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Query: UMLS:C0038454 (stroke)
 147,016 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Each year in the United Kingdom about 250,000 people die from acute myocardial infarction, other ischaemic heart disease or stroke. Many will already have evidence of established vascular disease that predisposes to such an event--such as angina, peripheral vascular disease, atrial fibrillation, transient ischaemic attacks or a previous myocardial infarction or stroke. Others will have risk factors such as hypertension, diabetes mellitus or hyperlipidaemia, but the stroke or heart attack is the first evidence of established vascular disease. Aspirin was first discovered to have antiplatelet properties 30 years ago and since then many randomised clinical trials have sought to determine whether it (or other antiplatelet agents) can protect patients from heart attack or stroke. In this article we review the evidence and update our earlier conclusions on stroke, myocardial infarction, and unstable angina, arguing that aspirin should be widely used to reduce cardiovascular morbidity and mortality in certain high-risk patients.
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PMID:Aspirin to prevent heart attack or stroke. 763 3

Cigarette smoking is a main risk-factor for enhanced cardiovascular morbidity and mortality. Some studies have even suggested that unvoluntary smoking increases the atherosclerotic risk. Smoking related cardiovascular diseases include coronary heart disease, acute myocardial infarction, sudden death, stroke, aortic aneurysm, atherosclerotic peripheral vascular disease. Risk is potentiated in patients with other coronary risk-factors i.e. hypertension and/or hypercholesterolemia. It is also proportionately related to the number of cigarettes smoked daily and smoking behavior. Combination of cigarette smoking and oral contraceptive use is the major cause of coronary events in female smokers under 50 years. Risk will be reduced only be smoking cessation. Underlying pathophysiologic mechanisms are complex; nicotine- and carbon-monoxide induced deleterious effects will be found on hemodynamic parameters, lipid status and hemorheology. Although clinical events due to acute coronary thrombosis and vasoconstriction are more often in smokers than in nonsmokers, angina pectoris is less common. Furthermore smoking diminishes beneficial effects of well established therapeutical procedures in treatment of coronary heart disease. Therefore, smoking cessation therapy should be a major goal for primary and secondary prevention programs as well.
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PMID:[Adverse cardiac effects of smoking]. 770 41

Independent clinical factors predicting reinfarction in the 1st year following an initial myocardial infarction were identified among 900 women and 2,795 men. Women were older (65.8 vs. 59.3 years; p < 0.001) but tended to suffer from reinfarction at a rate similar to that of men (6.9 vs. 5.6%, p = 0.17). Cumulative 1-month, 1- and 5.5-year all-cause mortality following the first infarction was higher among women who sustained reinfarction (43, 52 and 74%, respectively) than among men (29, 30 and 51%, respectively, p < 0.01 for each). Independent clinical predictors for recurrent myocardial infarction among women were (adjusted relative odds): peripheral vascular disease (3.2), postinfarction angina (2.3), diabetes mellitus (2.2), radiographic evidence of cardiomegaly (1.9), anterior location of the first infarction (2.0), congestive heart failure (1.8), prior angina (1.6) and age (10 years) increment (1.2). Predictive variables for men were: anterior infarct location (1.7), peripheral vascular disease (1.6, prior stroke (1.5), prior angina (1.4), systemic hypertension (1.3) and age (10 years) increment (1.1). Our data indicate (a) different cardiac risk factors for reinfarction among men and women after a first myocardial infarction, and (b) a prognostic advantage for men over women following reinfarction.
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PMID:Clinical predictors of reinfarction among men and women after a first myocardial infarction. SPRINT Study Group. Secondary Prevention Reinfarction Israeli Nifedipine Trial. 772 8

Giant cell arteritis (GCA) is a systemic disease of the elderly that occurs infrequently in blacks and seldom has peripheral vascular disease and stroke as its presenting major complications. The occurrence of bilateral lower limb gangrene and a fatal stroke as manifestations of occult systemic GCA in an African-American is such a unique combination of rare occurrences that it warrants documentation in the literature.
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PMID:Bilateral lower limb gangrene and stroke as initial manifestations of systemic giant cell arteritis in an African-American. 773 67

