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Query: UMLS:C0022116 (ischemia)
 91,303 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

An epidemiological study was conducted on 5163 men aged 40-59 years, made by occupational samples, from Florence and Rome to identify, by a three-stage procedure, subjects with asymptomatic silent ischemic heart disease (SIHD). This report describes some coronary risk factors. Men who are free from heart disease were compared with: (1) those having a low probability of SIHD (ECG signs only; n = 439); (2) those having a high probability of SIHD (ECG signs plus echographic signs, or positive markers of deficient perfusion, or altered radionuclide ventriculography; n = 104); (3) those having a definite SIHD (signs of the first two groups plus evidence from coronary angiography; n = 25). A clearcut increasing trend in the levels of major coronary risk factors, and in the multivariate estimated coronary risk for major events was found. The difference was not significant between highly probabile and definite cases of SIHD, due to the small numbers involved. Three multiple logistic models, with the three probability levels of silent ischemia as end-points, showed that four of 10 tested factors were associated with the presence of SIHD: age, systolic blood pressure, cigarette smoking and non-HDL serum cholesterol.
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PMID:Coronary risk factors and silent ischemic heart disease. The ECCIS Project. 799 59

Carotid duplex ultrasonography is the noninvasive procedure of choice for evaluating ECAD. However, carotid angiography should be performed before doing carotid endarterectomy. Multivariate logistic regression analysis showed that significant prognostic variables for ECAD in an elderly population are (1) cigarette smoking, (2) serum total cholesterol, (3) serum HDL cholesterol (inverse association), (4) diabetes mellitus, and (5) prior CAD. Patients with 80-100% ECAD develop a higher incidence of ABI and TIA than patients with 40-80% ECAD. Patients with 40-80% ECAD develop a higher incidence of ABI and TIA than patients with 0-40% ECAD. Patients with ECAD have a higher prevalence of prior CAD and develop a higher incidence of new coronary events than patients without ECAD. In patients with ECAD, significant prognostic variables for new coronary events are (1) silent ischemia, (2) prior CAD, (3) serum HDL cholesterol (inverse association), and (4) cigarette smoking. Risk factors for ECAD and CAD should be treated in patients with ECAD. Cigarette smoking must be stopped. Hypertension, dyslipidemia, and diabetes mellitus should be treated. Aspirin, 325 mg/d, should be administered to patients with ECAD. Ticlopidine hydrochloride, 250 mg two times per day should be considered in patients with ECAD who are unable to tolerate aspirin or who develop cerebrovascular events on aspirin. Carotid endarterectomy should be considered in symptomatic patients with 70-99% ECAD.
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PMID:Extracranial carotid arterial disease. 818 62

E.Z. former world champion and holder of several gold and silver medals from Olympic Games as long-distance runner, underwent at the age of 71 comprehensive investigations. In 1993 following methods were used to establish E.Z. body build and health: Family, personal and sports history, anthropometry, somatotype, body composition posture values, sports medicine examination, ECG at rest, X-rays of the lung and heart, echocardiography at rest, systolic time intervals at rest, spirography at rest, hematology, biochemistry, X-rays of bones, exercise ECG changes and spiroergometry. Today, a typical feature of E.Z.'s bodybuild is a great amount of body fats, flabby musculature, faulty posture, restricted mobility of the spinal column and surprisingly good foot arches. The clinical findings are appropriate for his age, on his ECG at rest are signs of subendocardial ischemia above the left ventricle, atrial fibrillation and ventricular extrasystoles (Lown 1 a-b). Exercise ECG resulted in a deepening of the ischaemic changes already at a working load of 50 W. Hematology revealed normochromic macrocyt anaemia, biochemistry a borderline mineralogram, hyperuricaemia, higher S-GMT and HDL-C, T-C at the limit of normal values. X-rays of the bones were remarkable in two findings of that age. The pelvis, lumbar spine and knee joints were free of the usual pathological findings (osteoarthrosis), but presented with an exceptionally advanced osteoporosis.
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PMID:Medical and anthropological study of a world and Olympic champion, long-distance runner, 35 years after the end his racing career. 864 15

