrasonography were included. Thorough prenatal ultrasonographic screening was carried out to detect associated congenital anomalies. Chromosome study by either amniocentesis or cordocentesis was performed for all 61 of the fetuses with single umbilical artery. Thorough physical examination or autopsy was performed after delivery. Results: All 61 fetuses were confirmed to have single umbilical artery after delivery. Ten (16.4%) of the 61 fetuses with single umbilical artery had abnormal karyotypes. In the single umbilical artery group with abnormal karyotyping, 8 had detectable structural abnormalities, 1 had symmetrical intrauterine growth retardation, and 1 had no apparent congenital anomalies. For the 51 fetuses with normal karyotyping, 28 had abnormal ultrasonographic findings. In 23 fetuses with single umbilical artery without chromosomal or structural anomalies diagnosed in utero, 7 (30.4%) were found to have structural anomalies (3 with congenital heart disease, 3 with congenital renal disease, and 1 with limb deformity) after birth. Conclusion: Prenatal diagnosis of single umbilical artery should be made with caution to avoid false positive cases. When single umbilical artery is diagnosed prenatally, we suggest 1) targeted ultrasonography for detection of anomalies with cardiovascular, genitorenal, and limb-skeletal systems; 2) chromosome study for those with intrauterine growth retardation or other associated defects; and 3) thorough investigation after birth.
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PMID:Perinatal Management and Outcome of Fetuses with Single Umbilical Artery Diagnosed Prenatally. 989 48

We have studied 92 patients with Alagille syndrome (AGS) to determine the frequency of clinical manifestations and to correlate the clinical findings with outcome. Liver biopsy specimens showed paucity of the interlobular ducts in 85% of patients. Cholestasis was seen in 96%, cardiac murmur in 97%, butterfly vertebrae in 51%, posterior embryotoxon in 78%, and characteristic facies in 96% of patients. Renal disease was present in 40% and intracranial bleeding or stroke occurred in 14% of patients. The presence of intracardiac congenital heart disease was the only clinical feature statistically associated with increased mortality (P <.001). Initial measures of hepatic function in infancy including absence of scintiscan excretion were not predictive of risk for transplantation or increased mortality. The hepatic histology of these AGS patients showed a significant increase in the prevalence of bile duct paucity (P =.002) and fibrosis (P <.001) with increasing age. Liver transplantation for hepatic decompensation was necessary in 21% (19 of 92) of patients with 79% survival 1-year posttransplantation. Current mortality is 17% (16 of 92). The factors that contributed significantly to mortality were complex congenital heart disease (15%), intracranial bleeding (25%), and hepatic disease or hepatic transplantation (25%). The 20-year predicted life expectancy is 75% for all patients, 80% for those not requiring liver transplantation, and 60% for those who required liver transplantation.
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PMID:Features of Alagille syndrome in 92 patients: frequency and relation to prognosis. 1005 85

Prospective controlled clinical trials with cardiovascular events and mortality as end points are needed to provide clinicians with a fully informed choice of optimal hypertensive therapy. Seven trials (six of them still ongoing) have provided insight into the effects of the third-generation calcium antagonist, amlodipine, on mortality and end-organ damage in patients with hypertension or other forms of cardiovascular disease. The completed PRAISE study has addressed the safety of amlodipine in patients with advanced heart failure (CHF). The trial showed that amlodipine does not increase mortality or morbidity in CHF patients and significantly reduces the risk for these end points in patients whose CHF has a nonischemic etiology. The PRAISE-2 study is now under way to further evaluate the benefits of amlodipine in nonischemic CHF patients. The ALLHAT trial compares the effects of standard diuretic treatment with three alternative treatments (amlodipine, lisinopril, and doxazosin) on the incidence of fatal coronary artery disease (CAD) and nonfatal myocardial infarction (MI) in 40,000 hypertensive patients. The ASCOT trial compares the effects of amlodipine +/- perindopril with atenolol +/- bendrofluazide on fatal CAD and nonfatal MI in 18,000 high-risk patients. The PREVENT trial tests a similar hypothesis, looking at the effects of amlodipine on arterial atherosclerotic lesions, and the AASK trial is evaluating the effects of amlodipine on renal disease. The PRAISE trial has provided valuable information on the safety and efficacy of amlodipine in preventing death and disability in patients with CHF. The six ongoing trials will provide important additional information on the effect of amlodipine in patients with heart disease of other etiologies.
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PMID:Long-term morbidity and mortality trials with amlodipine. 1007 Dec 56

