Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0018799 (heart disease)
 34,133 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Primary care physicians have a vital role to play in identifying depression in their elderly patients. Diagnosis may be difficult, because symptoms are atypical and frequently include psychomotor agitation, somatic symptoms, and complaints of memory loss. Patients with medical illnesses, such as cancer, postmyocardial infarction, stroke, Parkinson's disease, and early Alzheimer's disease are particularly vulnerable to depression. Drugs that may cause depressive symptoms are digitalis at toxic levels, beta-blockers, centrally acting antihypertensives, immunosuppressants, and nonsteroidal anti-inflammatory agents. Cyclic antidepressants are the drugs of first choice. Selection depends on the patient's physical health and current medications and the side effect profile of the drug. Side effects are more pronounced in old age because of drug accumulation owing to slowed clearance. Troublesome side effects are anticholinergic effects, orthostatic hypotension, sedation, cardiotoxicity, and weight gain. The most useful antidepressants for geriatric patients are the secondary amines, desipramine and nortriptyline. The second-generation drug trazodone has the advantage of causing the least anticholinergic effects, but it is very sedating. Before treatment, the patient should have an electrocardiogram, liver function tests, tonometry, sitting and standing blood pressures, evaluation of urinary symptoms for outflow obstruction, review of current medications, and estimation of suicide risk. Cyclic antidepressants are contraindicated during recovery from myocardial infarction, in heart disease when there is severe impairment of myocardial performance, in seizure disorders, and in the presence of glaucoma or a large prostate. Drug interactions that may cause trouble can occur with epinephrine, MAO inhibitors, thyroid hormone, cimetidine, and centrally acting antihypertensives. Dosage should start low, increasing usually by 25 mg every 4 to 5 days until a therapeutic level is reached. Failure of a noradrenergic antidepressant after 4 to 5 weeks can be followed by a trial of a serotonergic drug. Drug serum level monitoring is useful for imipramine, desipramine, and nortriptyline. Monoamine oxidase inhibitors are effective in many elderly patients who are resistant to TCAs. Sympathomimetic drugs must be avoided with MAOIs. Elderly patients are at high risk of toxicity and drug interactions with lithium. Electroconvulsive therapy is useful for patients who do not respond to drug treatment, but medical complications, particularly cardiovascular, often occur in patients 75 or older. Many patients relapse after ECT. Psychotherapy together with pharmacotherapy may be the optimal treatment for elderly depressives. Older patients are more likely to become chronically depressed than younger patients. The risk of suicide in depressed elderly males is high, particularly in those with psychosocial problems, and depression rises with age.
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PMID:Management of depression in the elderly. 266 41

In order to discover the prevalence of white matter low attenuation (WMLA) in the brain and its relationship to vascular risk factors in our Memory Disorders Clinic patients we assessed brain CT scans of 202 patients referred to our clinic between January 1991 and December 1992. One hundred patients (49.5%) had WMLA, and the prevalence increased with increasing severity of cognitive impairment. It was 12% in patients with no evidence of dementia, 32% in those with isolated memory loss, and 59%) in patients with possible or probable dementia. There was a correlation between WMLA and systolic blood pressure, heart disease, peripheral vascular disease, focal neurological signs on examination and central atrophy on CT. No correlation was found between WMLA and low blood pressure, blood glucose or cholesterol level. Our findings indicate that WMLA probably plays an important role in cognitive impairment, and that thromboembolic rather than haemodynamic factors are probably more important in its pathogenesis.
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PMID:The relationship between white matter low attenuation on brain CT and vascular risk factors: a memory clinic study. 866 45

Heart disease, breast cancer, and hormone therapy were top clinical concerns in women's health in 1997. One of the major reports on heart disease confirmed that women are no different from men in terms of early infarct-related artery patency rates, reocclusion after thrombolytic therapy, and ventricular functional response to injury/reperfusion; nevertheless, women have 3 times the mortality of men in the first 30 days after an acute myocardial infarction. Research brought only modest gains in the understanding of breast cancer etiology in 1997, but engendered major debate on whether women younger than 50 years should have mammograms every 1 to 2 years. A National Institutes of Health consensus conference said no, but the National Cancer Institute's National Cancer Advisory Board said yes. Evidence of estrogen benefits and risks mounted: One report added to the data suggesting that estrogen may retard age-related memory loss, while another study reported that the risk of breast cancer significantly increased with long-term use of estrogens. The interest in selective estrogen receptor modulators (SERMs), also called "designer estrogens," grew. Efforts to develop pharmacologic treatment for obesity suffered a setback in 1997 when a team reported that 1 in 3 patients who used d-fenfluramine developed abnormal valvular thickening, with the most severe cases needing valve replacement. One of the most promising events in colorectal cancer, the third most common cancer in women, was the set of screening guidelines issued by the Agency for Health Care Policy and Research. The year ended with major ethical debates about multiple gestation and cloning.
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PMID:Perspective on women's health: editors' 1997-1998 year in review. 973 99