68 middle aged men (43.8 +/- 7.4 years) without apparent health problems were examined. Medical check up, individual and family history, physical performance test on a bicycle ergometer, blood lipid level (total, T-, HDL-, LDL-cholesterol, triglycerides) and anthropometric measurements were executed. No serious health problems and complaints were assessed. Average values of body mass index (BMI = 26.7 +/- 3.4 kg/m2 and the percentage of depot fat (20.8 +/- 4.2%) were increased according to standard values. Waist/hip ratio was 0.9 +/- 0.1. Nearly a quarter of men was evaluated as obese. The results of work load test on a bicycle ergometer showed adequate results, however especially the diastolic blood pressure was increased in 11.5% of men at rest, and in an approximately same number of men there appeared the symptoms of cardiac ischemia after the work load. The prevalence of hypertension according to WHO criteria was 9.6%. TCH was 5.35 +/- 1.04, HDL 1.11 +/- 0.19, and triglycerides 1.81 +/- 0.77 mmol/l. Atherogenic index was 4.9 +/- 1.1. Glycemia was 5.04 +/- 0.66 mmol/l. In more than 20% of men there appeared risk values of blood lipids. -Indices evaluated from anthropometric measurements such as waist/hip ratio correlated significantly with blood lipids (positive correlation: total cholesterol, triglycerides, atherogenic index) and/or the level of physical performance (negative correlation), which indicated the possibility to use them as simple markers of cardiovascular risk in larger population samples examined under field conditions.
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PMID:The relationship of cardiorespiratory variables, blood lipids, amount and distribution of fat in middle aged men. 871 15

To evaluate the effects of short-term cholesterol-lowering treatment on myocardial effort ischemia, 22 patients with stable effort ischemia and mild to moderate hypercholesterolemia (low density lipoprotein [LDL] cholesterol 160 to 220 mg/dl) were randomly allocated at baseline (TO) in 2 groups. Group A included 12 patients treated with simvastatin 10 mg bid; group B included 10 patients treated with placebo. All patients underwent a treadmill electrocardiography (ECG) test; total cholesterol, HDL and LDL cholesterol, triglycerides, plasma, and blood viscosity were measured. All tests were repeated after 4 and 12 weeks. For 18 of the same patients (11 taking simvastatin, 7 receiving placebo), forearm strain-gouge plethysmography was performed at baseline and after 4 weeks, both at rest and during reactive hyperemia. At 4 and 12 weeks, group A showed a significant reduction in total cholesterol (p <0.05) and LDL (p <0.05), with unchanged HDL, triglycerides, blood, and plasma viscosity. Effort was unmodified, ST-segment depression at peak effort and ischemic threshold were significantly improved after 4 and 12 weeks (all p <0.05) with unchanged heart rate x systolic blood pressure product. A significant increase in the excess flow response to reactive hyperemia was detected in group A (p <0.03); group B showed no changes in hematochemical and ergometric parameters. These data suggest that cholesterol-lowering treatment is associated with an improvement in myocardial effort ischemia; this might be explained by a more pronounced increase of coronary blood flow and capacity of vasodilation in response to effort.
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PMID:Effects of short-term reduction in serum cholesterol with simvastatin in patients with stable angina pectoris and mild to moderate hypercholesterolemia. 885 79

30 patients (mean age 51.4 +/- 11.6 years; female n = 6) were studied early after orthotopic heart transplantation (11.6 +/- 5.5 weeks). Twelve recipients had undergone specific treatment for biopsy proven rejection. Using a mechanical intravascular ultrasound device (3.5-F catheter), 153 coronary artery segments (16 left coronary main stem, 122 left anterior descending artery, 15 left circumflex artery) were studied. Intimal index and circumferential extension of a three-layer appearance of the vessel wall were assessed. In all segments, systolic-diastolic changes in area (delta A) with respect to vessel area and pressure (delta P) were used to study normalized compliance (normalized compliance = [delta A/A]/delta P [mm Hg-1 x 10(3)]). Intravascular ultrasound findings were correlated to perioperative ischemia time, LDL/HDL-ratio, Lp(a) and donor age. In a subgroup of 13 recipients, intravascular ultrasound investigation was repeated after an interval of 67.4 +/- 10.2 weeks. At first investigation, mean intimal index of all coronary segments was 0.07 +/- 0.10. Mean circumferential extension of a three-layer appearance of the vessel wall was 84 +/- 112 degrees. Normalized compliance was 2.43 +/- 1.90 mm Hg-1 in the left main stem 2.45 +/- 1.47 mm Hg-1 within the left anterior descending artery, and 2.66 +/- 1.72 mm Hg-1 within the circumflex artery (differences n.s.). No correlation was found between intimal index and normalized compliance (r = -0.322), nor between circumferential extension of intimal thickening and normalized compliance (r = -0.362). Furthermore, there was no correlation between normalized compliance and donor age. Normalized compliance was significantly lower in recipients with proven rejection than in those without (1.76 +/- 0.81 versus 2.95 +/- 1.22 mm Hg-1, p = 0.005). Both, intimal index and circumferential extension of intimal thickening, were significantly higher in recipients following rejection periods (p < 0.05). The extent of coronary vessel wall alterations on ultrasound correlated to donor age but not to perioperative ischemia time, LDL/HDL-ratio and Lp(a). Re-investigation of a subgroup of 13 recipients 67.4 +/- 10.2 weeks after the first study showed an insignificant increase of the intimal index (from 0.03 to 0.09) and of the circumferential extension of intimal thickening (from 40 to 111 degrees). Normalized compliance changed from 2.53 +/- 1.48 to 2.87 +/- 1.33 mm Hg-1 (differences n.s.). Early after orthotopic heart transplantation, a significant correlation between atherosclerotic coronary vessel wall alterations assessed by intravascular ultrasound and donor age can be confirmed. Heart recipients following rejection periods present with significantly more atherosclerotic vessel wall alterations and a severely reduced compliance of the coronary vessels.
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PMID:[Intravascular sonographic findings after orthotopic heart transplantation: comparison with clinical factors]. 901 41