1. About one in four adults in the United States has high blood pressure on the basis of a single evaluation. Hypertension is associated with an increased risk of developing coronary heart disease, stroke, congestive heart failure, renal insufficiency, and peripheral vascular disease. 2. Weight loss, reduced sodium intake, reduced alcohol consumption, and exercise have documented efficacy as interventions to decrease high blood pressure. A number of intervention programs in community based settings and in health care provider practice based settings have documented that behavioral change and relevant reductions in blood pressure are feasible. 3. Occupational health nurses are in unique positions to both initiate and support intervention programs. Interventions could be conducted by individual occupational health nurses as well as sponsored by corporate employers or local occupational health nursing constituencies.
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PMID:Primary prevention of hypertension: a challenge for occupational health nurses. 777 9

Little attention may be paid during follow up of colorectal cancer patients to other medical problems because the follow up is normally focused upon the diagnosis of recurrence and the detection of metachronous neoplasms. Attention directed at improving the medical condition of patients would be justified if it were shown that other diseases had a significant effect upon survival. Review of a selected consecutive series of 207 patients included collection of data about variables relating to demography, pathology, presentation, smoking, present and past health, performance, surgery, complications, length of stay, mortality, follow up and cause of death. Significance of relationships between medical and surgical problems and the outcome was determined by analyses of variation. Medical problems were present in 79% of patients; correlated with advancing age. Medical problems were not associated with complications, or with inpatient death. Previous cerebrovascular accident, dementia, limited mobility and increasing numbers of problems were associated with prolonged stay. Prolongation of stay, however, was related mainly to surgical complications. Smoking, which was present in 50% of patients, did not alter performance status, stage or substage, stay or survival significantly. Smoking and respiratory complications were associated significantly. Patients with heart or peripheral vascular disease had significantly poorer survival (P = 0.007) than those without those problems. Survival was reduced significantly for patients known to have diabetes, cardiovascular and cerebrovascular disease and limited mobility. Other malignant neoplasms were responsible for 18% of deaths which were unrelated to colorectal cancer. Residual or recurrent colorectal cancer had a more rapid adverse influence upon outcome than did medical problems.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:The influence of other diseases upon the outcome of colorectal cancer patients. 778 62

This paper reviews the evidence of hypertensive target organ damage (HTOD) in Africa, and the difficulties of its assessment, with a focus on implications for further research and prevention. Specific examples of HTOD reviewed include left ventricular hypertrophy, heart failure, ischaemic heart disease, arrhythmias and sudden death, kidney failure, cerebrovascular accidents, retinopathy and central as well as peripheral vascular disease. There is evidence that the prevalence of hypertension is increasing in some parts of Africa, thus increasing the number of people who suffer from fatal and nonfatal complications. Analysis of the type, frequency and distribution of HTOD is critical to the design of interventions to prevent and manage hypertension, and in the design of future clinical research. As would be expected, the frequency of atherosclerotic complications, particularly involving the heart, is lower in Africa than in developed countries. Stroke, renal failure and heart failure appear to be the principal adverse outcomes and are likely to be associated with a high case fatality rate. Community-based data on these issues are limited, however, and hospital series cannot estimate the population burden and may be unreliable in describing the case mix. Improved data on HTOD will more accurately reflect the health impact of hypertension, provide the basis for aggressive efforts at prevention, detection and control of high BP and establish their relevance in the overall scheme of resource allocation during fiscal austerity and limited healthcare spending. Additionally, knowledge of the prevalence and relative frequencies of HTOD has direct and important implications for clinical outcomes research in hypertension.
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PMID:Spectrum of hypertensive target organ damage in Africa: a review of published studies. 785 22