This review describes to date the experience with combined heart-kidney transplant (HNTx) from a single donor. HNTxs are very uncommon relative to single-organ transplants of the heart and kidney, as well as combined kidney-pancreas and combined kidney-liver transplants. Two groups of patients seem to be candidates for HNTx: 1) those with end-stage heart disease and fixed (nonreversible) renal disease, and 2) those with end-stage renal disease and severe cardiac disease unamenable to other treatment. In both groups, significant disease should be limited to the heart and kidney. Reports to date generally suggest decreased cardiac rejection in HNTx relative to heart-only transplants. Renal rejection in HNTx seems markedly reduced relative to kidney-only transplants. Simultaneous rejection of both organs is very uncommon, and, therefore, surveillance of both organs is necessary. Short-term patient survival seems to be acceptable in HNTx. Long-term patient and graft survival remains unknown, and further multi-center reports are needed.
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PMID:An overview of combined heart and kidney transplantation. 1019 70

The autoimmune nature of insulin-dependent, or type 1, diabetes targets the beta-cells of the pancreas for destruction and results in a lifelong commitment to insulin replacement therapy. Although the number of formulations and dosing of insulin have become more sophisticated and more efficient in recent years, insulin therapy alone is unable to prevent nephropathy, retinopathy, or vascular and heart disease, which still occur in a large number of patients. Different approaches have been attempted to eliminate the requirement of exogenous insulin administration. Historically, these have included pancreatic and islet transplants, which were later combined with treatments intended to halt the destructive process directed against the islets. Despite significant advances made in all of these areas, each approach faces a hostile immunological response that frequently ends with the loss of the islets. Gene therapy-based approaches add a new dimension to the efforts aimed at specifically blocking the immunological attack against the islets in genetically at-risk individuals (autoimmunity) or the immunological response against transplanted allogeneic islets (rejection). This new technology may have an important role in the therapy and cure of type 1 diabetes.
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PMID:Targeting autoimmune diabetes with gene therapy. 1053 43

The long-term consequences of cardiac alterations in children with chronic renal failure (CRF) and after renal transplantation (TX) are largely unknown. Studies in adults with end-stage renal disease (ESRD) assume that the fate of many pediatric patients is determined by a high cardiovascular morbidity and mortality. This review describes clinical manifestations, pathophysiology, cardiac function and structure, and management of heart disease in children with CRF and post transplant. Echocardiography and Doppler ultrasonography allow differentiation of three functional disturbances: hypercirculation, systolic left ventricular (LV) dysfunction, and diastolic LV dysfunction, in addition to analysis of LV size and myocardial mass. From adult studies LV hypertrophy is recognized as an early prognostic marker of cardiovascular disease. It is present in about half of children with ESRD and after TX. It may regress, at least in part, by control of hypertension, hypervolemia, and anemia. Experimental studies have shown that, independent of these hemodynamic complications, uremia is associated with structural abnormalities of the heart, which were also described in adult patients with ESRD. These lesions consist mainly of hypertrophy of cardiomyocytes, interstitial fibrosis, and vascular changes (rarefied capillaries, thickened arteriolar walls). Cardiac complications in children with CRF and after TX deserve regular clinical and echocardiographic monitoring in order to minimize later cardiovascular morbidity by appropriate treatment.
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PMID:Cardiac function and structure in patients with chronic renal failure. 1060 58

Hypertension and end-stage renal disease (ESRD) constitute a major health threat to Puerto Ricans in the United States and in the Commonwealth. In the Hispanic population of the United States, Puerto Ricans seem to have a worse health status than Mexican- and Cuban Americans. Poverty, language, and lack of education increase the risk of less-than-adequate diagnosis and treatment of hypertension. In the Commonwealth, hypertension is a common problem. Deaths caused by heart disease continue to increase on the island. Although the health care system in Puerto Rico continues to improve, changes in diet, increased social stress, and the high prevalence of diabetes mellitus and obesity may add to the increased death rate from cardiovascular causes. The incidence and prevalence of ESRD in Puerto Rico is as high as in the United States; however, diabetes mellitus seems to be the primary diagnosis in a larger number of patients with ESRD than in the U.S. Preventive and control measures must be urgently taken by public health officials to minimize the impact of these disorders in the health of Puerto Ricans.
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PMID:Hypertension and renal disease in Puerto Ricans. 1061 61


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