The epidemiologic approach to investigation of atherosclerotic cardiovascular disease has provided many insights into the preclinical and clinical spectrum of the disease. The hazard of developing atherosclerotic cardiovascular disease is substantial with coronary heart disease (CHD), the most common and most lethal feature. The outlook in those who manage to survive the initial episode is also serious, with a 10-year mortality rate of 37% for persons with angina and a 55% rate for those sustaining a myocardial infarction. Fifteen percent of persons developing CHD present with a fatal event, and 38% of infarctions go unrecognized. The presence of atherosclerosis in one vascular territory imposes an increased risk of its appearing in another area at two to six times the general population rate. The major cardiovascular risk factors adversely affect all arterial vascular territories so that correction of risk factors targeted at one particular atherosclerotic outcome may also favorably influence the other risk factors. Coronary disease is the most prevalent lethal hazard of hypertension, dyslipidemia, glucose intolerance, and cigarette smoking. These risk factors cluster and optimal therapy must improve the whole risk profile. Women share the same risk factors for CHD as men. Although women have a lower absolute risk for most risk factors, a high total/HDL cholesterol ratio, left ventricular hypertrophy, and diabetes each tend to eliminate the female advantage. Menopause also promptly escalates risk threefold. Although women tend to have a lower incidence than men, the initial attack is just as highly lethal in women, and their subsequent outlook as survivors is at least as serious as for men. Sudden death is a pre-eminent feature of coronary disease and cardiac failure. Coronary disease increases sudden death risk 3.3-fold and cardiac failure 4.8-fold. Sudden death incidence varies in relation to the same cardiovascular risk factors as coronary heart disease, with no unique risk factors identified. However, multivariate combinations of these in a profile can identify high-risk candidates for sudden death as well as coronary attacks in general. The key to prevention of sudden death is to prevent coronary attacks and cardiac failure. Despite aggressive cardiac revascularization and treatment of hypertension, congestive heart failure (CHF) has not decreased in prevalence, and innovations in the treatments of overt failure have not substantially improved survival. Median survival is only 1.7 years for men and 3.2 years for women. The conditional probability of developing CHF can be estimated using a logistic function comprised of age, systolic pressure, vital capacity, heart rate, ECG-left ventricular hypertrophy (LVH), glucose intolerance, x-ray enlargement, and presence of CHD and heart murmurs. Eighty percent of CHF events occur in persons in the upper quintile of multivariate risk. Continued clinical, metabolic, and epidemiologic research have expanded and refined atherosclerosis risk factors. The lipid connection is now concerned with the apoprotein makeup of the lipids, subfractions of lipids, and Lp(a). The diabetic influence is now focused on insulin resistance. Ambulatory monitoring is being used to evaluate blood pressure and silent ischemia. Fibrinogen and leukocyte counts have emerged as possible indicators of unstable lesions. Prospects for primary and secondary prevention are good if public health measures, health education, and preventive medicine are implemented based on existing knowledge of correctable or avoidable risk factors. The potential for more effective prevention continues to expand, and great advances have already been made in countries where aggressive preventive measures have been implemented to correct the major established risk factors.
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PMID:Hazards, risks, and threats of heart disease from the early stages to symptomatic coronary heart disease and cardiac failure. 921 Oct 12

