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 124,988 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Fasting and postglucose hyperinsulinemia are recognized risk factors for acute coronary events. The insulin reactivity of patients with acute coronary syndromes, however, has not been carefully compared with that of patients with chronic stable angina. We used Bergman's minimal model to analyze the insulin response to intravenous glucose in 21 subjects: 8 patients with previous (>3 months) acute coronary syndrome but no effort-related angina; 6 patients with stable effort angina but no prior acute event; and 7 healthy controls. Diabetes mellitus, systemic hypertension, dyslipidemias, and obesity were excluded. All patients underwent coronary angiography. Insulin sensitivity, glucose effectiveness, and glucose tolerance were determined from insulin and glucose concentrations measured frequently up to 3 hours after a 0.33 g/kg intravenous glucose bolus. Patients with previous unstable angina or acute myocardial infarction had less extensive disease at angiography than patients with stable angina (p = 0.007). Both patient groups had higher basal and 180-minute insulinemia than controls (p <0.0007). However, patients with stable angina did not differ significantly from controls with regard to early and late insulinemic response to glucose. In contrast, patients with previous acute onset of ischemia had significantly greater 180-minute integrated insulinemia (p = 0.04) and reduced insulin sensitivity (p = 0.05) after the glucose challenge than did the stable angina group. These data suggest that patients with acute presentation of coronary artery disease, compared with patients with uncomplicated chronic stable angina, have an impaired insulin response to glucose despite less extensive coronary disease at angiography.
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PMID:Comparison of insulin response to intravenous glucose in healed myocardial infarction, in "cooled-off" unstable and stable angina pectoris, and in healthy subjects. 1053 2

Coronary heart disease (CHD), the single greatest cause of death in women, is often unrecognized by health care providers and individuals suffering from the disease. CHD is a process in which atherosclerotic lesions composed of lipoprotein particles, macrophages, leukocytes, and smooth muscle cells narrow the lumen of coronary arteries. Two clinical conditions may develop, acute myocardial infarction (AMI) and unstable angina. Signs and symptoms of CHD in women may differ from those of men, leading to delays in treatment and diagnosis. Several well-recognized risk factors for CHD have been identified, including aging, hypertension, hyperlipidemia, diabetes, smoking, obesity, and sedentary lifestyle. The role of the laboratory in CHD involves diagnosing and monitoring persons at risk for developing CHD, diagnosing AMI, monitoring effectiveness of perfusion post AMI, and patient risk stratification.
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PMID:Coronary heart disease in women and the role of the laboratory. 1055 11

In a cross-sectional study of 293 nondiabetic patients (169 men and 124 women) referred for the diagnosis and treatment of hyperlipidemia, our specific aim was to determine whether fasting serum insulin independently contributes to the prediction of atherosclerotic cardiovascular disease (ASCVD) status. Of the 169 men and 124 women, 65 (38%) and 44 (35%), respectively, had ASCVD with at least one of the following: unstable angina, myocardial infarction (MI), angioplasty, coronary artery bypass graft (CABG), claudication, transient ischemic attack, or ischemic stroke. In addition, 42% and 38% had fasting hyperinsulinemia (> or =20 microU/mL). Fasting serum insulin of 20 microU/mL or higher was very common in women (59% to 100%) and men (67% to 88%) when hypertension, obesity, top-decile triglyceride (TG), and bottom-decile high-density lipoprotein cholesterol (HDLC) were concurrent in various combinations. ASCVD events (present or absent) were dependent variables in a stepwise logistic regression model with explanatory variables including age, gender, race, hypertension, cigarette smoking, ASCVD in first-degree relatives at age 55 years or less, Quetelet Index, fasting serum insulin, a gender x insulin interaction term, anticardiolipin antibodies (ACLAs) IgG and IgM, total cholesterol to HDLC ratio, TG, lipoprotein(a) [Lp(a)], and homocysteine. The risk odds ratio for ASCVD (109 events and 184 nonevents) for subjects with top-decile insulin (vthe bottom nine deciles) was 3.71, with a 95% confidence interval (CI) of 1.62 to 8.9 (P = .002). For patients with MI and/or CABG and/or angioplasty ([MCA] 63 events and 184 nonevents), the risk odds ratio for top-decile insulin versus the rest was 5.07 (95% CI, 1.83 to 14.8, P = .002). For patients with MCA at age 55 or less, the gender x insulin interaction term was significant (P = .0004); the risk odds ratio for men with top-decile insulin was 13.28 (95% CI, 3.82 to 51.65, P = .0001). Hyperinsulinemia is very common in nondiabetic hyperlipidemic women and men. Fasting serum insulin, a crude, simple, practical, and inexpensive measure, independently and uniformly improved the prediction of ASCVD status beyond traditional risk factors and lipid variables in patients referred for treatment of hyperlipidemia.
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PMID:Contribution of fasting hyperinsulinemia to prediction of atherosclerotic cardiovascular disease status in 293 hyperlipidemic patients. 1058 54