There is growing evidence that post menopausal use of estrogen may have a beneficial effect on cognition and may reduce the risk of dementia. In a vast majority of studies, the use of estrogen replacement in the postmenopausal period was associated with a reduced risk of dementia. Meta-analyses of both retrospective case controlled and prospective studies indicate a 30% reduction in the risk of dementia, with larger effect sizes (50% reduction) reported in the latter. Some, but not all, large epidemiological studies indicate that estrogen use is associated with better performance on both verbal and visual memory testing in later life. However, studies of the effect of estrogen on patients with Alzheimer's disease are less convincing with minimal effects reported in open trials and following brief exposure. Biological mechanisms, which could be responsible for some of these effects, include activation of the cholinergic system, anti-oxidant action, neurotrophic stimulation and anti-amyloidogenic properties. Beneficial effects of estrogen in primary prevention but not secondary prevention of heart disease indicates that the ability to observe beneficial effects may depend on the point at which intervention occurs. Ongoing double-blind randomized clinical trial to determine if estrogen is a safe and effective treatment for the prevention of memory loss and Alzheimer's disease will be described. Future work will undoubtedly include the identification of specific estrogenic receptors in the central nervous system that can be selectively activated without adverse involvement of other biologic systems.
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PMID:Understanding the role of estrogen on cognition and dementia. 1096 33

Several of the physical symptoms and illnesses related to HIV disease and its treatment--such as fatigue, weight changes, memory loss, depression, and atherosclerosis--mimic typical age-related health problems. It is estimated that at least 10% of HIV positive people in the United States are 50 years of age or older--a number that will certainly increase as people with HIV live longer thanks to effective antiretroviral therapy. For older women, sorting out the interplay between HIV, aging, and the side effects of medications can be very difficult. Many health problems are exacerbated by smoking, obesity, and poor health behaviors that can lead to an increased risk of illness or death. This article addresses two common health risks in aging women with HIV: heart disease and osteoporosis.
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PMID:Women and HIV. Aging with HIV. 1661 Jan 17

Postmortem studies have revealed a state of chronic inflammation in affected regions of the brain in Alzheimer's disease (AD). Chronic inflammation can be damaging to host cells and the brain may be particularly vulnerable as neurons are not replaced. Evidence suggests that the inflammation is killing neurons in AD brain, so anti-inflammatory agents might slow the process of the disease. More than 20 epidemiological studies have shown that persons taking nonsteroidal anti-inflammatory drugs (NSAIDs) have a greatly reduced incidence of AD. In one clinical trial, indomethacin appeared to halt the progression of memory loss in AD patients. NSAIDs inhibit synthesis of prostaglandins, which are fringe players in the inflammatory process. Agents that would block the more important actors, such as the complement system, activated microglia and inflammatory cytokines, might have important therapeutic benefits in AD as well as in other conditions, such as heart disease and stroke, where inflammation also plays a deleterious role.
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PMID:Chronic inflammation in Alzheimer's disease offers therapeutic opportunities. 1981 Oct 46