Post-reperfusion inflammation as well as anti-allograft response occur following kidney transplantation. We evaluated tissue damage by multiple renal indicators and searched for rejection predictors forewarning serum creatinine upturns. Twenty recipients (43 +/- 9 y; donors' age 35 +/- 16 y) of first renal grafts were studied. All through their hospital stay (35 +/- 18 d, range 17-75 d) we measured serum levels of urea, creatinine and electrolytes along with urinary excretion rates of total protein, albumin, enzymes (GGT, NAG, AAP) and electrolytes. During the period of observation, peaks were seen on the 1st day for serum creatinine, serum K+ and urine albumin output; on the 2nd day for urine Na+, GGT, AAP and protein excretion rates; on the 4th day for urea and creatinine outputs; on the 5th day for NAG output. On the 14th day, serum urea and creatinine as well as urine GGT, NAG, AAP, albumin and total protein were still elevated compared to 20 healthy control subjects. Delayed/slow graft function was observed in six recipients with higher pre-transplantation plasma lipids and lower donor HDL cholesterol. Hospital stay time was correlated with need for post-transplantation dialysis (p = 0.01) and recipient proteinuria by time 0 (TO) to day 3 (p = 0.02). Cold ischemia time was positively associated with 0-3 d serum creatinine, 0-3 d urinary urea and protein outputs (multiple r 0.9, p < 0.001). Multivariate analysis of longitudinal data showed that recipients' serum creatinine was positively correlated (p < 0.001) with urine AAP and negatively correlated with urine albumin, with diuresis volume and urine creatinine (p < 0.01). Serum creatinine elevations were preceded (previous 1-7 d) by increases in urinary indicators, the probability being higher in the presence of multiple simultaneous abnormalities. Useful parameters predictive of favorable graft outcome prior to transplantation included a brief cold ischemia time and a normal donor/recipient serum lipoprotein profile. Following transplantation, useful parameters were a high diuresis volume at time zero along with low urine NAG and high albumin outputs; early (first opst-graft 3 d) polyuria, low urea and GGT, high K, NAG and total protein excretions.
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PMID:Urinary excretion rates of multiple renal indicators after kidney transplantation: clinical significance for early graft outcome. 957 59

Peripheral vascular disease (PVD) is characterized by arteriosclerosis and lower extremity ischemia which cause intermittent claudication. Patients grouped in the Fontaine stage II have more than 75% organic stenosis in their large coronary arteries and exhibit a number of alterations in blood coagulation and plasma lipids. The aim of this study was to evaluate an intervention program of lifestyle habits including dietary recommendations, moderate exercise and decreased smoking in a population of patients with PVD for a period of 15 months, with respect to plasma-lipid and lipoprotein composition as well as LDL susceptibility to peroxidation. These parameters are well known risk indicators of arteriosclerosis and coronary heart disease. A total 13 subjects diagnosed with PVD (Fontaine stage II) were selected, while a healthy age-matched group (n=20) was used as a reference. This study design was an uncontrolled trial of lifestyle interventions. The group of patients was examined at 0, 3, 6, 9, 12 and 15 months. Patients smoking one or more packets of cigarettes per day at the beginning of the study (54.2%) decreased smoking by as much as 7.7% 15 months later. In addition, physical activity intensified significantly (walking > 1 km: 13.1-77%) and treadmill running increased over the study period while the energy intake decreased by 10%. The percentage of saturated fat in the diet decreased by 10% while the intake of polyunsaturated fat rose, and monounsaturated-fat intake showed a parallel trend to increase; the average intake of cholesterol also fell by 10% and plasma triglycerides and HDL-cholesterol showed a trend to decrease and increase, respectively. No permanent changes in LDL lipid fractions for patients were detected during the follow-up period and no differences between patients and the age-matched reference group were found. The macrophage uptake of plasma-oxidized LDL was significantly higher in patients than in the reference group and no differences due to the intervention period were detected. In conclusion, the education in lifestyle and nutritional habits of patients with PVD led to reduced energy intake parallel with augmented physical activity as well to a fall in plasma triglycerides and a rise in HDL-cholesterol, which are good indicators of a reduced risk of vascular and myocardial complications.
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PMID:Lifestyle changes in free-living patients with peripheral vascular disease (Fontaine stage II) related to plasma and LDL lipid composition: a 15 month follow-up study. 1060 35

The role of vascular cells during inflammation is critical and is of particular importance in inflammatory diseases, including atherosclerosis, ischemia/reperfusion, and septic shock. Research in vascular biology has progressed remarkably in the last decade, resulting in a better understanding of the vascular cell responses to inflammatory stimuli. Most of the vascular inflammatory responses are mediated through the IkappaB/nuclear factor-kappaB system. Much recent work shows that vascular inflammation can be limited by anti-inflammatory counteregulatory mechanisms that maintain the integrity and homeostasis of the vascular wall. The anti-inflammatory mechanisms in the vascular wall involve anti-inflammatory external signals and intracellular mediators. The anti-inflammatory external signals include the anti-inflammatory cytokines, transforming growth factor-beta, interleukin-10 and interleukin-1 receptor antagonist, HDL, as well as some angiogenic and growth factors. Physiological laminar shear stress is of particular importance in protecting endothelial cells against inflammatory activation. Its effects are partly mediated through NO production. Finally, endogenous cytoprotective genes or nuclear receptors, such as the peroxisome proliferator-activated receptors, can be expressed by vascular cells in response to proinflammatory stimuli to limit the inflammatory process and the injury.
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PMID:Anti-inflammatory mechanisms in the vascular wall. 1134 96


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