Recently, unstable angina, acute myocardial infarction and sudden cardiac death have often been put together under the name 'acute coronary syndromes', because almost all of these conditions have been shown to be caused by thrombotic occlusion of a coronary artery following atherosclerotic plaque disruption. Acute coronary syndromes occur more frequently in the coronary arteries with no significant organic stenosis than in those with a higher degree of stenosis. A plaque prone to disruption has a thin fibrous cap, a large lipid core and increased infiltration of macrophages and T lymphocytes. The elimination or control of risk factors for atherosclerosis such as dyslipidemia, hypertension, smoking, diabetes mellitus, obesity and lack of exercise is essential for the prevention of acute coronary syndromes.
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PMID:[Acute coronary syndromes]. 1130 10

The aim of this study was to evaluate the distribution and hospital treatment of cardiovascular risk factors in coronary patients. A transverse observational study was carried out in 77 cardiological centres throughout France. All patients with a history of myocardial infarction or of unstable angina during the month of January 1998 were enrolled. The clinical features of 1334 patients (71.4% men, 746 myocardial infarction, 588 unstable angina) on hospital admission were analysed. The prevalence of smoking, dyslipidaemia, hypertension and obesity was 49, 45, 42, 19 and 11% respectively in the men and 17, 46, 63, 23 and 10% respectively in the women. The number of treatable risk factors slightly decreased in the oldest age group. The prevalence of hypertension increased with age whereas smoking and dyslipidaemia decreased in both men and women. Obese and diabetic patients had more risk factors than the others. A little less than half of patients with dyslipidaemia were under no preventive measures (diet and/or lipid-lowering drugs) and 40% of men with a previous history of coronary artery disease continued to smoke. The authors conclude that men over 85 and women over 75 years of age have fewer risk factors than other age groups and the type of risk factor varies with age. The treatment of dyslipidaeamia and smoking is still inadequate and should be improved.
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PMID:[Distribution and treatment of cardiovascular risk factors in coronary patients: the Prevenir Study]. 1149 27

Certain markers of systemic inflammation are powerful predictors of cardiovascular events. Fibrinogen, C-reactive protein (CRP), and cytokines are among the inflammatory markers associated with various cardiovascular end points. Fibrinogen and CRP both have been associated with coronary artery disease (CAD) mortality in patients with stable angina. High-sensitivity CRP (hs-CRP) and fibrinogen also have prognostic value in patients with unstable angina. In addition to prognostic implications, several cardiovascular risk factors (eg, smoking, obesity, diabetes) are associated with high levels of fibrinogen and hs-CRP. Benefits from aspirin are more likely in patients whose hs-CRP levels are very high. Some fibrates decrease fibrinogen levels and hs-CRP. Statin therapy either reduces the CAD risk associated with system inflammation or lowers circulating levels of hs-CRP.
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PMID:Utility of inflammatory markers in the management of coronary artery disease. 1286 50