Increased blood pressure can be observed in about 15-20% of the Swiss population. Hypertension causes few or no symptoms, but is an important risk factor for myocardial infarction, stroke, renal failure and peripheral vascular disease. All these clinical complications of hypertension are preceded by functional changes of blood vessels and the myocardium (left ventricular hypertrophy). In conduit arteries, hypertension is associated with atherosclerotic changes, while in resistance arteries only increased medial thickness can be observed. In atherosclerosis, functional changes of the endothelium, vascular smooth muscle, platelets and monocytes occur. These changes lead to hypercontractility, increased interaction of circulating blood cells with the blood vessel wall, and to proliferation and migration of vascular smooth muscle cells. These events impair local blood flow and eventually may cause vascular occlusion. The endothelium plays a particularly important role as a regulator of these mechanisms. Accordingly, it is likely that an endothelial dysfunction occurs at the very beginning of the atherosclerotic process. In resistance arteries, remodeling of vascular smooth muscle cells leads to thickening of the media with encroachment on the lumen due to an increased media lumen ratio. These hypertension-induced vascular changes are in part reversible by antihypertensive drugs. Hypertension-induced vascular disease is preceded by numerous alterations in the expression, secretion and action of mediators and receptors of endothelial cells, vascular smooth muscle, platelets and monocytes. It is hoped that increased understanding of the cellular/molecular mechanisms of hypertensive vascular disease will allow more effective therapy (and in the future also gene therapy) as well as better prevention of coronary artery disease in hypertensive patients.
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PMID:[Hypertension and vascular diseases: molecular and cellular mechanisms]. 787 5

HRT is likely to benefit menopausal women with concurrent conditions. In particular, women with atherosclerosis and its sequelae who use HRT may live longer. Our knowledge concerning the differential pharmacologic, biologic, and clinical effects of various estrogen preparations and routes is rudimentary, particularly in the sick climacteric woman. What data do exist, however, suggest that estrogen use is likely to improve the morbidity or mortality of women with coronary heart disease, myocardial infarction, congestive heart failure, hypertension, peripheral vascular disease, diabetes mellitus, stroke, and thromboembolic disorders. Whether there are any advantages to oral versus nonoral administration in these clinical circumstances has not been concretely determined. In order to minimize hepatic impact, it may be prudent to administer by a nonoral route estrogens that naturally occur in women to those with dyslipidemias, coagulopathies, liver disease, and cholelithiasis. Women who smoke are unlikely to accrue the full benefits of HRT. Although prospective, randomized clinical trials are expensive and tedious to execute, they are needed to determine the impact in sick menopausal women of estrogens and progestins in general and the different preparations, routes, and regimens in particular.
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PMID:Hormonal management of the sick menopausal woman. 793 43

Although low systemic vascular resistance occurs during normothermic and hypothermic cardiopulmonary bypass, the determinants of depressed systemic vascular resistance and its effect on outcomes are unknown. To assess the predictors and clinical effects of low systemic vascular resistance, 555 patients undergoing isolated coronary artery bypass grafting were evaluated prospectively. The extent of low systemic vascular resistance during bypass was estimated by the amount of the vasoconstrictor phenylephrine administered: group 1, 0 to 160 micrograms; group 2, 161 to 800 micrograms; group 3, more than 800 micrograms. Multivariate analysis identified bypass temperature, bypass time, and ventricular function as determinants of low systemic vascular resistance. Patients on normothermic bypass accounted for 65% of the patients in group 3 and only 34% of the patients in group 1 (p < 0.0001). The bypass time was longer in the patients in group 3 (97 +/- 28 minutes) than in the patients in group 1 (89 +/- 24 minutes; p < 0.006). Patients with a preoperative left ventricular ejection fraction of 0.40 or less required less phenylephrine during cardiopulmonary bypass (498 +/- 68 micrograms) than did patients with a fraction exceeding 0.40 (1,087 +/- 88 micrograms; p < 0.001). By multivariate analysis, advanced age and the presence of peripheral vascular disease were found to decrease the likelihood of low systemic vascular resistance during normothermic bypass. Diabetes, the left ventricular ejection fraction, the bypass time, and the total cardioplegia infused were found to influence the likelihood of low systemic vascular resistance during hypothermic bypass. Patients in group 3 had a higher cardiac index and lower-mean arterial pressure and systemic vascular resistance postoperatively. In those patients who received a left internal mammary artery graft, the incidences of the low-output syndrome (group 1, 4.9%; group 3, 2.7%; p = not significant) and myocardial infarction (group 1, 1.4%; group 3, 1.8%; p = not significant) were not influenced by the amount of phenylephrine infused during cardiopulmonary bypass. In those patients who were at high risk of suffering a stroke preoperatively, the hypotension induced by the low systemic vascular resistance and its treatment with phenylephrine was not associated with an increased incidence of stroke (group 1, 5.8%; group 3, 2.8%; p = not significant).
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PMID:Determinants of low systemic vascular resistance during cardiopulmonary bypass. 794 47


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