Memory loss is a prominent health concern, second only to heart disease for older individuals. Docosahexaenoic acid (DHA), the principle omega-3 fatty acid in brain and heart, plays an important role in neural and cardiac function. Decreases in plasma DHA are associated with cognitive decline in healthy elderly and Alzheimer's patients. Higher DHA intake and plasma levels are inversely correlated with increased relative risk of Alzheimer's disease (AD) and fatal coronary heart disease. DHA provides well known cardiovascular benefits (e.g. lower triglycerides, increased HDL cholesterol, decreased resting heart rate) in older adults. Preclinically, DHA supplementation restores brain DHA levels, enhances learning and memory tasks in aged animals, and significantly reduces beta amyloid, plaques, and tau in transgenic AD models. To date, clinical studies with DHA+EPA supplementation have shown some positive effects in mild cognitive impairment but not in AD, suggesting that early intervention may be a key factor to providing effective therapies. A recent clinical study examined individual effects of 900mg/d algal DHA as a nutritional supplement for age-related cognitive decline (ARCD). This randomized, double blind, placebo controlled study (n=485) found significantly fewer CANTAB Paired Associate Learning errors with algal DHA at six months versus placebo (diff. score -1.63+/-0.76, p=0.03). Positive effects on Verbal Recognition Memory (p<0.02) and significant decreases in resting heart rate with DHA (p<0.03) were observed, indicating improved learning and episodic memory functions and cardiovascular benefits for ARCD. Collectively, data reveal a potentially beneficial role for DHA in preventing or ameliorating cognitive decline and cardiovascular disease in the aged.
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PMID:Cognitive and cardiovascular benefits of docosahexaenoic acid in aging and cognitive decline. 2008 10

Vitamin D is a hormone that maintains healthy cells. It functions by regulating the low resting levels of cell signalling components such as Ca(2+) and reactive oxygen species (ROS). Its role in maintaining phenotypic stability of these signalling pathways depends on the ability of vitamin D to control the expression of those components that act to reduce the levels of both Ca(2+) and ROS. This regulatory role of vitamin D is supported by both Klotho and Nrf2. A decline in the vitamin D/Klotho/Nrf2 regulatory network may enhance the ageing process, and this is well illustrated by the age-related decline in cognition in rats that can be reversed by administering vitamin D. A deficiency in vitamin D has also been linked to two of the major diseases in man: heart disease and Alzheimer's disease (AD). In cardiac cells, this deficiency alters the Ca(2+) transients to activate the gene transcriptional events leading to cardiac hypertrophy and the failing heart. In the case of AD, it is argued that vitamin D deficiency results in the Ca(2+) landscape that initiates amyloid formation, which then elevates the resting level of Ca(2+) to drive the memory loss that progresses to neuronal cell death and dementia.This article is part of the themed issue 'Evolution brings Ca(2+) and ATP together to control life and death'.
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PMID:Vitamin D, reactive oxygen species and calcium signalling in ageing and disease. 2737 27

Environmental pollutants, such as pesticides, herbicides, additives to food and water, and electromagnetic fields threaten public health by promotion of cancer, heart disease and chronic diseases of aging. Many of these pollutants cause adverse health outcomes by effects on mitochondrial function to produce oxidative stress through loss of the active site complex for oxidative phosphorylation, thioretinaco ozonide oxygen nicotinamide adenine dinucleotide phosphate, from opening of the mitochondrial permeability transition pore. Glyphosate, fluoride, and electromagnetic fields are examples of carcinogenic pollutants that promote loss and decomposition of the active site for oxidative phosphorylation, producing mitochondrial dysfunction and oxidative stress. Ionizing radiation has long been known to be carcinogenic, and non-ionizing electromagnetic fields from microwaves, radar, cell phones and cathode ray screens are carcinogenic and produce deleterious effects on capillaries, nerve cells, blood brain barrier, embryonic and germ cells, lenses and cardiac function. Adverse health effects of electromagnetic fields include cataracts, infertility, congenital malformations, cancer, lymphocytosis, leukemia, hearing loss, blindness, retinal hemorrhages, cardiac arrhythmias, dermatitis, hair loss, depression, memory loss, premature aging, heart attacks, and weaponized mind control. The hyperhomocysteinemia, suppressed immunity, and altered oxidative metabolism observed in atherosclerosis and dementia are attributed to deficiency of adenosyl methionine which results from increased polyamine biosynthesis by pathogenic microbes that are demonstrated in atherosclerotic plaques and cerebral plaques. Thus, environmental pollutants potentially promote diseases of aging, atherosclerosis, cancer, and premature aging by production of mitochondrial dysfunction.
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PMID:Environmental Pollution, Oxidative Stress and Thioretinaco Ozonide: Effects of Glyphosate, Fluoride and Electromagnetic Fields on Mitochondrial Dysfunction in Carcinogenesis, Atherogenesis and Aging. 3258 Oct 36