Antiplatelet drugs have an established place in the prevention of vascular events in a variety of clinical conditions, such as myocardial infarction, stroke and cardiovascular death. Both European and American guidelines recommend the use of antiplatelet drugs in patients with established coronary heart disease and other atherosclerotic disease. In high-risk patients, such as those with post-acute myocardial infarction (AMI), ischaemic stroke or transient ischaemic attack, and in patients with stable or unstable angina, peripheral arterial occlusive disease or atrial fibrillation, antiplatelet treatment may reduce the risk of a serious cardiovascular event by approximately 25%, including reduction of non-fatal myocardial infarction by 1/6, non-fatal stroke by 1/4 and cardiovascular death by 1/6. Some data indicate that antiplatelet drugs may also have a role in primary prevention. In people who are aged over 65 years, or have hypertension, hypercholesterolaemia, diabetes, obesity or familial history of myocardial infarction at young age, aspirin may reduce both cardiovascular deaths and total cardiovascular events. Aspirin has been studied and used most extensively. It may exert its beneficial effect not only by acting on platelets, but also by other mechanisms, such as preventing thromboxane A2 (TXA2)-induced vasoconstriction or reducing inflammation. Indeed, experimental data show that low-dose aspirin may suppress vascular inflammation and thereby increase the stability of atherosclerotic plaque. Moreover, in human studies, aspirin seems to be most effective in those with elevated C-reactive protein levels. Vascular events, however, do occur despite aspirin administration. This may be due to platelet activation by pathways not blocked by aspirin, intake of drugs that interfere with aspirin effect or aspirin resistance. In the CAPRIE (Clopidogrel vs. Aspirin in Patients at Risk of Ischaemic Events) study, long-term clopidogrel administered to patients with atherosclerotic vascular disease was more effective than aspirin in reducing the combined risk of ischaemic stroke, myocardial infarction or vascular death. In the setting of coronary stenting, a double regimen including aspirin and ticlopidine or clopidogrel has proved more effective in the prevention of in-stent thrombosis than aspirin alone. Chronic oral administration of the inhibitors of platelet membrane receptor GP IIb/IIIa has been largely disappointing.
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PMID:Role of antiplatelet drugs in the prevention of cardiovascular events. 1459 62

The Tunisian epidemiological data on cardiovascular disease in the hospital environment are scarce. The aim of this study was to evaluate the frequency of cardiovascular risk factors and their association in patients hospitalised for coronary disease in coronary care units at Rabta, Charles Nicolle, Habib Thameur and Military hospitals, Tunis, over the period 1994-1998. The clinical features of 6901 patients (75.7% men, 3760 myocardial infarction, 3141 unstable angina) on hospital admission were analysed. The prevalence of smoking, dyslipidemia, hypertension, diabetes and obesity was 86; 49.8; 33.9; 40.7 and 15.2% respectively in the men and 12.9; 52.4; 64.6; 53.4 and 29.8% respectively in women. With this risk factor profile Tunisia has to implement a national strategy of primary prevention and heart health promotion in addition to the efforts recently made in secondary prevention of some chronic disease such as hypertension, diabetes and smoking.
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PMID:[Distribution of cardiovascular risk factors in a Tunisian cohort of 6901 coronary patients]. 1500 6

Morbidity and mortality rates from heart diseases are highly represented in geriatric-aged patients, but these patients also have supporting diseases. Acute coronary syndrome includes unstable angina and acute myocardial infarction with and without ST elevation. The aim of this study was to make a retrospective morbidity analysis of patients admitted to the emergency department. The study is made for a period of three years (from 1998 to 2000). It includes 588 patients divided by age (395 were 65-75 years old; 193 were older than 75 years) and sex (there were 326 men and 262 women). Comorbidity and mortality were investigated. Patients with one, two, three, and more than three supporting diseases were 6.29%, 23.13%, 68.53%, and 2.04%, respectively, of the total number. The most frequent geriatric patients had heart failure, followed by endocrinological diseases (type 2 diabetes, obesity, struma), neurological diseases (insultus, paresis), and chronic kidney diseases (pielonephritis, nephrolithiasis). The combination of hypertension, heart failure, and type 2 diabetes had the highest comorbidity frequency. The mortality rate for 1998 was 8.81%, for 1999 7.74%, and for 2000 13.41%. The mortality rate at the first 12 hours at the beginning of the acute coronary syndrome was 66.6%. Geriatric patients suffer from many diseases, and at the beginning of the onset of acute coronary syndrome they have multiorganal failure. Elderly patients are a high-risk contingent in intensive coronary care units.
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PMID:Acute coronary syndrome, comorbidity, and mortality in geriatric patients. 1524 1

A 34-year-old woman with hypertension, obesity, and history of smoking presented with unstable angina and severe stenosis of the proximal left anterior descending artery. Percutaneous coronary intervention was performed with stent implantation resulting in adequate expansion. She was treated with aspirin and ticlopidine for 1 month, then only aspirin for 1 month. One year after stenting, she presented with acute myocardial infarction and total occlusion at the stent. Balloon angioplasty was performed. She took ticlopidine and aspirin for 9 months. Two months later, she presented with acute myocardial infarction with reocclusion at the stent. Blood examination showed no manifest collagen disease or thrombophilia. This case of repeated late stent thrombosis occurred in a young woman not treated by brachytherapy.
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PMID:[Young woman with repeated late stent thrombosis: a case report]. 1570 Sep 26


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